Herbal extracts as adjunct in supportive periodontal therapy

Centella asiatica and Punica granatum are medicinal plants that have been reported to promote tissue healing and modulate host responses. Preliminary study revealed positive clinical effects of an innovative preparation from the two herbal extracts in the form of biodegradable chips as a subgingival adjunct to scaling and root planing. The purpose of this research was to evaluate further augmenting efficacy the combined herbal preparation may have among maintenance patients in comparison to standard supportive periodontal therapy (SPT), with additional monitoring of certain inflammatory markers. Fifteen patients in the recall programme who had completed conventional periodontal therapy with remaining probing pocket depth 5-8 mm were enrolled. After baseline examination and collection of gingival crevicular fluid (GCF) samples, SPT was provided and the target teeth in the test group received subgingival delivery of the medicated chips. The clinical parameters which included probing pocket depth (PD), attachment level (AL), bleeding index (BI), gingival index (GI) and plaque index (PI) were recorded and GCF samples were collected at baseline, 3 and 6 months. The results showed significant improvement of PD, AL, GI at 3 and 6 months and BI at 6 months in the test group compared to control. No significant differences in PI were found between the two treatment modalities at all subsequent visits. The test group also showed statistically greater reduction of IL-1ß at both 3 and 6 months and lower IL-6 concentration which almost reached significant level at 6 months. The results indicate that adjunctive local delivery of extracts from C. asiatica in combination with P. granatum significantly improved clinical signs of chronic periodontitis and IL-1ß level in maintenance patients. Keywords: Centella asiatica, Punica granatum, supportive periodontal therapy, biodegradable chips, subgingival delivery