ABSTRACT
Introduction:
The usage of antimicrobials as local drug delivery (LDD) agents in the treatment of periodontitis has posed limitations due to the development of bacterial resistance, high cost, and unavailability, thus indicating the need for safer and economic alternatives.
Methodology:
A split-mouth randomized clinical trial was carried out on 10 patients. Three sites in different quadrants were assigned, treatment modality of scaling and root planing (SRP) alone, SRP with LDD of curcumin gel, and SRP with LDD of 99% pure aloe vera gel, respectively. Clinical parameters were recorded at baseline and on 30th day postoperatively.
Results:
Curcumin and aloe vera in addition to SRP demonstrated improvements in clinical parameters, though 99% aloe vera extract produced more statistically significant results when used as an LDD agent, as shown in intergroup comparisons for changes in periodontal parameters.
Conclusion:
Curcumin 10mg (Curenext) and 99% aloe vera extract as LDD along with regular mechanical debridement is a promising therapy in the treatment of chronic periodontitis.
KEYWORDS: Chronic periodontitis, curcumin, LDD, scaling, and root planing
INTRODUCTION
Aloe vera and curcumin, two herbal remedies, have both been discovered to be Efficient as LDD.[1]
A perennial plant in the Zingiberaceae family, Curcuma longa, is the source of the Asian spice turmeric. Its use in traditional medicine is attributed to its anti-inflammatory, antioxidant, anticariogenic, antiviral, and antimicrobial qualities.[1]
The leaves of aloe vera belongs to the Alliacea family. Aloe vera has been used in dentistry for several documented purposes, including the treatment of gingivitis, and aphthous stomatitis, as well as an antiseptic and anti-candida agent.[2]
99% aloe vera gel extract was used in this research to evaluate its effectiveness as an LDD agent and to compare it to curcumin, which is already being used to treat patients with chronic periodontitis.
METHODS
After receiving approval from the institutional ethical committee, the current investigation was carried out in the department of periodontology at Rama Dental College, Hospital, and Research Centre. In the research, 99% aloe vera gel extracts and curcumin gel, were administered as LDD agents for the treatment of chronic periodontitis patients.
Inclusion criteria
Ten systemically healthy individuals were chosen; they ranged in age from 36-58 years and had pocket depth ≥5 mm and ≤8 mm at three nonadjacent locations in different quadrants of the mouth. Informed consent was received.
Exclusion criteria
Patients under systemic antibiotic treatment, antibiotic mouthwash, orthodontic treatment, prosthesis, pregnant or lactating females, or allergic to the drugs used in the study were excluded from the study.
Ten patients participated in this split-mouth randomized clinical study. A lottery method was used to distribute the patient among the groups. Scaling and root planing alone (SRP), SRP with LDD of curcumin gel, and SRP with LDD of 99% pure aloe vera gel were the three treatment modalities allocated to the three sites in the various quadrants. Clinical indicators like probing pocket depth, clinical attachment level, Plaque index, gingival index, and modified sulcus bleeding index, were recorded at baseline. On the 30th postoperative day, the parameters were documented once again. The data were analyzed using SPSS for Windows, version 21.0.
RESULTS
10 patients taken for the study had a mean age of 47.4 which consisted of 6 females and 4 males. When a comparison of all the parameters were was done within group I, II, and III statistically significant result was found.
When Intergroup comparison of all the parameters was done between group I and group II at baseline and 30th-day post intervention statistically significant result was seen for PPD, GI, and mSBI.
Intergroup comparison between group I and group III for all the parameters at baseline and on the 30th day postintervention showed statistically significant results for PPD, GI, and mSBI respectively.
Similarly, when an Intergroup comparison of all the parameters was carried out between group II and group III at baseline and on the 30th-day post treatment statistically significant result was found for PPD.
DISCUSSION
Determining the effectiveness of 99% aloe vera extracts and curcumin as LDD agents was the main purpose of the study. According to Cugini et al.[3] and other studies, sites treated with SRP alone demonstrated a statistically significant decline in mean values of clinical parameters from baseline to 30 days postoperatively.
In comparison to sites where chlorhexidine gel was applied, the research by Anitha et al.[4] reveals similar outcomes at sites where curcumin gel was applied in periodontal pockets as LDD. Thus, it can be concluded that Curcumin, when used in combination with SRP is just as efficient as LDD agents like Ornidazole gel and Chlorhexidine gel.
Significant reductions were in periodontal parameters with Aloe vera extract as LDD in adjunct to SRP which is in accordance with a study conducted by Bhat et al.[5] where a statistically significant reduction of pocket depth was seen in areas of aloe vera gel treatment combined with SRP.
