Benefit of nanohydroxyapatite combined with triamcinolone for non-surgical treatment of severe periodontitis: a retrospective study.

Abstract

Objectives: To evaluate the possible benefit of combining nanohydroxyapatite (nHA) with triamcinolone (TR) in the non-surgical management of severe periodontitis and to assess the influence of baseline inflammation on treatment outcomes.

Methods: A retrospective analysis was conducted on 120 patients who received one of the following local treatments: nHA+TR, nHA alone, TR alone, or conventional subgingival scaling. All patients were followed for 6 months. Clinical data - including probing depth (PD), clinical attachment level (CAL), periodontal pocket closure rate, bleeding on probing (BoP), plaque index (PI), gingival index (GI), and gingival recession (GR) - along with inflammatory biomarkers [interleukin-1 beta (IL-1β), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and C-reactive protein (CRP)] were evaluated over the follow-up period. Correlation, regression, and subgroup analyses were performed.

Results: The nHA+TR group showed the greatest improvements in PD, CAL, and pocket closure rate, along with significant reductions in IL-1β, TNF-α, IL-6, and CRP (all P < 0.01). Changes in PD and CAL were strongly correlated with declines in inflammatory markers (r > 0.80, both P < 0.001). Multivariable analysis identified combination therapy and higher baseline PD, PI, and BoP as positive predictors of clinical improvement, whereas elevated baseline CRP and IL-1β were associated with poorer outcomes (all P < 0.01). Treatment with nHA+TR was significantly associated with clinical success - defined as a ≥ 2 mm reduction in PD and ≥ 1 mm gain in CAL (odds ratio = 48.49; all P < 0.001). In patients with CRP > 3 mg/L, combination therapy showed enhanced clinical benefits, with a significant interaction between treatment and baseline inflammation (P_interaction = 0.032). All interventions were well tolerated, with no serious adverse events reported.

Conclusions: The combination of nHA and TR may enhance both clinical and inflammatory outcomes in the non-surgical treatment of severe periodontitis. Further randomized controlled trials are warranted to confirm these findings.