Main Article Content
Objective: To evaluate and compare the clinical effects between locally delivered Andrographis paniculata gel (AP gel) and 10% doxycycline gelas an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis subjects, who were involving on supportive periodontal therapy (SPT).
Materials and Methods: Twenty nine systemically healthy subjects with chronic periodontitis, who were involving on supportive periodontal therapy, were recruited in this split mouth, single–blinded, randomized controlled clinical trial (RCT), 6 months study. The subjects had to have three non–adjacent single root teeth with probing depth (PD) ≥ 5 mm and bleeding on probing (BOP), they had not recieved periodontal therapy within 6 months before study. The disease sites were randomly treated with; SRP plus AP gel, SRP plus 10% doxycycline gel, or SRP alone. Probing depth (PD), relative attachment level (RAL), gingival index (GI), plaque index (PI) and BOP were recorded at baseline, 3 and 6 months after treatments.
Results: Clinical changes were significantly improved in all treatment groups (p<0.05). When compared the clinical outcomes among the treatments, found that the treated sites with SRP plus AP gel or SRP plus 10% doxycycline gel were similar. These two treatment modalities can increased more number of treated sites with RAL gain >2 mm and reduced GI better than SRP alone.
Conclusion: The local application of AP gel or 10% doxycycline gel as an adjunct to SRP showed better
improvement of clinical parameters. These benefit may be reduce the need of periodontal surgery in some patients or reduce the frequency of periodontal maintenance visit.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. Lancet 2005; 366: 1809–20.
Smally JW. Pathogenesis mechanisms in periodontal disease. Adv Dent Res 1994; 8: 320-8.
Greenstein G. Nonsurgical periodontal therapy in 2000: a literature review. J Am Dent Assoc 2000; 131: 1580-92.
Waerhaug J. Healing of the dento-epithelial junction following subgingival plaque control. II: As observed on extracted teeth. J Periodontol 1978; 49: 119-34.
Fleischer HC, Mellonig JT, Brayer WK, Gray JL, Barnett JD. Scaling and root planing efficacy in multirooted teeth. J Periodontol 1989; 60: 402-9.
Eickholz P, Kim TS, Burkin T, Schacher B, Renggli HH, Schaecken MT, et al. Non-surgical periodontal therapy with adjunctive topical doxycycline: a double-blind randomized controlled multicenter study. (I). study design and clinical results. J Clin Periodontol 2002; 29: 108-17.
Gupta R, Pandit N, Aggarwal S, Verma A. Comparative evaluation of subgingivally delivered 10% doxycycline hyclate and xanthan-based chlorhexidine gels in the treatment of chronic periodontitis. J Contemp Dent Pract 2008; 9: 25-32.
Deo V, Ansari S, Mandia S, Bhongade M. Therapeutic efficacy of subgingivally delivered doxycycline hyclate as an adjunct to non-surgical treatment of chronic periodontitis. J Oral Maxillofac Res 2011;2:1-7.
Wennstrom JL, Newman HN, MacNeill SR, Killoy WJ, Griffiths GS, Gillam DG, et al. Utilisation of locally delivered doxycycline in non-surgical treatment of chronic periodontitis. A comparative muti-centre trial of 2 treatment approaches. J Clin Periodontol 2001; 28: 753-61.
Garrett S, Johnson L, Drisko CH, Adams DF, Bandt C, Beiswanger B, et al. Two multi-center studies evaluating locally delivered doxycycline hyclate, placebo control, oral hygiene, and scaling and root planing in the treatment of periodontitis. J Periodontol 1999; 70: 490-503.
Dental Health Division. The 2008, 6th National Oral Pathfinder Survey. Ministry of Public Health, Thailand, 2006-2007: 35-8.
Jewvachdamrongkul Y, Chokechaijaroenporn O, Chavalittumrong P, Dechatiwongse T. Chemical quality evaluation of fah talai jone. Bull Dept Med Sci 1987; 29: 231-7.
National Drug Committee. List of herbal medicinal products A.D. 2006. Bangkok: Agricultural Cooperative Community of Thailand Publishing; 2006: 40-52.
Amornchat C, Kraivaphan P, Kraivaphan V, Triratana T. The antibacterial activity of Andrographis paniculata crude extracts on oral bacteria. J Dent Assoc Thai. 1991; 41: 178-85.
Puri A, Saxena R, Saxena RP, Saxena KC, Srivastana V, Tandon JS. Immunostimulant agent from Andrographis paniculata. J Nat Prod. 1993; 56: 995-9.
Atsawasuwan P, Sirirat M, Amornchat C, Komwatchara T, Rojanapanthu P, et al. Subgingival administration of Andrographis paniculata gel and Metronidazole gel as an adjunct in the treatment of adult periodontitis: Clinical and microbiological effects. M Dent J 1998; 5: 97-101.
Boonchaipanichwatana P, Sirirat M, Amornchat C. The comparative clinical and microbiologicaleffects of Andrographis paniculata gel and minocycline ointment as an adjunct in the treatment of early onset periodontitis. M.S. Thesis in Periodontics: Faculty of Graduate Studies, Mahidol University;2001.
