Effect of Switching to the Tobacco Heating System Versus Continued Cigarette Smoking on Chronic Generalized Periodontitis Treatment Outcome: Protocol for a Randomized Controlled Multicenter Study

Sandrine Pouly, Wee Teck Ng, Muriel Benzimra, Alexandre Soulan, Nicolas Blanc, Filippo Zanetti, Patrick Picavet, Gizelle Baker, Christelle Haziza, Sandrine Pouly, Wee Teck Ng, Muriel Benzimra, Alexandre Soulan, Nicolas Blanc, Filippo Zanetti, Patrick Picavet, Gizelle Baker, Christelle Haziza

Abstract

Background: Smoking is a significant risk factor for periodontal disease and tooth loss, as shown in several clinical studies comparing smokers and nonsmokers. Although only a few longitudinal studies have assessed the outcome of periodontal disease after smoking cessation, they indicated that recovery after nonsurgical treatment was more successful in those who had quit smoking. As part of tobacco harm reduction strategies, substituting cigarettes with alternative, less harmful tobacco products is an approach complementary to cessation for smokers who would otherwise continue to smoke. The Tobacco Heating System (THS), developed by Philip Morris International (commercialized as IQOS), is part of the heat-not-burn product category. The IQOS device electrically heats tobacco instead of burning it, at much lower temperatures than cigarettes, thereby producing substantially lower levels of harmful and potentially harmful constituents, while providing the nicotine, taste, ritual, and a sensory experience that closely parallel those of cigarettes. Phillip Morris International has published the results from a broad clinical assessment program, which was established to scientifically substantiate the harm reduction potential of the THS among adult healthy smokers switching to the THS. The program is now progressing toward including adult smokers with smoking-related diseases.

Objective: The goal of this study is to demonstrate favorable changes of periodontal endpoints in response to mechanical periodontal therapy in patients with generalized chronic periodontitis who completely switched to THS use compared with continued cigarette smoking.

Methods: This is a randomized controlled two-arm parallel-group multicenter Japanese study conducted in patients with chronic generalized periodontitis who switch from cigarettes to THS compared with smokers continuing to smoke cigarettes for 6 months. The patients were treated with mechanical periodontal therapy as per standard of care in Japan. The primary objective of the study is to demonstrate the beneficial effect of switching to THS use compared with continued cigarette smoking on pocket depth (PD) reduction in all sites with an initial PD≥4 mm. The secondary objectives include evaluation of other periodontal parameters (eg, clinical attachment level or gingival inflammation) and overall oral health status upon switching to THS. Safety was monitored throughout the study.

Results: In total, 172 subjects were randomized to the cigarette (n=86) or THS (n=86) groups, and all 172 completed the study. The conduct phase of the study is completed, while data cleaning and analyses are ongoing.

Conclusions: This study is the first to test a heat-not-burn tobacco product in smokers with an already established disease. The results should further strengthen the evidence that switching to THS can significantly reduce the risk of smoking-related diseases if favorable changes in the evolution of chronic generalized periodontitis after mechanical therapy are found when compared with continued cigarette smoking.

Trial registration: ClinicalTrials.gov NCT03364751; https://ichgcp.net/clinical-trials-registry/NCT03364751.

International registered report identifier (irrid): DERR1-10.2196/15350.

Keywords: Tobacco Heating System; clinical attachment level; modified risk tobacco product; oral health; periodontal pocket; periodontitis; probing depth; smoking; tobacco.

Conflict of interest statement

Conflicts of Interest: The work reported in this publication involved a candidate reduced risk product developed by PMI Research & Development. All authors are employees of PMI. PMI is the sole source of funding and sponsor of this project.

©Sandrine Pouly, Wee Teck Ng, Muriel Benzimra, Alexandre Soulan, Nicolas Blanc, Filippo Zanetti, Patrick Picavet, Gizelle Baker, Christelle Haziza. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 18.01.2021.

Figures

Figure 1
Figure 1
Design of the study. Eligibility criteria were checked at V1. Enrolled subjects were randomized at V2. Periodontal assessments were performed at V1, V3, and V4. Times of collection of buccal samples are indicated on the chart. BS: buccal swabs; GCF: gingival crevicular fluid; mo: month; SP: subgingival plaque; SRP: scaling and root planing; V: visit; THS: Tobacco Heating System.
Figure 2
Figure 2
Product use classification tree. Cig: cigarette; HS: HeatSticks.

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