Studies have shown that aloe vera gel actively contributes to wound healing and aid in immune system control. It actively decreases the activity of MMP-2, and MMP-9, which are key players in the tissue damage associated with periodontitis, according to research by Kudalkar et al.[6]
Studies comparing the intergroup differences in periodontal values between SRP and LDD with curcumin extract in Tables 1-3 show that it is more effective at reducing plaque than SRP alone. Anuradha et al.,[7] reported statistically significant periodontal reduction on LDD with Curcumin in their research. Both Curcumin and aloe vera in addition to SRP demonstrated improvements in clinical parameters, though 99% aloe vera extract produced more statistically significant results when used as an LDD agent as demonstrated in Table 3.
Table 1.
Intergroup comparison of periodontal parameters in subjects of Group 1 And Group 2 at baseline and on 30th day postintervention
| Parameters | Sampling stages | Group 1 (mean±SD) | Group 2 (mean±SD) | P |
|---|---|---|---|---|
| PPD | Baseline | 6.1±0.73 | 6.3±0.67 | 0.22 |
| 30th day | 4.8±0.91 | 3.8±0.48 | 0.02* | |
| CAL | Baseline | 4.5±0.52 | 4.6±0.51 | 0.66 |
| 30th day | 3.5±0.52 | 3.5±0.51 | 0.33 | |
| PI | Baseline | 2.6±0.31 | 2.6±0.50 | 0.33 |
| 30th day | 1.9±0.41 | 1.5±0.42 | 0.12 | |
| GI | Baseline | 1.85±0.41 | 2.3±0.25 | 0.56 |
| 30th day | 1.2±0.42 | 1.6±0.24 | 0.04* | |
| mSBI | Baseline | 1.65±0.21 | 2.2±0.25 | 0.37 |
| 30th day | 1.11±0.24 | 1.7±0.25 | 0.03* |
Table 3.
Intergroup comparison of periodontal parameters in subjects of Group 2 and Group 3 at baseline and on 30th day postintervention
| Parameters | Sampling stages | Group 2 (mean±SD) | Group 3 (mean±SD) | LOS |
|---|---|---|---|---|
| PPD | Baseline | 6.3±0.67 | 6.3±0.67 | 0.11 |
| 30th day | 3.8±0.48 | 3.6±0.87 | 0.18 | |
| CAL | Baseline | 4.6±0.51 | 4.6±0.51 | 0.46 |
| 30th day | 3.5±0.51 | 3.3±0.52 | 0.43 | |
| PI | Baseline | 2.6±0.50 | 2.6±0.25 | 0.31 |
| 30th day | 1.5±0.42 | 1.4±0.24 | 0.23 | |
| GI | Baseline | 2.3±0.25 | 2.3±0.51 | 0.72 |
| 30th day | 1.6±0.24 | 1.1±0.48 | 0.48 | |
| mSBI | Baseline | 2.2±0.25 | 2.2±0.25 | 0.32 |
| 30th day | 1.7±0.25 | 1.55±0.15 | 0.56 |
Table 2.
Intergroup comparison of periodontal parameters in subjects of Group 1 And Group 3 at baseline and on 30th day postintervention
| Parameters | Sampling stages | Group 1 (mean±SD) | Group 3 (mean±SD) | LOS |
|---|---|---|---|---|
| PPD | Baseline | 6.3±0.67 | 6.3±0.67 | 0.18 |
| 30th day | 3.8±0.48 | 3.6±0.87 | 0.01* | |
| CAL | Baseline | 4.6±0.51 | 4.6±0.51 | 0.45 |
| 30th day | 3.5±0.51 | 3.3±0.52 | 0.37 | |
| PI | Baseline | 2.6±0.50 | 2.6±0.25 | 0.33 |
| 30th day | 1.5±0.42 | 1.4±0.24 | 0.33 | |
| GI | Baseline | 2.3±0.25 | 2.3±0.51 | 0.74 |
| 30th day | 1.6±0.24 | 1.1±0.48 | 0.03* | |
| mSBI | Baseline | 2.2±0.25 | 2.2±0.25 | 0.37 |
| 30th day | 1.7±0.25 | 1.55±0.15 | 0.01* |
CONCLUSION
There is no doubt that the adjunctive use of Curenext gel and aloe vera extract as LDD along with regular mechanical debridement is a promising therapy.
However, for use in routine clinical practice and to identify better outcomes, more research on this product must be conducted with larger sample size and frequent application.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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