Komwatchara T. The development of Andrographis paniculata extract gel for microbial inhibition in adult periodontitis. M.S. Thesis in Pharmacy; Faculty of Graduate Studies, Mahidol University; 1996.
Silness J and Löe H. Periodontal Disease in Pregnancy. II. Correlation between Oral Hygiene and Periodontal Condition. Acta Odontol Scand 1964; 22: 121-35.
Löe H and Silness J. Periodontal Disease in Pregnancy. I. Prevalence and Severity. Acta Odontol Scand 1963; 21: 533-51.
Ainamo J and Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J 1975; 25: 229-35.
Wennstrom JL, Tomasi C, Bertelle A, Dellasega E. Full-mouth ultrasonic debridement versus quadrant scaling and root planing as an initial approach in the treatment of chronic periodontitis. J Clin Periodontol 2005; 32: 851-9.
American Academy of Periodontology Statement on Local Delivery of Sustained or Controlled Release Antimicrobials as Adjunctive Therapy in the Treatment of Periodontitis. J Periodontol 2006; 77: 1458.
Badersten A, Nilveus R, Egelberg J. Effect of nonsurgical periodontal therapy: III. Single versus repeated instrumentation. J Clin Periodontol 1984; 11: 114-24.
van Winkelhoff AJ, Rams TE, Slot J. Systemic antibiotic therapy in periodontics. Periodontol 2000. 1996; 10: 45-78.
Hamasakwattanakul A. The effect of Andrographis paniculata gel on the migration of human periodontal ligament fibroblast. M.S. Thesis in Periodontics; Faculty of Graduate Studies, Mahidol University; 2004.
Löe H, Theilade E, Jensen SB. Experimental gingivitis in man. J Periodontol. 1965; 36: 177-87.
Cortellini P, Pini-Prato G, Tonetti M. Periodontal regeneration of human infrabony defects (V). Effect of oral hygiene on long-term stability. J Clin Periodontol 1994; 21: 606-10.
Radvar M, Pourtaghi N, Kinane DF. Comparison of 3 periodontal local antibiotic therapies in persistent periodontal pockets. J Periodontol 1996; 67: 860–5.
Bogren A, Teles RP, Torresyap G, Haffajee AD, Socransky SS, Wennstrom JL. Locally Delivered Doxycycline During Supportive Periodontal Therapy. A 3-Year Study. J Periodontol 2008; 79: 827-35.
Tomasi C, Koutouzis T, Wennstrom JL. Locally Delivered Doxycycline as an Adjunct to Mechanical Debridement at Retreatment of Periodontal Pockets. J Periodontol 2008; 79: 431-9.
Tonetti MS, Lang NP, Cortellini P, Suvan JE, Eickholz P, Fourmousis I, et al. Effects of a single topical doxycycline administration adjunctive to mechanical debridement in patients with persistent/recurrent periodontitis but acceptable oral hygiene during supportive periodontal therapy. J Clin Periodontol 2012; 39: 475–82.
Green stein G. Periodontal Response to Mechanical Non‐Surgical Therapy: A Review. J Periodontol 1992; 63:118–30.
Teparat-Burana T, Samarnsotthiwong C, Kasetsuwan J, Sirirat M, Rojanapanthu P. The efficacy of subgingivally delivered Andrographis paniculata gel to treat patients with periodontitis. Journal of Research and Practice in Dentistry 2015, Article ID 786773, DOI: 10.5171/2015.786773
Samarnsotthiwong C and Sirirat M. Clinical evaluation of non-surgical periodontal therapy with adjunctive subgingival Andrographis paniculata gel. M.S. Thesis in Periodontics:, Faculty of Graduate Studies, Mahidol University; 2011.
Hujoel PP and DeRouen TA. Validity issues in split-mouth trials. J Clin Periodontol 1992; 19: 625-7.
Goodson JM, Cugini MA, Kent RL, Armitage GC, Cobb CM, Fine D, et al. Multicenter evaluation of tetracycline fiber therapy: I. Experimental design, methods and baseline data. J Periodontal Res 1991; 26: 361-70.
Goodson JM, Cugini MA, Kent RL, Armitage GC, Cobb CM, Fine D, et al. Multicenter evaluation of tetracycline fiber therapy: II. Clinical response. J Periodontal Res 1991; 26: 371-9.
Kuphasuk Y, Srichati A, Sirirat M, Kasetsuwan J. Pharmacokinetic profile of a locally administered Andrographis paniculata gel in crevicular fluid saliva and blood plasma. Thai J Periodont 2008; 1: 38-47.
Stoller N, Johnson L, Trapnell S, Harrold CQ, Garrett S. The pharmacokinetic profile of a biodegradable controlled release delivery system containing doxycycline compared to systemically delivered doxycycline in gingival crevicular fluid, saliva and serum. J Peridontol 1998; 69: 1085-91.
Pitcher GR, Newman HN, Strahan JD. Access to subgingival plaque by disclosing agents using mouthrinsing and direct irrigation. J Clin Periodontol 1980; 7: 300-8.