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PeriodontitisNCT04692246

Effect of Essential Oils as Adjutants on the Treatment of Subjects With Periodontitis: Assessment of Metabolic Variables as Effect Modifiers

A study testing Plant-based oral rinse in people with Periodontitis, run by Universidad de Granada at 1 site in Spain.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

Periodontitis, an infectious disease that affects the tooth-supporting tissues and shows a wide range of clinical, microbiological, and immunological manifestations, is associated with and probably caused by dynamic interaction among infectious agents, host immune responses, hazardous environmental exposure and… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Periodontitis
What is being tested?
Plant-based oral rinse
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
60 participants
Where
1 siteSpain
Study dates
1 Nov 2019to 1 Mar 2020
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients attended in the University of Granada School of Dentistry (Granada, Spain)
  • Accepting to be enrolled in the study and signing of a written consent.

Who cannot join

  • Age under 18 years,
  • Received periodontal treatment in the last year,
  • Anti-microbial therapy in the previous 3 months
  • Allergies
  • Multiple pregnancy
  • Presence of neoplastic or severe infectious diseases.

Trial locations and contacts

1 site in 1 country.

Spain1 site
  • University of Granada School of Dentistry

    Granada, 18071

Other trials in Spain

About this study

Periodontitis, an infectious disease that affects the tooth-supporting tissues and shows a wide range of clinical, microbiological, and immunological manifestations, is associated with and probably caused by dynamic interaction among infectious agents, host immune responses, hazardous environmental exposure and genetic propensity. Bacteria are necessary for the disease to appear, but are not sufficient and do not account for all cases of periodontitis. According to one survey in the USA, chronic periodontitis affects approximately 46% of the adult population, with an even higher prevalence among the elderly. This prevalence refers to the cohort of young adults according to the WHO, with ages ranging from 35 to 44 years. Forms of periodontitis that appear at younger ages (before the age of 30 years), and that have other characteristics in addition to age, are known as aggressive periodontitis. The prevalence of this disorder ranges from 0.2% in Caucasians to 2.6% in Afro-Americans. The microbiota of the human oral mucosa together with other anatomical locations in the body constitute the human microbiome. The equilibrium between these organisms and the host response plays a fundamental role in human biology, both in health maintenance and in the appearance of disease. Unfavorable alterations in the composition of the microbiota are termed dysbiosis.

Antiseptics and antibiotics such as Chlorhexidine or Metronidazole, are delivered locally as an adjunct to scaling and root planing procedures, in order to eradicate the subgingival microbes, hence creating a healthy subgingival environment. However, the results presented in the literature are inconclusive. There is a need for further clinical trials with strict methodological criteria for allowing a more precise assessment of the efficacy of local antimicrobials in the treatment of chronic periodontitis.

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Recently, there has been renewed interest in the application of natural products. Several natural products and herbs have claimed to have better properties and less side effects than chemical agents for irrigation. The use of natural extracts and essential oils as an irrigation agent for ultrasonic instrumentation has shown to promote slight adjunctive effect compared to chlorhexidine or water. In other study, natural extract showed a greater improvement compared to controls in patients with a more severe degree of periodontitis. However, in other studies this pocket reduction and clinical attachment gain were no significant when compared to water. Natural products have also been tested in forms of oral spray, and have shown to be effective against common oral pathogens without significant cytotoxicity in an in vitro study. Thus, it has the potential to prevent the infections and may serve as adjunctive treatment to conventional therapy. They claim to have the same or even more anti-microbial effect and anti-inflammatory effect without adding any chemicals. But still there is no adequate scientific evidence to support this hypothesis.

This study aims to test the effect as an adjutant to therapy of a nutraceutical composed of several plant extracts in patients with periodontitis and different levels of risk for metabolic syndrome. Specifically:

  1. The response of periodontal clinical variables to non-surgical periodontal treatment in patients treated with the extract, compared to controls.
  2. The effect on local inflammatory markers, in patients treated with the extract compared to controls.
  3. The modifier effect of metabolic syndrome-related variables in the treatment outcomes of the patients treated with the extract compared to controls.

Hypothesis:

The application of the plant extract would act as an anti-inflammatory agent, contributing to better treatment outcomes of periodontitis, in terms of clinical and biochemical variables.

Read the detailed description

METHODOLOGY

Study design Randomized, controlled, double-blinded clinical trial.

Study unit/population Subjects with diagnosis of periodontitis according to the joint EFP/AAP 2018 criteria for the case definition of periodontitis.

Inclusion criteria Patients attended in the University of Granada School of Dentistry (Granada, Spain) Signing of a written consent.

Exclusion criteria Age under 18 years, received periodontal treatment in the last year, anti-microbial therapy in the previous 3 months, multiple pregnancy and the presence of neoplastic or severe infectious diseases.

