{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:34:52Z","timestamp":1786649692950,"version":"build-2736575974"},"reference-count":41,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Chronic periodontitis is an infectious disease of the oral cavity that causes progressive destruction of periodontal tissues, leading to structural changes like attachment loss, bone resorption, resulting in bony defects, and potential tooth loss if left untreated. Effective drugs, such as alendronate, rosuvastatin (RSV), atorvastatin, melatonin, and metformin (MF), have been used as adjuncts to scaling and root planning and require evaluation for their comparative effectiveness in treating bony defects in patients with chronic periodontitis. This study aims to compare the effectiveness of these drugs for treating such defects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>This network meta-analysis (NMA) was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and registered in PROSPERO (CRD42024600432). A comprehensive search of PubMed, Scopus, and Cochrane Library identified 11 eligible randomized clinical trials reporting changes in clinical attachment level (CAL) and bone fill (BF) at 6 months posttreatment. The NMA systematically compared treatment outcomes across different intervention groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>MF was the most effective treatment for CAL and BF at 6 months. Ranking probabilities indicated that MF and RSV had the highest likelihood of being the most effective treatments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>These findings from the NMA suggest that MF may be an effective option for CAL improvement and BF. Further research is needed to validate these results and optimize treatment strategies for bony defects in chronic periodontitis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/drj.drj_174_25","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T16:00:25Z","timestamp":1767110425000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Evidence on pharmacological agents for treating bony defects in chronic periodontitis: A network meta-analysis"],"prefix":"10.4103","volume":"22","author":[{"given":"Shivani Sanjay","family":"Koli","sequence":"first","affiliation":[{"name":"Department of Periodontics and Implantology, Ranjeet Deshmukh Dental College and Research Centre, Nagpur, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Surekha Ramrao","family":"Rathod","sequence":"additional","affiliation":[{"name":"Department of Periodontics and Implantology, Ranjeet Deshmukh Dental College and Research Centre, Nagpur, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pranjali","family":"Bawankar","sequence":"additional","affiliation":[{"name":"Department of Periodontics and Implantology, Ranjeet Deshmukh Dental College and Research Centre, Nagpur, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishwajeet","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, AIIMS, Nagpur, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Savitha","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, AIIMS, Nagpur, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,12]]},"reference":[{"key":"R1-20251230","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1177\/0022034512457373","article-title":"Prevalence of periodontitis in adults in the United States:2009 and 2010","volume":"91","author":"Eke","year":"2012","journal-title":"J Dent Res"},{"issue":"(suppl B)","key":"R2-20251230","doi-asserted-by":"crossref","first-page":"B3","DOI":"10.1093\/eurheartj\/suq003","article-title":"European workshop in periodontal health and cardiovascular disease\u2014scientific evidence on the association between periodontal and cardiovascular diseases:a review of the literature","volume":"12","author":"Sanz","year":"2010","journal-title":"Eur Heart J Suppl"},{"key":"R3-20251230","doi-asserted-by":"crossref","first-page":"19","DOI":"10.2147\/CCIDE.S166164","article-title":"Optimal management of intrabony defects:current insights","volume":"11","author":"Shukla","year":"2019","journal-title":"Clin Cosmet Investig Dent"},{"key":"R4-20251230","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1111\/jcpe.12732","article-title":"Impact of the global burden of periodontal diseases on health, nutrition and wellbeing of mankind:A call for global action","volume":"44","author":"Tonetti","year":"2017","journal-title":"J Clin Periodontol"},{"key":"R5-20251230","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1038\/sj.ebd.6401287","article-title":"Periodontal disease has an impact on patients'quality of life","volume":"19","author":"Reynolds","year":"2018","journal-title":"Evid Based Dent"},{"key":"R6-20251230","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1034\/j.1600-0757.2000.2220105.x","article-title":"Focus on intrabony defects--conservative therapy","volume":"22","author":"Lang","year":"2000","journal-title":"Periodontol 2000"},{"key":"R7-20251230","doi-asserted-by":"crossref","first-page":"34","DOI":"10.3390\/dj6030034","article-title":"Furcation Involvement Classification:A Comprehensive Review and a New System Proposal","volume":"6","author":"Pilloni","year":"2018","journal-title":"Dent J (Basel)"},{"issue":"4","key":"R8-20251230","first-page":"540","article-title":"Alendronate in periodontics:Where are we?","volume":"1","author":"Gupta","year":"2014","journal-title":"Int J Dent Health