Local Insulin Application with Collagen Sponge Improves Periodontal Intra-bony Defects and Reduces Postoperative Pain

<b>Periodontal intra-bony defects</b> represent a significant challenge in dentistry, leading to tooth loss and impaired oral function. Current regenerative therapies often involve complex surgical procedures and expensive biomaterials, with variable success rates in achieving predictable bone and tissue regeneration. Insulin, known for its anabolic and anti-inflammatory properties, and <b>hyaluronic acid (HA)</b>, a key component of the extracellular matrix involved in wound healing, are emerging as promising, cost-effective adjunctive biomaterials. This study investigates their local application to enhance regeneration and reduce discomfort, addressing a critical gap in accessible and effective periodontal treatment options.

This pilot randomized controlled clinical trial enrolled <b>21 periodontitis patients</b> with intra-bony defects, assigning them equally to three groups (<b>n=7</b> each). All patients underwent the single flap approach (SFA). Group I received <b>insulin</b> combined with an absorbable collagen sponge (ACS); Group II received <b>hyaluronic acid (HA)</b> with ACS; and Group III served as control, receiving ACS alone. Primary outcome was clinical attachment level (CAL), with probing pocket depth (PPD), postoperative pain (VAS), radiographic linear defect depth (RLDD), and bone density as secondary outcomes. Measurements were taken at baseline and <b>6 months</b> postoperatively, with VAS scores also assessed at <b>24</b> and <b>48 hours</b>.

All treatment groups demonstrated significant improvements in PPD and CAL over time (<b>P < 0.001</b>), indicating overall clinical benefit from the SFA technique, though no significant intergroup differences were observed for these primary clinical parameters. > Postoperative pain, assessed by VAS scores, was significantly lower in both the <b>insulin</b> and <b>HA</b> groups compared to controls at <b>24 hours</b> (<b>P = 0.004</b>) and <b>48 hours</b> (<b>P = 0.007</b>), with the <b>insulin</b> group exhibiting the lowest pain scores overall (<b>P = 0.008</b>). Radiographically, RLDD decreased significantly across all groups (<b>P < 0.001</b>). However, the <b>HA</b> + ACS group showed a greater reduction in RLDD compared to both the <b>insulin</b> and control groups at <b>6 months</b> (<b>P = 0.027</b>). Bone density significantly increased over time in the <b>insulin</b> + ACS group (<b>P < 0.001</b>) and the <b>HA</b> + ACS group (<b>P = 0.022</b>), whereas the ACS alone group showed no significant change (<b>P = 0.860</b>). Despite these individual improvements, intergroup differences in bone density were not statistically significant.