Clinical and radiographic evaluation of local application of insulin versus hyaluronic acid using resorbable collagen sponge in management of periodontal intra-bony defects: a pilot randomized controlled clinical trial.

چکیده اصلی

OBJECTIVES: We aimed to evaluate the clinical and radiographic effectiveness of locally applied insulin versus hyaluronic acid (HA), each combined with absorbable collagen sponge (ACS), using the single flap approach (SFA) in the management of periodontal intra-bony defects. MATERIALS AND METHODS: 21 periodontitis patients with intra-bony defects were randomly assigned to 3 groups: group I (SFA + insulin + ACS; n = 7), group II (SFA + HA + ACS; n = 7), and group III (SFA + ACS; n = 7). Primary outcome was clinical attachment level (CAL), assessed at baseline and 6 months postoperatively; secondary outcomes included probing pocket depth (PPD), measured at baseline and 6 months; postoperative pain, using visual analogue scale (VAS) at 24 and 48 h; and radiographic parameters, including radiographic linear defect depth (RLDD) and bone density, assessed at baseline and 6 months. RESULTS: PPD and CAL improved significantly over time in all groups (P < 0.001), with no intergroup differences. VAS scores were significantly lower in the insulin and HA groups than in controls at 24 h (P = 0.004) and 48 h (P = 0.007), with the lowest scores in the insulin group (P = 0.008). RLDD decreased significantly in all groups (P < 0.001), with a greater reduction in HA + ACS compared to insulin and controls at 6 months (P = 0.027). Bone density increased significantly over time in insulin + ACS (P < 0.001) and HA + ACS (P = 0.022), with no change in the ACS group (P = 0.860), with non-significant intergroup differences. CONCLUSION: In the management of periodontal intrabony defects, SFA with both insulin and HA soaked in collagen sponge showed favorable clinical and radiographic improvements. CLINICAL RELEVANCE: Local insulin may represent a promising, simple, and cost-effective biomaterial in periodontal treatment; however, more studies are needed. CLINICAL TRIAL REGISTRATION: NCT05746676.

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