Introduction

Periodontitis is a chronic multifactorial inflammatory disease associated with dysbiotic dental biofilms and characterized by the progressive destruction of the tooth-supporting structures, including the periodontal ligament, cementum, and alveolar bone.[1,2] If left untreated, periodontitis can lead to tooth mobility, tooth loss, and impaired oral health-related quality of life. Although microbial plaque is the primary etiological factor, the severity and progression of periodontal destruction are largely influenced by the host immune-inflammatory response.[3,4]

Scaling and root planing (SRP) is considered the gold standard non-surgical treatment for periodontitis and aims to eliminate microbial deposits and disrupt subgingival biofilms.[5] While SRP effectively reduces periodontal inflammation and improves clinical parameters, complete resolution of the disease is not always achieved, particularly in patients with an exaggerated inflammatory response. Consequently, interest has grown in host modulation therapy as an adjunctive approach to conventional periodontal treatment.[6,7] Omega-3 polyunsaturated fatty acids (PUFAs), particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have attracted considerable attention because of their anti-inflammatory and pro-resolving properties.[8] These essential fatty acids are metabolized into specialized pro-resolving mediators, including resolvins, protectins, and maresins, which play important roles in controlling inflammation and promoting tissue healing. Omega-3 fatty acids have been shown to reduce the production of pro-inflammatory cytokines such as interleukin-1β, interleukin-6, and tumor necrosis factor-α, all of which are implicated in periodontal tissue destruction.[8,9]

Several studies have reported that adjunctive omega-3 supplementation may improve periodontal clinical outcomes, including reductions in probing pocket depth, bleeding on probing, and gains in clinical attachment level. Furthermore, omega-3 fatty acids are generally well tolerated, readily available, and associated with minimal adverse effects, making them a promising adjunctive therapy for periodontal management. However, despite encouraging evidence, the clinical effectiveness of omega-3 supplementation in conjunction with non-surgical periodontal therapy remains an area of ongoing investigation, particularly in diverse patient populations.[10]

Therefore, the present randomized clinical trial was undertaken to evaluate the effect of omega-3 fatty acid supplementation on periodontal healing following scaling and root planing in patients with periodontitis. The study aimed to determine whether adjunctive omega-3 therapy could provide additional clinical benefits beyond those achieved with conventional non-surgical periodontal treatment alone

Materials and Methods

Study Design and Participants” This randomized controlled clinical trial was conducted in the Department of Periodontology to evaluate the effect of omega-3 fatty acid supplementation on periodontal healing following non-surgical periodontal therapy. The study protocol was approved by the Institutional Ethics Committee, and written informed consent was obtained from all participants before enrollment.

A total of 30 patients diagnosed with periodontitis were recruited for the study. Participants were aged between 25 and 50 years and were selected from patients seeking periodontal treatment at the institution.

Inclusion Criteria:

• Participants fulfilling the following criteria were included:
• Age between 25 and 50 years.
• Diagnosis of periodontitis according to the current periodontal classification.
• Presence of at least 20 natural teeth.
• Presence of at least two non-adjacent teeth with probing pocket depth (PPD) ≥4 mm.
• Willingness to participate and provide written informed consent.

Exclusion Criteria:

The following patients were excluded from the study:

• History of periodontal therapy within the previous 6 months.
• Current smokers or tobacco users.
• Pregnant or breastfeeding women.
• Patients with systemic diseases such as diabetes mellitus, cardiovascular disorders, autoimmune diseases, or other conditions that could influence periodontal healing.
• Use of antibiotics, immunosuppressive drugs, or anti-inflammatory medications within the preceding 3 months.

• Known allergy to fish oil or omega-3 supplements.

Randomization and Allocation

The 30 eligible participants were randomly assigned into two groups of 15 patients each using a computer-generated randomization sequence.

• Group I (Control Group): Received scaling and root planing (SRP) alone.
• Group II (Test Group): Received scaling and root planing (SRP) along with oral omega-3 fatty acid supplementation.

Allocation concealment was maintained using sealed opaque envelopes opened only after baseline examination.

Clinical Examination

All clinical measurements were recorded by a single calibrated examiner at baseline and 3 months after treatment.

