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Table of Contents
ORIGINAL ARTICLE
Year : 2018  |  Volume : 5  |  Issue : 3  |  Page : 1-4

Curcumin gel and diode laser: A new duo in the treatment of chronic periodontitis


1 Professor and Head, Department of Periodontics, SRM Kattankulathur Dental College, Kancheepuram, Tamil Nadu, India
2 Postgraduate Student, Department of Periodontics, SRM Kattankulathur Dental College, Kancheepuram, Tamil Nadu, India
3 Ex. Postgraduate Student, Department of Periodontics, SRM Kattankulathur Dental College, Kancheepuram, Tamil Nadu, India
4 Senior Lecturer, Department of Periodontics and Implantology, College of Dental Science, Davanagere, Karnataka, India
5 Periodontist, Department of Periodontics, Jawaharlal Nehru Memorial Hospital, Srinagar, Jammu and Kashmir, India

Date of Web Publication30-Jan-2019

Correspondence Address:
Dr. P L Ravishankar
Department of Periodontics, SRM Kattankulathur Dental College, Kancheepuram, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INPC.INPC_7_18

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  Abstract 


Introduction: The aim of the present study was to investigate the effects of SRP assisted by the two clinical treatment methods of diode laser or Curcumin Gel applications in comparison with SRP alone..
Materials and Method: This single-blind clinical trial, performed in a split mouth design, was conducted on 10 patients with moderate to severe chronic periodontitis. Following a baseline examination at first day which included the assessments of plaque index (PI), gingival index (GI), and probing depth (PD); patients randomly received either SRP in one quadrant (control group), or SRP combined with Curcumin gel in another quadrant (experimental group). All cases were examined again, assessing PI, GI, and PD at baseline and 90th day. Presence of P. gingivalis was tested by PCR method.
Results: In all patients, there was a significant improvement in the in GI and PD for both quadrants treated only with SRP or combination of SRP and Curcumin. However, experimental group presented significantly lower GI (P = 0.0001) and PD (P = 0.009) than the control group at the end of study period.
Conclusion: This study revealed that local application of curcumin gel could be considered as an adjunctive treatment with scaling and root planning for chronic periodontitis.

Keywords: Curcumin, laser therapy, local drug delivery, P. gingivalis


How to cite this article:
Ravishankar P L, Malakar M, Rao S, Chakraborty P, Aftab N, Mushtaq I. Curcumin gel and diode laser: A new duo in the treatment of chronic periodontitis. Int J Prev Clin Dent Res 2018;5:1-4

How to cite this URL:
Ravishankar P L, Malakar M, Rao S, Chakraborty P, Aftab N, Mushtaq I. Curcumin gel and diode laser: A new duo in the treatment of chronic periodontitis. Int J Prev Clin Dent Res [serial online] 2018 [cited 2019 Dec 6];5:1-4. Available from: http://www.ijpcdr.org/text.asp?2018/5/3/1/251054




  Introduction Top


Chronic periodontitis is an infectious disease resulting in inflammation of the supporting tissue of the teeth, with progressive attachment loss and bone loss.

Clinic findings include attachment loss, gingival recession, alveolar bone loss, and pocket formation. There may have periods of rapid progression of the disease, and it may lead to loss of the tooth. The development of periodontitis appears to be associated with a shift from predominantly Gram-positive bacteria to a predominance of Gram-negative bacteria. Of these Gram-negative ones, the dark-pigmented Porphyromonas gingivalis (Pg) is one of the periodontopathogenic bacteria, which is a major pathogen. Pg being a strict anaerobe occurs with great frequency and higher levels in active size of the disease.[1]

Mechanical debridement of these bacteria through scaling and root planing (SRP) is the cornerstone of successful periodontal treatment, which can be accomplished by either nonsurgical or surgical approach. Majority of the periodontal patients can be managed by nonsurgical periodontal treatment. Hence, various adjuncts to SRP have been introduced into periodontal practice over the years. Among these, local drug delivery and laser treatment have attracted considerable attention during the past two decades.[2]

Many antibacterial agents have been tested for intrapocket delivery including tetracycline, doxycycline, minocycline, chlorhexidine, and metronidazole, but none are without side effects. To overcome the side effects of synthetic artificial drugs, various natural products have been made available. At present, a large number of herbal products are researched for oral use in the form of mouth rinses, gels, etc., Herbal extract has an advantage of cost-effectiveness, minimal side effect, and good patient compliance. One such natural product which holds the medicinal value is curcumin. Curcumin is derived from dried rhizome of the East Indian turmeric plant (Curcuma longa).