Sci"},{"key":"R9-20251230","first-page":"1299","article-title":"Applications of Metformin in Dentistry-A review","volume":"18","author":"Hammad","year":"2023","journal-title":"J Taibah Univ Med Sci"},{"key":"R10-20251230","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1359\/jbmr.2002.17.7.1219","article-title":"Melatonin at pharmacologic doses increases bone mass by suppressing resorption through down-regulation of the RANKL-mediated osteoclast formation and activation","volume":"17","author":"Koyama","year":"2002","journal-title":"J Bone Miner Res"},{"key":"R11-20251230","doi-asserted-by":"crossref","first-page":"383","DOI":"10.2147\/DDDT.S10812","article-title":"Rosuvastatin, inflammation, C-reactive protein, JUPITER, and primary prevention of cardiovascular disease--a perspective","volume":"4","author":"Kones","year":"2010","journal-title":"Drug Des Devel Ther"},{"key":"R12-20251230","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1080\/03639045.2016.1224895","article-title":"Thiolated alginate-based multiple layer mucoadhesive films of metformin forintra-pocket local delivery:in vitro characterization and clinical assessment","volume":"43","author":"Kassem","year":"2017","journal-title":"Drug Dev Ind Pharm"},{"key":"R13-20251230","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1902\/jop.2012.110729","article-title":"1% alendronate gel as local drug delivery in the treatment of Class II furcation defects:a randomized controlled clinical trial","volume":"84","author":"Pradeep","year":"2013","journal-title":"J Periodontol"},{"key":"R14-20251230","first-page":"236","article-title":"Effects of adjective use of melatonin and vitamin C in the treatment of chronic periodontitis:A randomized clinical trial","volume":"11","author":"Chitsazi","year":"2017","journal-title":"J Dent Res Dent Clin Dent Prospects"},{"key":"R15-20251230","first-page":"e61008","article-title":"Evaluation of Clinical Efficacy of 1.2% Rosuvastatin Hydrogel as an Adjunct to Scaling and Root Planing in Generalized Chronic Periodontitis","volume":"16","author":"Pawar","year":"2024","journal-title":"Cureus"},{"key":"R16-20251230","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1902\/jop.2012.120393","article-title":"Clinical efficacy of subgingivally delivered 1.2% atorvastatin in chronic periodontitis:a randomized controlled clinical trial","volume":"84","author":"Pradeep","year":"2013","journal-title":"J Periodontol"},{"key":"R17-20251230","first-page":"276520","article-title":"A primer on network meta-analysis for dental research","volume":"2012","author":"Tu","year":"2012","journal-title":"ISRN Dent"},{"key":"R18-20251230","article-title":"Cochrane handbook for systematic reviews of interventions","year":"2011","journal-title":"Version 5.1.0. The Cochrane Collaboration"},{"key":"R19-20251230","doi-asserted-by":"crossref","first-page":"777","DOI":"10.7326\/M14-2385","article-title":"The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions:checklist and explanations","volume":"162","author":"Hutton","year":"2015","journal-title":"Ann Intern Med"},{"key":"R20-20251230","doi-asserted-by":"crossref","first-page":"g7647","DOI":"10.1136\/bmj.g7647","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015:elaboration and explanation","volume":"350","author":"Shamseer","year":"2015","journal-title":"BMJ"},{"key":"R21-20251230","doi-asserted-by":"crossref","first-page":"n160","DOI":"10.1136\/bmj.n160","article-title":"PRISMA 2020 explanation and elaboration:updated guidance and exemplars for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"R22-20251230","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1097\/01.NAJ.0000368959.11129.79","article-title":"Evidence-based practice, step by step:asking the clinical question:a key step in evidence-based practice","volume":"110","author":"Stillwell","year":"2010","journal-title":"Am J Nurs"},{"key":"R23-20251230","doi-asserted-by":"crossref","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration's tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ"},{"key":"R24-20251230","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/1471-2288-8-22","article-title":"Recommendations by Cochrane Review Groups for assessment of the risk of bias in studies","volume":"8","author":"Lundh","year":"2008","journal-title":"BMC Med Res Methodol"},{"key":"R25-20251230","doi-asserted-by":"crossref","first-page":"e12334","DOI":"10.1111\/jicd.12334","article-title":"One percent alendronate and aloe vera gel local host modulating agents in chronic periodontitis patients with class II furcation defects:A randomized, controlled clinical trial","volume":"9","author":"Ipshita","year":"2018","journal-title":"J Investig Clin Dent"},{"key":"R26-20251230","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.jobcr.2018.05.006","article-title":"The comparative evaluation of 1% alendronate gel as local drug delivery system in chronic periodontitis in smokers and non smokers:Randomized clinical trial","volume":"9","author":"Sheokand","year":"2019","journal-title":"J Oral Biol Craniofac Res"},{"key":"R27-20251230","doi-asserted-by":"crossref","DOI":"10.1111\/jicd.12215","article-title":"Comparative evaluation of subgingivally delivered 1% alendronate versus 1.2% atorvastatin gel in treatment of chronic periodontitis:a randomized placebo-controlled clinical trial","volume":"8","author":"Pradeep","year":"2017","journal-title":"J Investig Clin