الفهرس 
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Abstract
N
on-surgical periodontal therapy (NSPT) is considered the gold standard of periodontal treatment and its clinical efficacy is well documented. However, to improve its results, novel techniques had been proposed to be an adjunct to mechanical debridement. Local drug delivery is one of the commonly used adjunctive therapies and Metformin therapy was documented to have a good clinical effect in managing periodontitis.
The objective of the present study was to assess the clinical effect of using 1% Metformin gel as an adjunctive therapy to the SRP in managing stage II periodontitis grade B and to further analyze (NSPT) and its effect on microbial load of periodontal pathogens.
The present study included 26 patients diagnosed with stage II and grade B periodontitis. Patients were randomly allocated to either group 1 included 13 patients treated with non-surgical periodontal therapy (NSPT) followed by injecting 0.25mm of 1% Metformin gel in the selected sites or group 2 was treated with NSPT followed by injecting placebo gel in the selected sites which served as control group.
Clinical parameters including plaque index (PI), gingival index (GI), pocket depth (PD) and clinical attachment level (CAL) were recorded at baseline and three months postoperatively. Moreover, GCF samples were collected with perio-paper strip for microbiological assessment of four periodontal pathogens. which was performed at baseline, 2 weeks and 2 months postoperatively.
Regarding the plaque index (PI) scores, both studied groups showed statistically significant changes throughout the experimental period, changes in the plaque index (PI) were significant after 3 and 6 months compared to baseline, Meanwhile, both groups showed statistically significant changes in gingival index (GI) scores after 3 and 6 months compared to baseline, yet there was no significant difference between 3 and 6 months postoperatively.
Both groups showed a statistically significant reduction in probing pocket depth (PPD) at 3 and 6 months postoperatively compared to baseline and a statistically significant difference when compared to each other, Considering Clinical attachment level (CAL) gain as a clinical outcome, both groups of the present study showed a statistically significant CAL gain at 3 and 6 months postoperatively compared to baseline and a statistically significant difference when compared to each other.
Regarding the microbial analysis, concerning the P.gingivalis bacteria, both groups showed non-significant bacterial load difference at baseline and 2weeks, yet showed a statistically significant difference at 2months time interval A.actynomycetemcomitans, both groups showed non-significant bacterial load difference at baseline and 2 weeks, yet showed a statistically significant difference at 2 months interval.
While for the For the P.intermedia bacteria, both groups showed significant bacterial load difference at baseline and 2 weeks, also showed a statistically significant difference at 2 months interval. on the contrary T.pallidum, the control showed a higher significant bacterial load difference at baseline, 2 weeks and 2 months interval