It has been used as a therapeutic agent for thousands of years in Ayurvedic medicine. Recently, it has been researched that curcumin holds anti-inflammatory, antioxidant, antiallergic, anticarcinogenic, antimutagenic, anticoagulant, antifertility, antidiabetic, antibacterial, antifungal, antiprotozoal, antiviral, antifibrotic, antivenom, antiulcer, enhancer of healing, myogenic, hypotensive, and hypocholesteremic effects.

Reduction of bacterial load and inflammation utilizing low-level laser therapy can be an effective tool when used as an adjunct to conventional treatment such as SRP. The diode laser in the treatment of diseased periodontal soft tissue allows significant bacterial reduction and removal of inflammatory products while providing excellent hemostasis.

The present study is an attempt to determine the efficacy of diode laser therapy and curcumin as a local drug delivery system in adjunct to SRP in the therapeutic management of chronic periodontitis.


  Materials and Methods Top


Ten patients with moderate-to-severe chronic periodontitis visited in the Department of Periodontics, SRM Kattankulathur Dental College and Hospital, Potheri, Tamil Nadu, each with at least six pockets of 4–7 mm deep were selected for the study. Over 60 pockets with untreated chronic periodontitis were selected and randomly treated by SRP + diode laser (Laser group) or SRP + curcumin gel (Gel group). The participants were nonsmoker, none of them had any known systemic disorder or used prescribed antibiotics or anti-inflammatory medications in the last 3 months, and none of them previously undergone any treatment for their chronic periodontitis. Written inform consent was obtained from the patients before inclusion in this study.

Clinical and microbiological parameters

Clinical parameters including pocket probing depth (PPD), clinical attachment level (CAL), and microbial count of Pg were measured and evaluated after baseline and 3 months. Pg count was measured by polymerase chain reaction (PCR).

Before the initiation of treatment, one sample per site was obtained from the deepest part of the periodontal pocket for microbiologic evaluation. Sterile paper points (size-40) were used for this purpose. Paper points are introduced in periodontal pockets as far apically as possible and kept still 15 s after that subgingival portion of each paper point was cutoff and put into a jar-containing transport material.

Treatment procedure

At the first treatment session, all patients underwent ultrasonic scaling. A week later, patients were checked again for any remaining calculus and undergone another session of SRP. In following session, a week later, the patients were subjected to diode laser therapy and curcumin gel therapy. In this way, 30 pockets were randomly selected for laser therapy and 30 pockets for gel therapy, while leaving the rest of the pockets without either of the adjunctive therapies to be used as control.

In the Laser group, 980-nm diode laser operating at a power output of 1.5 W was used. The fiber was used in the light contact with a sweeping action that covers the entire epithelial lining, from the base of the pocket upward.

In the Gel group, curcumin gel (CURENEXT, Abbot Pharma) was used. The round blunt tip syringe containing the gel was placed into the pocket progressing into its depth so that the gel encompassed in overall pocket wall with its excess coming out-of-the-pocket opening.

Three months after the first session, all patients underwent another evaluation of the periodontal parameters and microbiologic samples were obtained from the same periodontal pocket as in the first examination.

Microbiologic evaluation

Samples are then transferred to the Tris-EDTA (TE) buffer solution. They are then washed with TE buffer for three times and processed for centrifugation. We set the centrifuge at 12,000 rpm for 10 min. Temperatures kept at 4°C. Samples are taken out and crushed and again put for centrifuge under the same parameters. Samples are boiled at 100°C for 10 min and put into the centrifuge under same parameters. The supernatant then taken out in a fresh tube and saved it under 20°C. We set the PCR for 32 cycles.

