Abstract
BackgroundThe gold standard in treatment of periodontitis is mechanical removing of dental biofilm but using local delivery drugs as adjunctive to SRP is widely used to modulate inflammatory host and eradicate microbes. Tea tree oil (TTO) has a broad-spectrum antimicrobial, anti-inflammatory, antifungal, antiviral, antioxidant effect. This study aimed to assess clinically and biochemically the effect of intrapocket application of TTO (Melaleuca alternifolia) gel adjunctive to scaling and root planing (SRP) in the treatment of stage 2 (moderate) periodontitis and to correlate the biochemical levels with clinical response.MethodsA randomized, controlled clinical trial was conducted on thirty patients with stage 2 periodontitis. Patients were equally divided into two groups: Control Group treated with (SRP) alone and Test Group treated with SRP and locally delivered 5% TTO gel. Clinical assessment included pocket probing depth (PPD), clinical attachment loss (CAL), gingival index (GI) and bleeding on probing (BOP) measured at baseline and after 3 and 6 months. The level of matrix metalloproteinase-8 (MMP-8), in the gingival crevicular fluid (GCF) was also assessed at baseline and after1, 3 and 6 months by Enzyme-linked immunosorbent assay (ELISA) kit. Chi-square, Student t- tests, Mann–Whitney U test and Spearman correlation were the statistical tests used in the study.ResultsAn improvement of all clinical and biochemical parameters was observed (at p < 0.001) in both groups. A significant difference between the two groups was found in both clinical and biochemical parameters.ConclusionThe local delivery of TTO gel adjunctive to SRP proved to be effective in the treatment of stage II periodontitis.Trial registration The study was retrospectively registered at clinicaltrials.gov NCT04769271, on 24/2/2021.
Highlights
Periodontitis is a common microbial infection-induced inflammatory disease that results in destruction of the periodontium leading to tooth loss
Salivary interleukin-6 (IL-6) levels in periodontitis patients were assessed by Isola etal (2020) as an inflammatory biomarker and they found that periodontitis patients presented significant higher salivary IL-6 levels compared to healthy subjects and that salivary IL-6 levels were inversely associated with the number of teeth in those patients [6]
Clinical periodontal outcome The clinical efficacy of the Tea tree oil (TTO) gel applied subgingivally for the treatment of stage 2 periodontitis was assessed using clinical parameters at baseline and at 3 and 6 months
Summary
Periodontitis is a common microbial infection-induced inflammatory disease that results in destruction of the periodontium leading to tooth loss. The onset, progression and severity of the disease depend mainly on the host immune-inflammatory response to microbial dental plaque. Periodontal tissue destruction is controlled mainly by matrix metalloproteinases (MMPs), a family of zinc and calcium-dependent proteolytic enzymes, which are secreted by cells of the immune system such as polymorphonuclear leukocytes and fibroblasts [7,8,9]. Metalloproteinases are classified among a large group of metal-dependent endopeptidases formed by connective tissue cells [1, 2, 7]. They are secreted as latent proenzymes and activated in the extracellular environment. This study aimed to assess clinically and biochemically the effect of intrapocket application of TTO (Melaleuca alternifolia) gel adjunctive to scaling and root planing (SRP) in the treatment of stage 2 (moderate) periodontitis and to correlate the biochemical levels with clinical response
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