The following periodontal parameters were assessed:

• Plaque Index (PI) (Silness and Löe, 1964)
• Gingival Index (GI) (Löe and Silness, 1963)
• Bleeding on Probing (BOP)
• Probing Pocket Depth (PPD) measured using a UNC-15 periodontal probe
• Clinical Attachment Level (CAL)

Measurements were recorded at six sites per tooth: mesiobuccal, midbuccal, distobuccal, mesiolingual, midlingual, and distolingual.

Non-Surgical Periodontal Therapy

All participants underwent full-mouth scaling and root planing using ultrasonic scalers and Gracey curettes under local anesthesia whenever required. Oral hygiene instructions were provided to all participants, and reinforcement was performed during follow-up visits.

Omega-3 Fatty Acid Supplementation

Participants in the test group received omega-3 fatty acid capsules containing 1000 mg fish oil (providing approximately 180 mg EPA and 120 mg DHA) once daily for a period of 3 months following SRP. Participants were instructed to take the supplement after meals and maintain their regular oral hygiene practices throughout the study period.

Follow-Up Evaluation

Clinical parameters were reassessed at 3 months following treatment. Compliance with omega-3 supplementation was monitored through patient interviews and capsule count records during follow-up visits.

Statistical Analysis

Data were entered into Microsoft Excel and analyzed using Statistical Package for the Social Sciences (SPSS) software version 25.0. Descriptive statistics were calculated for all variables. Intragroup comparisons between baseline and 3-month measurements were performed using the paired t-test. Intergroup comparisons were analyzed using the independent t-test. A p-value of less than 0.05 was considered statistically significant.

Result

Table 1 presents the comparison of clinical periodontal parameters between the control group (SRP alone) and the test group (SRP with omega-3 fatty acid supplementation) at baseline and 3 months.

At baseline, both groups exhibited comparable mean values for Plaque Index (PI), Gingival Index (GI), Bleeding on Probing (BOP), Probing Pocket Depth (PPD), and Clinical Attachment Level (CAL), indicating a similar periodontal status prior to treatment.

After 3 months, both groups showed improvements in all clinical parameters following periodontal therapy. The Plaque Index decreased substantially in both groups, with no statistically significant difference observed between them (p = 0.187). This finding suggests that both groups maintained comparable levels of plaque control throughout the study period.

The Gingival Index was significantly lower in the test group (0.79 ± 0.17) compared with the control group (1.19 ± 0.24) at the 3-month follow-up (p = 0.009), indicating a greater reduction in gingival inflammation with adjunctive omega-3 supplementation.

Similarly, Bleeding on Probing was significantly reduced in the test group (19.7 ± 5.4%) compared with the control group (34.5 ± 6.8%) (p = 0.006), demonstrating improved periodontal tissue health and reduced inflammatory response among patients receiving omega-3 fatty acids.

The reduction in Probing Pocket Depth was also significantly greater in the test group, which achieved a mean PPD of 3.36 ± 0.41 mm compared with 3.92 ± 0.47 mm in the control group (p = 0.013). This finding indicates enhanced periodontal healing and pocket reduction associated with omega-3 supplementation.

Furthermore, the test group exhibited a significantly greater gain in Clinical Attachment Level, with a mean CAL of 4.21 ± 0.51 mm compared with 4.86 ± 0.59 mm in the control group at 3 months (p = 0.010). This suggests superior periodontal attachment recovery in patients receiving adjunctive omega-3 fatty acids.

Overall, the results indicate that while scaling and root planing effectively improved periodontal health in both groups, adjunctive omega-3 fatty acid supplementation provided additional benefits by significantly reducing gingival inflammation, bleeding on probing, probing pocket depth, and improving clinical attachment levels.

Statistically significant (p < 0.05).

Discussion

The present randomized clinical trial evaluated the effect of omega-3 fatty acid supplementation as an adjunct to scaling and root planing on periodontal healing in patients with periodontitis. The findings demonstrated that both treatment modalities resulted in significant improvements in clinical periodontal parameters; however, patients receiving adjunctive omega-3 fatty acid supplementation exhibited significantly greater reductions in gingival inflammation, bleeding on probing, and probing pocket depth, along with greater gains in clinical attachment level compared with SRP alone.

