The impact of vitamin D status on periodontal surgery outcomes

Abstract

Vitamin D regulates calcium and immune function. While vitamin D deficiency has been associated with periodontitis, little information exists regarding its effect on wound healing and periodontal surgery outcomes. This longitudinal clinical trial assessed outcomes of periodontal surgery and teriparatide administration in vitamin-D-sufficient and -insufficient individuals. Forty individuals with severe chronic periodontitis received periodontal surgery, daily calcium and vitamin D supplements, and self-administered teriparatide or placebo for 6 wks to correspond with osseous healing time. Serum 25(OH)D was evaluated at baseline, 6 wks, and 6 mos post-surgery. Clinical and radiographic outcomes were evaluated over 1 yr. Placebo patients with baseline vitamin D deficiency [serum 25(OH)D, 16-19 ng/mL] had significantly less clinical attachment loss (CAL) gain (-0.43 mm vs. 0.92 mm, p < 0.01) and probing depth (PPD) reduction (0.43 mm vs. 1.83 mm, p < 0.01) than vitamin-D-sufficient individuals. Vitamin D levels had no significant impact on CAL and PPD improvements in teriparatide patients at 1 yr, but infrabony defect resolution was greater in teriparatide-treated vitamin-D-sufficient vs. -deficient individuals (2.05 mm vs. 0.87 mm, p = 0.03). Vitamin D deficiency at the time of periodontal surgery negatively affects treatment outcomes for up to 1 yr. Analysis of these data suggests that vitamin D status may be critical for post-surgical healing. (ClinicalTrials.gov number, CT00277706).

Trial registration: ClinicalTrials.gov NCT00277706.

Figure.

Clinical and radiographic outcomes of vitamin-D-sufficient and -deficient participants supplemented with placebo or teriparatide for 6 wks. Mean (± SE) changes from baseline for clinical attachment level gain (A, B), probing depth reduction (C, D), and linear defect resolution as measured radiographically with bitewing radiographs (E, F). In participants taking placebo, clinical attachment level gain was significantly greater in vitamin-D-sufficient individuals at all time-points, with vitamin-D-deficient persons experiencing a loss of attachment compared with baseline (A, p < 0.01). Probing depth reductions were significantly greater in vitamin-D-sufficient participants compared with vitamin-D-deficient participants at all time-points (C, p < 0.01). Neither group experienced significant radiographic defect resolution compared with baseline, or between groups (E, p = NS). For those supplemented with teriparatide, both vitamin-D-sufficient and -deficient groups experienced significant improvement in all parameters at 12 mos compared with baseline (B,D,F, p < 0.01). Clinical attachment level gain and probing depth reduction were not significantly different between vitamin D groups at the 12-month time-point, although vitamin-D-deficient participants had significantly less improvement in clinical attachment gain at 6 mos (B, p < 0.01) and significantly less improvement in probing depth reduction at 3, 6, and 9 mos (D, p < 0.01). Teriparatide recipients who were vitamin-D-sufficient experienced significantly greater radiographic linear defect resolution than -deficient participants beginning at 6 mos (F, p = 0.03).