Sampling and randomization It is estimated to explore at least 60 patients, of which 30 will be randomized to each group, accordingly to similar studies on the topic available in the literature. The group allocation will also follow similar studies published previously in the field (7-9, 12, 13). All patients will receive standard periodontal treatment with an ultrasonic new generation device (AIRFLOW® Prophylaxis Master, EMS Dental, Nyon, Switzerland), and the group division will be based on the use of the extract as an adjunct to non-surgical treatment.

Test group: Patients that will receive the application of the extract in form of irrigation solutions in the periodontal pockets during regular periodontal treatment. Patients would continue at home during the follow-up period, taking the essential oils in as a rinse twice per day, and as a spray when regular toothbrush could not be performed.

Control group: Patients that will follow the same protocol, but using regular irrigation and a placebo spray at home.

The researchers that will perform the clinical examinations will be blinded for the group allocation of the participants, since the random allocation and prescription will be performed by a different researcher. Study products and placebo will be provided previously by the company BIONAP.

Study variables

  1. Sociodemographic variables: sex, age, smoking habit (cigs/day), alcohol consumption (g/day).
  2. Periodontal clinical variables: Periodontal examination will be performed by a calibrated researcher using PCPUNC15 periodontal probe (Hu-friedy, Chicago, IL, USA) and dental exploration mirror. Six surfaces in each implant will be measured: mesiovestibular, vestibular, distovestibular, distolingual, lingual, mesiolingual. All clinical data will be recorded in a periodontal chart. Clinical data will be gathered at baseline, and at 2 and 6 months of follow-up. Bleeding on probing: The percentage of bleeding implants while probing, will the registered following the index of Ainamo and Bay (14). Oral hygiene: Oral hygiene will be measured using the Plaque Index proposed by Tonetti (15). The presence of plaque will be registered by visual examination without using a plaque revealing agent.
  3. Metabolic syndrome-related variables:
  • Body weight
  • Body height
  • Body mass index
  • Waist circumference
  • Blood pressure
  1. Biochemical variables:

Samples of saliva, subgingival plaque and gingival crevicular fluid will be obtained at the beginning of the study, at 2 months and at the end of follow-up. A panel of inflammatory cytokines will be assessed.

Blood samples will be obtained at the beginning of the study, at 2 months and at the end of follow-up for the assessment of:

  • Fasting blood glucose
  • Lipid profile (Total cholesterol, Triglycerides, LDL-cholesterol and HDL-cholesterol).

Data management and statistical analysis A database in Excel format will be prepared including all recorded variables. The data will be analyzed by a single researcher. The statistical software SPSS v.21.0 (IBM Inc., Chicago, IL, USA) will be used, performing descriptive statistics (means, standard deviations and percentages) and analytical procedures (95% confidence intervals, Mann-Whitney test, Chi-square, Student's t-test for paired samples, and univariate and multivariate regression analysis). A 5% significance level will be considered for all tests.

ETHICAL CONSIDERATIONS The study will be designed in order to comply with the standards of the las revision of the Helsinki declaration. Approval from the Research Ethics Committee in Human Studies of the University of Granada will be obtained prior to the beginning of the study. Written informed consent will be obtained from all participants in the study. All obtained data will be anonymous and the study will be designed following the CONSORT guidelines for reporting clinical trials (16).

WORK PLAN

The project has been planned to be performed in a period of 2 years:

  1. Study registration, ethical approval, and planning: December 2018 - February 2019.
  2. Study enrollment, allocation, samples and data gathering. Follow-up period: March 2019 - April 2020.
  3. Statistical analysis of all data: June 2020 - September 2020.
  4. Manuscript preparation and publication process: October 2020 - April 2021.
Conditions
Periodontitis
Being tested
Plant-based oral rinse, Placebo oral rinse
Keywords
Anti-inflammation, Nutraceuticals, Periodontal therapy, Periodontitis
Medical subject headings
Periodontitis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Plant-based oral rinseOther

    Oral rinse enriched with plant-based essential oils.

  • Placebo oral rinseOther

    Oral rinse with the exact characteristics in terms of colour and odour of the plant-based one, but without the essential oils aimed to test in this study

Study groups in NCT04692246
Study groupRoleWhat they receive
Test GroupExperimentalPatients that will receive the application of the extract in form of irrigation solutions in the periodontal pockets during regular periodontal treatment. Patients would continue at home during the follow-up period, taking the essential oils in as a rinse twice per day, and as a spray when regular toothbrush could not be performed.
Receives: Other: Plant-based oral rinse
Control GroupPlacebo comparatorPatients that will follow the same protocol, but using placebo irrigation and a placebo spray at home.
Receives: Other: Placebo oral rinse

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Pocket probing depth

    Depth of periodontal pockets present in the teeth of each patient in millimeters (mm) using a periodontal probe (PCPUNC-15)

