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The aim of this study will be to evaluate: 1- the effect of full-mouth (FM) scaling and root (SRP) planing in 24 hours associated with or without extensive application of chlorhexidine (CLX) on clinical, microbiological, glycemic and immunological parameters in diabetic subjects with chronic periodontitis at 3, 6 and 12 months post-therapy. The hypothesis is that FMSRP associated with CLX use will provide the best clinical, microbiological, glycemic and immunological outcomes for the treatment of diabetic subjects with periodontitis. Sixty diabetic subjects with chronic periodontitis will be divided in the following therapeutic groups (n=20 subjects per group): FMSRP+CLX group - FMSRP in a maximum of 24 hours, application and irrigation of chlorhexidine 2% gel, rinsing chlorhexidine 0.12% solution during 60 days; FMSRP + placebo group - FMSRP in a maximum of 24 hours, application and irrigation of placebo, rinsing placebo solution during 60 days; Partial-mouth (PM) SRP group: SRP in 4-6 sessions in a maximum of 2 weeks. The following clinical parameters will be evaluated at 3, 6 and 12 months post-therapy: plaque accumulation, gingival bleeding, probing depth, clinical attachment level, bleeding on probing and suppuration. At these same periods, glycated hemoglobin levels will be obtained from all subjects. In addition, six subgingival biofilm samples per subject will be analyzed by checkerboard DNA-DNA hybridization for 40 bacterial species at baseline, 3, 6 and 12 post-therapy. Finally, gingival crevicular fluid samples from two shallow and two deep sites will be evaluated for the levels of cyto/chemokines by ELISA. Data will be submitted to appropriate statistical analysis.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| FMSRP+CLX | Experimental | Full-mouth scaling and root planing in a maximum of 24 hours, application and irrigation of chlorhexidine 2% gel, rinsing chlorhexidine 0.12% solution during 60 days |
|
| FMSRP + placebo group | Placebo Comparator | Full-mouth scaling and root planing in a maximum of 24 hours, application and irrigation of placebo, rinsing placebo solution during 60 days |
|
| PMSRP group | Active Comparator | Partial-mouth scaling and root planing in 4-6 sessions in a maximum of 2 weeks |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| FMSRP | Procedure | FMSRP in a maximum of 24 hours. |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Changes in clinical attachment level (CAL) in sites with initial PD ≥7mm from baseline to 12 months. | From baseline to 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Changes in percentage of sites with probing depth ≥5mm | From baseline to 12 months | |
| Changes in serum levels of glycemic hemoglobin | From baseline to 12 months | |
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Inclusion Criteria:
Exclusion Criteria:
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| ID | Term |
|---|---|
| D010518 | Periodontitis |
| D003920 | Diabetes Mellitus |
| D055113 | Chronic Periodontitis |
| ID | Term |
|---|---|
| D010510 | Periodontal Diseases |
| D009059 | Mouth Diseases |
| D009057 | Stomatognathic Diseases |
| D044882 | Glucose Metabolism Disorders |
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| ID | Term |
|---|---|
| D002710 | Chlorhexidine |
| ID | Term |
|---|---|
| D001645 | Biguanides |
| D006146 | Guanidines |
| D000578 | Amidines |
| D009930 | Organic Chemicals |
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| Chlorhexidine |
| Drug |
Application and irrigation of chlorhexidine, rinsing chlorhexidine solution during 60 days |
|
|
| PMSRP | Procedure | Scaling and root planing in 4-6 sessions in a maximum of 2 weeks |
|
| Placebo | Other | Application and irrigation of placebo, rinsing placebo solution during 60 days |
|
| Changes in the counts of pathogenic bacterial species |
| From baseline to 12 months |
| Changes in the levels of tumor necrosis factor-α in gingival crevicular fluid | From baseline to 12 months |
| Changes in the levels of plaque accumulation | From baseline to 12 months |
| Changes in the mean percentage of sites with bleeding on probing | From baseline to 12 months |
| Changes in the full-mouth probing depth | From baseline to 12 months |
| Changes in the serum levels of fasting plasma glucose | From baseline to 12 months |
| Changes in the proportions of pathogenic bacterial species | From baseline to 12 months |
| Changes in the levels of interferon (IFN)-γ in gingival crevicular fluid | From baseline to 12 months |
| Changes in the levels of interleukin (IL)-17 in gingival crevicular fluid | From baseline to 12 months |
| Changes in the levels of IL-23 in gingival crevicular fluid | From baseline to 12 months |
| Changes in the levels of IL-4 in gingival crevicular fluid | From baseline to 12 months |
| Changes in levels of receptor activator of NF-κß ligand (RANKL) in gingival crevicular fluid | From baseline to 12 months |
| Changes in the levels of osteoprotegerin (OPG) in gingival crevicular fluid | From baseline to 12 months |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D004700 | Endocrine System Diseases |
| D002908 | Chronic Disease |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |