Comparative Evaluation of Subgingivally Delivered 3% Saussurea Lappa Root Extract Gel with 0.2% Chlorhexidine Gel as an Adjunct to Scaling and Root Planing in the Management of Periodontitis: A Clinical & Microbiological Study.

Abstract

Introduction: Periodontitis is characterized by microbially–associated, host-mediated inflammation that results in loss of periodontal attachment. Mechanical therapy which includes Scaling and  Root Planing (SRP)  disrupts plaque biofilm effectively for the majority of patients with mild to moderate periodontitis. But mechanical therapy itself may not always reduce or eliminate the anaerobic infection at the base of pocket, within the gingival tissues, and in both structures inaccessible to periodontal instruments. To overcome this, systemic and local drug delivery of antimicrobials were initiated to enhance nonsurgical therapy by serving as an adjunct to SRP. Saussurea lappa C. B Clark, (Saussureacostus) belonging to the family Asteraceae, commonly known as Costus exhibits anti-inflammatory, anti-tumor, anti-oxidant, anti-fungal, anti-viral and anti-hepatotoxic activity. However, there is a lack of data regarding the use of Saussurea lappa as a gel for local drug delivery agents for the treatment of periodontitis. Objectives: This study aimed to evaluate and compare the efficacy of subgingivally delivered 3% Saussurea Lappa gel and 0.2% chlorhexidine gel as an adjunct to scaling and root planing in patients with periodontitis. Methods: : In total, 19 systemically healthy individuals with age group 18-60 years diagnosed with Localized /Generalized Stage I and II, Grade –A, Periodontitis having Interdental CAL which is detectable at ≥ 2 non- adjacent teeth, or Buccal or oral CAL ≥ 3mm with pocketing > 3 mm detectable at ≥ 2 teeth were included in the study. The study was a double-blind split-mouth randomized control clinical trial. Two sites were selected in each patient and were randomly allocated to control and test sites. At baseline, measurements of site-specific periodontal parameters and collection of subgingival plaque sample were done. After full-mouth SRP, subgingival delivery of 0.2% chlorhexidine gel in control sites and 3% Saussurea lappa root extract gel in test sites was done. At 1 and 3 months, subgingival plaque samples were collected again and site-specific periodontal parameters were measured. Results: The test group (3% Saussurea lappa root extract gel) showed statistically significant improvements in periodontal i.e., modified sulcus bleeding index (mSBI) at 1-month, probing pocket depth (PPD), and relative attachment level (RAL) and microbiologic parameters in the form of colony forming units (CFUs) in comparison with control group (0.2% chlorhexidine gel) at 1 month and 3 months