Title Sclerostin Antibody (Scl-ab) Treatment Can Result in Improved Clinical Outcomes Compared to No Treatment in the Regeneration of Periodontal Defects
Clinical Question In patients with periodontal defects, does the adjunctive use of sclerostin antibody improve regeneration outcomes as compared to no treatment or placebo?
Clinical Bottom Line In the treatment of periodontal defects, systemic administration of the Scl-ab will improve radiographic, histologic, and biochemical indicators of alveolar bone regeneration compared to control groups. The results were demonstrated in the rat and mouse model. Further research of higher evidence levels including clinical trails is required before the Scl-ab can be applied to clinical practice.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
23712325Taut/201318 rats with silk ligature-induced periodontitis Animal Study
Key resultsSix weeks post ligature removal, systemically administered Scl-ab treated rats had statistically similar bone volume fraction (BVF) (p=0.3378) and tissue mineral density (TMD) (p=0.4196) when compared to the periodontally healthy control group. Both BVF and TMD in the Scl-ab group and healthy control group were significantly higher than the group that received only the antibody vehicle. Local administration of Scl-ab demonstrated minimum effect on regeneration by analysis with micro-computed tomography (micro-CT). Bone formation markers including PINP and osteocalcin in the Scl-ab group were similar to the periodontally healthy group at 6 weeks. Authors concluded that the systemic administration of Scl-ab restored alveolar bone mass.
25757567Ren/2015 48 periostin knock out mice and age-matched controlsAnimal Study
Key resultsIn the periostin-knockout mouse model that developed periodontitis, early systemic administration of Scl-ab prevented alveolar bone loss compared to the no-treatment group by analysis with micro-CT and quantitative measurements of bone volume. Five-month-old Scl-ab treated mice also demonstrated alveolar bone loss rescue using radiographs and micro-CT images. Scanning electron microscopy revealed pathologic changes in osteocytes found in the periostin-knockout control group that were reversed in the Scl-ab treatment group.
Evidence Search (("Sost protein, mouse" [Supplementary Concept]) AND "Antibodies"[Mesh]) AND "Periodontitis"[Mesh] (("Sost protein, rat" [Supplementary Concept]) AND "Antibodies"[Mesh]) AND "Periodontitis"[Mesh]
Comments on
The Evidence
Currently, the number of studies involving the use of Scl-ab in the treatment of periodontal defects is limited in number and of low level of evidence (animal models). Nonetheless, the above studies are well designed with clearly defined test and control groups. Also, a variety of measurement tools were incorporated to analyze different markers of alveolar bone regeneration.
Applicability The use of Scl-ab in the treatment of periodontal defects is a new concept in the dental literature. Published studies are limited to animal and cell models at this time. These published studies demonstrate that the Scl-ab can aid in the regeneration of alveolar bone defects caused by periodontitis. The use of Scl-ab has already been shown to be effective in the treatment of other bone pathologies including osteoporosis in humans and fracture repair in the rabbit model. Clinical trials are required before the Scl-ab can be applied to patient care.
Specialty (Periodontics)
Keywords periodontitis, SOST gene, sclerostin antibody, regneration
ID# 2927
Date of submission 10/09/2015
E-mail rediske@livemail.uthscsa.edu
Author Michael Rediske, DDS
Co-author(s) e-mail
Faculty mentor Guy Huynh-Ba, DDS
Faculty mentor e-mail HuynhBa@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available