Targeted Therapy with Chitosan vs. Tetracycline: Exploring New Frontiers in Periodontal Care for Diabetic Patients Undergoing Maintenance Therapy

Background: Periodontal disease is a significant complication in patients with type-2 diabetes mellitus, further complicated by impaired immune response and increased susceptibility to infections. Effective management is essential as it influences both oral health and glycemic control. Traditional therapies frequently prove inadequate, necessitating the exploration of adjunctive treatments. Chitosan, known for its antibacterial, anti-inflammatory, and regenerative properties, offers potential benefits due to its non-toxicity, biodegradability, and biocompatibility. This study aims to systematically compare and evaluate the clinical outcomes and antimicrobial efficacy of 2mg resorbable Chitosan membranes versus 2mg resorbable tetracycline fibers (suspended in 25mg collagen) when used as adjuncts to scaling and root planing in patients with type-2 diabetes mellitus undergoing periodontal maintenance.Materials and methodology: In parallel study design, 26 patients with type II diabetes mellitus, undergoing maintenance therapy and diagnosed with periodontitis, were treated with scaling and root planing. Test group was given chitosan membranes, while control group received tetracycline fibers as local drug delivery agents in residual pockets with depth of 5mm or more. Clinical evaluations, including Plaque Index, Modified Sulcus Bleeding Index, probing pocket depth, attachment loss, and microbiological analysis, were conducted at baseline and again at 3 months. This trial was prospectively registered with Clinical Trials Registry – India (Trial REF/2022/04/053476; Registration number: CTRI/2023/10/058766).Results: Both groups showed significant improvements in plaque index (PI), sulcus bleeding index (SBI), probing pocket depth (PD), and clinical attachment level (CAL) from baseline to three months, with no significant intergroup differences. The presence of Streptococcus mitis/oralis did not differ significantly between groups at any point. Actinomyces israelii and Fusobacterium nucleatum showed significant differences at baseline but not at three months.Conclusion: Within the limits of the study, chitosan membrane showed similar results to tetracycline fibers at 3 months, making it a promising alternate modality in maintenance patients with chronic periodontitis.