Dent"},{"key":"R28-20251230","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1055\/s-0039-1688522","article-title":"Efficacy of Locally Administered 1.2% Rosuvastatin Gel in Patients with Periodontitis:A Randomized Placebo Controlled Clinical Trial","volume":"13","author":"Chatterjee","year":"2019","journal-title":"Eur J Dent"},{"key":"R29-20251230","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1902\/jop.2016.150706","article-title":"1.2% Rosuvastatin Versus 1.2% Atorvastatin Gel Local Drug Delivery and Redelivery in Treatment of Intrabony Defects in Chronic Periodontitis:A Randomized Placebo-Controlled Clinical Trial","volume":"87","author":"Pradeep","year":"2016","journal-title":"J Periodontol"},{"key":"R30-20251230","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1902\/jop.2016.160399","article-title":"1.2% Rosuvastatin and 1.2% Atorvastatin Gel Local Drug Delivery and Redelivery in the Treatment of Class II Furcation Defects:A Randomized Controlled Clinical Trial","volume":"88","author":"Garg","year":"2017","journal-title":"J Periodontol"},{"key":"R31-20251230","doi-asserted-by":"crossref","first-page":"1878","DOI":"10.1002\/JPER.21-0515","article-title":"Comparative evaluation of 1% melatonin gel in the treatment of intrabony defect:A randomized controlled clinical trial","volume":"93","author":"Gonde","year":"2022","journal-title":"J Periodontol"},{"key":"R32-20251230","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1902\/jop.2017.150096","article-title":"Efficacy of 1% Metformin Gel in Patients With Moderate and Severe Chronic Periodontitis:A Randomized Controlled Clinical Trial","volume":"88","author":"Pradeep","year":"2017","journal-title":"J Periodontol"},{"key":"R33-20251230","first-page":"D7","article-title":"Comparative evaluation of efficacy of 1.2% ATV gel and 1% ALN gel as local drug delivery for the treatment of intrabony defect in individuals with chronic periodontitis \u2013A randomized controlled clinical trial","volume":"9","author":"Sharma","year":"2022","journal-title":"Int J Contemp Med Res"},{"key":"R34-20251230","doi-asserted-by":"crossref","first-page":"820","DOI":"10.5005\/jp-journals-10015-2294","article-title":"Comparative Study between 1% Metformin and 1% Alendronate Gel in the Treatment of Infrabony Defects:A Randomized Controlled Trial","volume":"14","author":"Mitra","year":"2023","journal-title":"World J Dent"},{"key":"R35-20251230","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1002\/JPER.17-0434","article-title":"Comparative evaluation of subgingivally delivered 1.2% rosuvastatin and 1% metformin gel in treatment of intrabony defects in chronic periodontitis:A randomized controlled clinical trial","volume":"89","author":"Pankaj","year":"2018","journal-title":"J Periodontol"},{"key":"R36-20251230","doi-asserted-by":"crossref","first-page":"150","DOI":"10.3390\/dj12060150","article-title":"The Use of Statins as an Adjunctive Periodontal Disease Treatment:Systematic Review and Meta-Analysis","volume":"12","author":"Greethurst","year":"2024","journal-title":"Dent J (Basel)"},{"key":"R37-20251230","first-page":"8253","article-title":"Drug efficacy and safety of denosumab, teriparatide, zoledronic acid, and ibandronic acid for the treatment of postmenopausal osteoporosis:a network meta-analysis of randomized controlled trials","volume":"27","author":"Wang","year":"2023","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"R38-20251230","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s12903-022-02044-1","article-title":"Added effect of 1% topical alendronate in intra-bony and inter-radicular defects as part of step II periodontal therapy:a systematic review with meta-analysis and trial sequential analysis","volume":"22","author":"Arena","year":"2022","journal-title":"BMC Oral Health"},{"key":"R39-20251230","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1007\/s10787-022-00959-3","article-title":"Clinical efficacy of melatonin as adjunctive therapy to non-surgical treatment of periodontitis:a systematic review and meta-analysis","volume":"30","author":"Liu","year":"2022","journal-title":"Inflammopharmacology"},{"key":"R40-20251230","first-page":"5737","article-title":"Efficacy of locally delivered statins as an adjunct to scaling and root planning in the treatment of periodontitis:a systematic review and meta-analysis","volume":"25","author":"Cecoro","year":"2021","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"R41-20251230","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1111\/jre.12573","article-title":"Locally delivered metformin as adjunct to scaling and root planing in the treatment of periodontal defects:A systematic review and meta-analysis","volume":"53","author":"Akram","year":"2018","journal-title":"J Periodontal Res"}],"container-title":["Dental Research Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/drj.drj_174_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:57:09Z","timestamp":1786647429000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/drj.drj_174_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":41,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/drj.drj_174_25","relation":{},"ISSN":["1735-3327","2008-0255"],"issn-type":[{"value":"1735-3327","type":"print"},{"value":"2008-0255","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]},"assertion":[{"value":"2025-04-02","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-22","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}