The improvements observed in both groups can be attributed to the effectiveness of SRP in disrupting and removing subgingival biofilm and calculus deposits, thereby reducing the microbial burden responsible for periodontal inflammation. These findings are consistent with the established role of SRP as the gold standard non-surgical treatment for periodontitis.

In the present study, Plaque Index scores decreased significantly in both groups following treatment, with no statistically significant difference between the groups at the 3-month follow-up. This finding indicates that both groups maintained comparable oral hygiene levels throughout the study period. Therefore, the superior clinical outcomes observed in the test group cannot be attributed solely to differences in plaque control but are likely related to the biological effects of omega-3 fatty acid supplementation.

A significant reduction in Gingival Index and Bleeding on Probing was observed in the omega-3 supplementation group compared with the control group. These findings may be explained by the anti-inflammatory properties of omega-3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Omega-3 fatty acids serve as precursors for specialized pro-resolving mediators, including resolvins and protectins, which regulate inflammatory responses and promote the resolution of inflammation. In addition, omega-3 fatty acids have been shown to suppress the production of pro-inflammatory cytokines such as interleukin-1β, interleukin-6, and tumor necrosis factor-α, which are key mediators involved in periodontal tissue destruction.[11-14]

The results of the present study also demonstrated significantly greater probing pocket depth reduction and clinical attachment gain in the test group. These findings suggest that omega-3 supplementation may enhance periodontal tissue healing following non-surgical therapy. Reduced inflammatory burden within periodontal tissues may contribute to improved connective tissue repair and stabilization of periodontal attachment. The greater clinical attachment gain observed in the test group supports the potential role of omega-3 fatty acids as a host-modulatory agent in periodontal therapy.[15,16]

The findings of the present study are in agreement with previous investigations that have reported beneficial effects of omega-3 fatty acids on periodontal health. Several clinical studies have demonstrated that adjunctive omega-3 supplementation improves periodontal parameters when combined with conventional periodontal therapy. The observed reductions in gingival inflammation and probing pocket depth in the present study are consistent with these reports and further support the use of omega-3 fatty acids as a non-invasive adjunctive treatment strategy.

One of the strengths of the present study was the randomized design and the inclusion of systemically healthy participants, which minimized potential confounding factors that could influence periodontal healing. Furthermore, strict inclusion and exclusion criteria ensured a relatively homogeneous study population.

However, certain limitations should be acknowledged. The sample size was relatively small, comprising only 30 participants, and the follow-up period was limited to 3 months. Longer follow-up periods may be necessary to evaluate the sustainability of the observed clinical improvements. In addition, the study relied solely on clinical periodontal parameters and did not assess biochemical inflammatory markers such as interleukin-6, matrix metalloproteinase-8, or C-reactive protein, which could have provided further insight into the mechanisms underlying the beneficial effects of omega-3 fatty acids.

Within the limitations of the present study, adjunctive omega-3 fatty acid supplementation demonstrated a positive effect on periodontal healing following non-surgical periodontal therapy. The findings suggest that omega-3 fatty acids may serve as a safe, cost-effective, and biologically plausible host-modulatory adjunct capable of enhancing the clinical outcomes of conventional periodontal treatment.

Conclusion

Within the limitations of the present study, adjunctive omega-3 fatty acid supplementation demonstrated a beneficial effect on periodontal healing following non-surgical periodontal therapy. Both the control and test groups showed significant improvements in clinical periodontal parameters after scaling and root planing; however, patients receiving omega-3 supplementation exhibited significantly greater reductions in gingival inflammation, bleeding on probing, and probing pocket depth, along with superior gains in clinical attachment level.

The findings suggest that omega-3 fatty acids may enhance the therapeutic outcomes of conventional periodontal treatment through their anti-inflammatory and host-modulatory effects. Therefore, omega-3 fatty acid supplementation can be considered a safe and effective adjunct to scaling and root planing in the management of periodontitis. Further studies with larger sample sizes, longer follow-up periods, and assessment of inflammatory biomarkers are recommended to confirm these findings and establish standardized clinical protocols.

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