A COMPARISON OF TOPICAL KETOROLAC, SYSTEMIC FLURBIPROFEN, AND PLACEBO FOR THE INHIBITION OF BONE LOSS IN ADULT PERIODONTITIS

SYSTEMIC NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs) have been shown to reduce alveolar bone loss in periodontitis. This study assesses the efficacy of a topical NSAID rinse, containing ketorolac tromethamine as the active agent. Adult periodontitis patients (n = 55) were studied in this 6-month randomized, double blind, parallel, placebo and positive-controlled study. Each patient had a least 3 sites at high risk for bone loss as assessed by low dose bone scan. Groups, balanced for gender, were assigned to one of three regimens: bid ketorolac rinse (0.1%) with placebo capsule; 50 mg bid flurbiprofen caps;le (positive control) with placebo rinse; or bid placebo rinse and capsule. Prophylaxes were provided every 3 months. Monthly examinations assessed safety, gingival condition, and gingival crevicular fluid PGE(2). Standardized radiographs were taken at baseline and at 3 and 6 months for digital subtraction radiography. A significant loss in bone height was observed during the study period in the placebo group (-0.63+/-0.11; P <0.001), but not in the flurbiprofen (-0.10+/-0.12; P = 0.40) or ketorolac rinse (+0.20+/-0.11 mm; P = 0.07) groups. Nested ANOVA revealed that ketorolac and flurbiprofen groups had less bone loss (P <0.01) and reduced gingival crevicular fluid PGE(2) levels (P <0.03) compared to placebo. ANOVA suggests (P = 0.06) that ketorolac rinse preserved more alveolar bone than systemic flurbiprofen at the dose regimens utilized. These data indicate that ketorolac rinse may be beneficial in the treatment of adult periodontitis.