الفهرس 
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Abstract
study period. The mean percent reduction in RANKL level in group 1 was higher than in group 2 but the difference was statistically not significant.
Bostanci et al. (2011) evaluated the effect of SRP on GCF level of RANKL in chronic periodontitis patients, when the total amount of RANKL was considered, there were no significant changes over time after treatment by SRP. In contrast to the results of Bostanci et al. (2011), the results of the present study revealed significant reduction in RANKL level in GCF in patients treated by SRP.
Glucosamine sulfate was also shown to be effective in human OA osteoblasts. Glucosamine increased the osteoprotegrin/receptor activator of nuclear factor kappa-B ligand (RANKL) ratio and reduced bone resorption. This effect was increased when glucosamine was used in combination with chondroitin sulfate in invitro study (Montell et al., 2007).
The results of the present study demonstrated the oral bioavailability of glucosamine in the local periodontal environment and proved that its positive clinical effect after systemic administration might be mediated by the availability of the drug in GCF in concentrations that was enough to inhibit the local destructive effect of RANKL on the periodontium. The oral bioavailability of glucosamine in GCF could explain its beneficial effect in the management in chronic periodontitis by the presence of the drug in the local periodontal environment.
Within the limits of the present study, glucosamine sulphate could be regarded as a promising host response modulating agent in the management of chronic periodontitis via its inhibitory effect on RANKL level in GCF.
Conclusions
Based on the results of the present study, it could be concluded that:
1. Systemic glucosamine therapy for 3 months, as an adjunct to non surgical periodontal therapy might be an important addition to the therapeutic agents available for the management of generalized chronic periodontitis.
2. Glucosamine was bioavaliable in GCF and this could explain its beneficial effect in the management in chronic periodontitis by the presence of the drug in the local periodontal environment.
3. This study reflects the possible beneficial effects of glucosamine sulphate as a novel host response modulating agent in generalized chronic periodontitis patients via its inhibitory effect on RANKL level in GCF, since RANKL plays a key role in bone resorption in periodontal disease.
Recommendations
1. Double blind, randomized, multicenter clinical trials are recommended with larger sample size and longer follow up periods to evaluate the effect of systemic adjunctive glucosamine therapy on both the clinical and radiographic parameters of periodontal disease.
2. Further studies are required to evaluate the possible effects of adjunctive glucosamine therapy on patients with periodontitis associated with systemic disease.
3. Studies to evaluate the effect of systemic glucosamine adjunctive therapy on biomarkers of periodontal tissue destruction other than RANKL in GCF need to be carried out.