Statistical analysis

The SPSS 14.0 (SPSS Inc., Chicago, IL, USA) Statistical Package was used for all the statistical calculation. The data were analyzed by paired t-test, one-way ANOVA, and Turkey's honestly significant difference test.


  Results Top


Clinical parameters

At baseline, comparable readings were made and [Chart 1] and [Chart 2] indicate the PPD and CAL levels at baseline, respectively. CAL and PPD were increasingly high during baseline but effectively reduced after 3 months postoperatively which is evident from [Chart 3] and [Chart 4].



Microbiological parameters

This study showed the presence of Pg in both groups before and after 3 months, which is evident from [Figure 1].
Figure 1: Gel electrophoresis image of the presence of Porphyromonas gingivalis after 3 months

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  Discussion Top


There has been an essential change in concepts of the periodontal disease treatments over the past three decades. For instance, nowadays, local delivery of antimicrobials, host modulators, and laser has many applications in periodontal therapy. Therefore, the aim of this study was to investigate the efficacy of the two adjunctive methods, including therapies using diode laser and curcumin gel following a conventional SRP treatment.

In the present study, we had obtained significant reduction in the PPD and CAL after treating with diode laser which is almost similar to the results obtained by Moritz et al.[3] and Kamma et al.[4]

In contrast to our results, some other studies reported no significant change in the clinical parameters for diode laser applications for the treatment of periodontal disease.

Romanos et al.[5] showed that 980 nm is effective in the treatment of chronic periodontitis. Similar to our study, it showed that diode laser is effective in reducing the PPD and CAL.

Curcumin is a member of ginger family. Nagasri et al.,[1] in their study, reported that curcumin gel is more effective in the treatment of chronic periodontitis, which is similar to our study in respect to the CAL and PPD.

The presence of Pg was observed using PCR in both the groups before and after 3 months of the study, which is similar to the study done by Shiloah and Patters,[6] which concluded that Pg repopulates in the periodontal pocket even after 3 months of laser treatment and gel treatment.


  Conclusion Top


Based on the findings of the present study, treatment with diode laser or curcumin gel as an adjunct to SRP is equally effective and may improve periodontal health and microbiological indices compared to SRP alone.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Nagasri M, Madhulatha M, Musalaiah SV, Kumar PA, Krishna CH, Kumar PM, et al. Efficacy of curcumin as an adjunct to scaling and root planning in chronic periodontitis patients: A clinical and microbiological study. J Pharm Bioallied Sci 2015;7:S554-8.  Back to cited text no. 1
    
2.
Arunachalam LT, Sudhakar U, Vasanth J, Khumukchum S, Selvam VV. Comparison of anti-plaque and anti-gingivitis effect of curcumin and chlorhexidine mouth rinse in the treatment of gingivitis: A clinical and biochemical study. J Indian Soc Periodontol 2017;21:478-83.  Back to cited text no. 2
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3.
Moritz A, Gutknecht N, Doertbudak O, Goharkhay K, Schoop U, Schauer P, et al. Bacterial reduction in periodontal pockets through irradiation with a diode laser: A pilot study. J Clin Laser Med Surg 1997;15:33-7.  Back to cited text no. 3
    
4.
Kamma JJ, Vasdekis VG, Romanos GE. The effect of diode laser (980 nm) treatment on aggressive periodontitis: Evaluation of microbial and clinical parameters. Photomed Laser Surg 2009;27:11-9.  Back to cited text no. 4
    
5.
Romanos GE, Henze M, Banihashemi S, Parsanejad HR, Winckler J, Nentwig GH, et al. Removal of epithelium in periodontal pockets following diode (980 nm) laser application in the animal model: An in vitro study. Photomed Laser Surg 2004; 22:177-83.  Back to cited text no. 5
    
6.
Shiloah J, Patters MR. DNA probe analyses of the survival of selected periodontal pathogens following scaling, root planing, and intra-pocket irrigation. J Periodontol 1994;65:568-75.  Back to cited text no. 6
    


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