O uso de melatonina como terapia adjuvante da periodontite: uma revisão sistemática com meta análise e relatos de casos clínicos

Abstract

Periodontitis, a disease that affects the supporting tissues of the teeth, is associated with oxidative stress and metabolic conditions such as obesity. This metabolic disorder impacts the immune response, promotes inflammatory imbalances, and exacerbates periodontal tissue destruction. Additionally, low melatonin levels have been correlated with obesity and periodontitis, creating a systemic pro-inflammatory environment. Melatonin, a hormone secreted by the pineal gland and oral tissues, possesses antioxidant, immunomodulatory, and anti-inflammatory properties that may potentially improve the outcomes of nonsurgical periodontal therapy (NSPT). This study aimed to evaluate the effectiveness of melatonin as an adjuvant to NSPT in individuals with obesity and periodontal disease. A systematic review with meta-analysis was conducted, registered in PROSPERO (CRD42023472889), including 15 studies investigating clinical and biochemical parameters. A total of 845 periodontal sites were assessed (424 treated with NSPT combined with melatonin and 421 treated with NSPT alone or placebo). The search covered five major databases and gray literature. The risk of bias was analyzed using the RoB 2.0 tool, and the quality of evidence was assessed using the GRADE framework. The results showed significant improvements in clinical parameters such as probing depth (PD), clinical attachment level (CAL), gingival index (GI), and plaque index (PI), as well as reductions in pro-inflammatory biomarkers (IL-1β, IL-6, TNF-α), RANKL, and HbA1c in the melatonin + NSPT group. Although the certainty of evidence was classified as low to moderate, most studies demonstrated a low risk of bias. Case reports complemented these findings, utilizing an experimental 1% melatonin gel in a split-mouth model. After three months of follow-up, improvements in clinical parameters were observed compared to the control group treated with a placebo gel. Melatonin has shown potential as an adjuvant to NSPT, promoting clinical benefits and reducing systemic inflammation. However, further studies are needed to establish administration protocols, optimal dosages, and long-term effects, particularly in patients with obesity and periodontitis.