    Measured: Change from Baseline Pocket probing depth at 3 months

  2. Pocket probing depth

    Depth of periodontal pockets present in the teeth of each patient in millimeters (mm) using a periodontal probe (PCPUNC-15)

    Measured: Change from Baseline Pocket probing depth at 6 months

  3. Gingival recession

    Distance from the gingival margin to the cemento-enamel junction in the teeth of each patient in millimeters (mm) using a periodontal probe (PCPUNC-15)

    Measured: Change from Baseline Gingival recession at 3 months

  4. Gingival recession

    Distance from the gingival margin to the cemento-enamel junction in the teeth of each patient in millimeters (mm) using a periodontal probe (PCPUNC-15)

    Measured: Change from Baseline Gingival recession at 6 months

  5. Bleeding on probing

    Percentage of teeth (%) that showed bleeding during periodontal examination.

    Measured: Change from Baseline Bleeding on probing at 3 months

  6. Bleeding on probing

    Percentage of teeth (%) that showed bleeding during periodontal examination.

    Measured: Change from Baseline Bleeding on probing at 6 months

  7. Oral hygiene

    Percentage of teeth surfaces (4 in each tooth) that showed visible plaque during periodontal examination (Visual Plaque Index).

    Measured: Change from Baseline Visual Plaque Index at 3 months

  8. Oral hygiene

    Percentage of teeth surfaces (4 in each tooth) that showed visible plaque during periodontal examination (Visual Plaque Index).

    Measured: Change from Baseline Visual Plaque Index at 6 months

Secondary outcomes (15)
  1. Body weight

    Weight of each patient in kilograms (Kg) with a body scale.

    Measured: Change from Baseline Body weight at 3 months

  2. Body weight

    Weight of each patient in kilograms (Kg) with a body scale.

    Measured: Change from Baseline Body weight at 6 months

  3. Body height

    Height of each patient in centimeters (cm) with a scale.

    Measured: Baseline

  4. Waist circumference

    Waist abdominal circumference of each patient in centimeters (cm) with a measure tape.

    Measured: Change from Baseline Waist circumference at 3 months

  5. Waist circumference

    Waist abdominal circumference of each patient in centimeters (cm) with a measure tape.

    Measured: Change from Baseline Waist circumference at 6 months

  6. Systolic Blood pressure

    Systolic Blood pressure of each patient in Hg millimeters (Hg mm) measured with a sphygmomanometer.

    Measured: Change from Baseline Systolic Blood pressure at 3 months

  7. Systolic Blood pressure

    Systolic Blood pressure of each patient in Hg millimeters (Hg mm) measured with a sphygmomanometer.

    Measured: Change from Baseline Systolic Blood pressure at 6 months

  8. Diastolic Blood pressure

    Diastolic Blood pressure of each patient in Hg millimeters (Hg mm) measured with a sphygmomanometer.

    Measured: Change from Baseline Diastolic Blood pressure at 3 months

  9. Diastolic Blood pressure

    Diastolic Blood pressure of each patient in Hg millimeters (Hg mm) measured with a sphygmomanometer.

    Measured: Change from Baseline Diastolic Blood pressure at 6 months

  10. Glycemia

    Fasting glycemia of each patient in milligrams per deciliter (mg/dL) measured with a glucometer.

    Measured: Change from Baseline Glycemia at 3 months

  11. Glycemia

    Fasting glycemia of each patient in milligrams per deciliter (mg/dL) measured with a glucometer.

    Measured: Change from Baseline Glycemia at 6 months

  12. Total cholesterol

    Total cholesterol levels of each patient in mg/dL measured in serum samples.

    Measured: Change from Baseline Total cholesterol at 6 months

  13. Triglyceride

    Triglyceride levels of each patient in mg/dL measured in serum samples.

    Measured: Change from Baseline Triglyceride at 6 months

  14. LDL-cholesterol

    Low-density lipoprotein levels of each patient in mg/dL measured in serum samples.

    Measured: Change from Baseline LDL-cholesterol at 6 months

  15. HDL-cholesterol

    High-density lipoprotein cholesterol levels of each patient in mg/dL measured in serum samples.

    Measured: Change from Baseline HDL-cholesterol at 6 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted31 Dec 2020
  2. Study start1 Nov 2019
  3. Primary completion1 Mar 2020
  4. Study completion1 Mar 2020

Why it stopped: Due to COVID-19 Pandemic

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
60 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04692246
Sponsor's protocol ID
PON-FSE-2017-1
Status last verified
Dec 2020
First submitted
22 Dec 2020
Last updated
31 Dec 2020
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing Plant-based oral rinse in people with Periodontitis, run by Universidad de Granada at 1 site in Spain.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 31 Dec 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study was stopped early (reason given: Due to COVID-19 Pandemic). Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Pocket probing depth (time frame: Change from Baseline Pocket probing depth at 3 months). The study lists 8 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 31 Dec 2020.

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