Adjunctive Topical Melatonin Gel in Non-Surgical Periodontal Therapy for Periodontitis

Periodontitis is a chronic inflammatory disease affecting the supporting structures of the teeth and is one of the leading causes of tooth loss worldwide. The disease is initiated by pathogenic bacterial biofilm and progresses through a complex host inflammatory response that results in destruction of the periodontal ligament, alveolar bone loss, periodontal pocket formation, and clinical attachment loss. In Pakistan, periodontitis has a high prevalence and represents a significant oral health burden affecting quality of life and overall health.

Non-surgical periodontal therapy (NSPT), consisting primarily of scaling and root planing, is considered the gold standard treatment for periodontitis. NSPT effectively reduces microbial load and improves periodontal clinical parameters, including plaque index (PI), gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL). However, despite the effectiveness of mechanical debridement, complete resolution of inflammation and periodontal tissue regeneration may not always be achieved, leading researchers to investigate adjunctive therapeutic approaches.

Melatonin is a naturally occurring hormone mainly secreted by the pineal gland and is known for regulating circadian rhythm. In addition to its physiologic role, melatonin possesses antioxidant, anti-inflammatory, immunomodulatory, and bone-regenerative properties. Experimental and clinical studies have suggested that melatonin may reduce oxidative stress, regulate inflammatory mediators, inhibit tissue destruction, and promote osteoblastic activity and collagen formation. These biologic effects indicate its potential usefulness as an adjunctive agent in periodontal therapy.

Previous international studies have demonstrated promising results with topical melatonin application in periodontal treatment, showing improvements in inflammatory parameters and periodontal healing. However, there is limited evidence regarding its clinical effectiveness in the Pakistani population, and no randomized placebo-controlled clinical trial has been conducted locally to evaluate its adjunctive role with NSPT.

This study is designed as a randomized, double-blind, placebo-controlled clinical trial to assess the clinical outcomes of adjunctive topical melatonin gel in patients undergoing non-surgical periodontal therapy. A total of 30 patients diagnosed with periodontitis will be recruited from the Department of Periodontology at Liaquat College of Medicine & Dentistry, Karachi. Eligible participants will include adults aged 18-45 years who are systemically healthy or medically controlled and diagnosed with periodontitis with clinical attachment loss between 3-4 mm.

Participants will be randomly allocated into two groups. The experimental group will receive NSPT followed by intra-pocket application of 5% topical melatonin gel, while the control group will receive NSPT followed by placebo gel application. Both gels will be similar in appearance to maintain blinding. The study will follow a double-blind design in which both participants and the primary investigator assessing outcomes will remain unaware of group allocation.

Clinical periodontal parameters, including Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth (PPD), and Clinical Attachment Level (CAL), will be recorded at baseline and reassessed after three months. Participants will also be monitored for adverse effects such as burning sensation, taste alteration, or mucosal irritation throughout the study period.

The primary objective of the study is to compare the clinical effectiveness of adjunctive topical melatonin gel with placebo in improving periodontal clinical outcomes following NSPT. The findings of this study may contribute to the growing evidence regarding host-modulatory therapy in periodontics and help determine whether topical melatonin can serve as a cost-effective adjunctive treatment option in periodontal care within the local population.

Inclusion criteria

• Patients aged 18-45 years
• Patients diagnosed with periodontitis with clinical attachment loss (CAL) between 3-4 mm
• Systemically healthy individuals
• Patients with controlled systemic diseases (ASA I & II)
• Patients willing to participate and provide informed consent

Exclusion criteria

• Smokers or tobacco users
• Pregnant or lactating females
• Patients with uncontrolled diabetes mellitus (HbA1c >6.5%)
• Patients who received periodontal therapy within the last 6 months
• Patients who used antibiotics, anti-inflammatory drugs, sleeping pills, or antioxidant supplements within the last 6 months
• Individuals working night shifts -Patients with mental illness or neuromuscular disorders-
• Patients unwilling to participate or unable to comply with follow-up visits