Thermoreversible gel for intrapocket delivery of green tea catechin as a local drug delivery system: An original research

Weighing up the potential of "superfoods" compounds of green tea or turmeric as adjuncts in comparison to established therapeutical approaches for periodontal disease

OBJECTIVE

Aim of this study was to critically appraise clinical evidence on the potential benefits of adjunctive use of superfoods green tea and turmeric as mouthrinse or local delivery agents in the treatment of periodontal disease.

MATERIALS AND METHODS

Electronic searches were performed in four databases for randomized trials from inception to February 2024 assessing the supplemental use of superfoods green tea and turmeric for gingivitis/periodontitis treatment. After duplicate study selection, data extraction, and risk-of-bias assessment with the RoB 2 tool, random-effects meta-analyses of Mean Differences (MD) or Standardized Mean Differences (SMD) with their 95% confidence intervals (CI) were performed.

RESULTS

Nineteen studies (814 patients) were included, with 11 on gingivitis and 8 on periodontitis patients. No benefits were seen from the use of mouthwashes containing green tea extract or turmeric for gingivitis treatment, while green tea was associated with smaller Gingival Index (GI) reductions than chlorhexidine (5 studies; MD = 0.08; 95% CI = 0.01 to 0.14; P = 0.01). As far as periodontitis treatment is concerned, local supplementation with turmeric showed no benefits, whereas local supplementation with green tea extract was associated with improved treatment outcomes in terms of probing depth (4 studies; MD=-0.79; 95% CI=-1.29 to -0.29 mm; P = 0.002) and GI (3 studies; MD=-0.53; 95% CI=-1.01 to -0.05; P = 0.02) than the control group. However, the strength of evidence was moderate to very low due to bias, imprecision, and inconsistency.

CONCLUSION

Limited evidence indicates that supplemental use of green tea extract is associated with improved periodontal treatment outcomes. However, the strength of evidence is weak and further research is needed.

CLINICAL RELEVANCE

Green tea extract could be a natural adjunct to enhance periodontal treatment, without the potential side-effects of other adjuncts like chlorhexidine.

In-situforming drug-delivery systems for periodontal treatment: current knowledge and perspectives

Several chemical compounds are considered to be promising as adjuvants in the treatment of periodontitis. Antimicrobials, anti-inflammatory drugs or, more recently, pro-regenerative or antioxidant molecules have shown a very interesting potential to improve the outcomes of mechanical biofilm removal and promote the healing of the damaged tissues. However, their clinical effect is often limited by the challenge of achieving effective and prolonged drug delivery within the periodontal lesion, while limiting the risk of toxicity.In-situforming implants (ISFI) are 'implantable' drug-delivery systems that have gained considerable attention over the last few decades due to their multiple biomedical applications. They are liquids that, when injected at the site to be treated, form a semi-solid or solid dosage form that provides safe and locally controlled drug release. This review discusses current data and future prospects for the use of ISFI in periodontal treatment.

Different applications forms of green tea (Camellia sinensis (L.) Kuntze) for the treatment of periodontitis: a systematic review and meta-analysis

BACKGROUND

Scaling and root planning (SRP) is the gold standard for non-surgical periodontal treatment. Green tea as a supporting alternative in non-surgical periodontal treatment has been suggested as a therapeutic option in the treatment of periodontitis.

OBJECTIVE

To analyse the comparative effectiveness of green tea (Camellia sinensis) in its different forms and applications for the treatment of periodontitis.

METHODS

We included randomized clinical trials evaluating green tea as an adjuvant therapeutic agent to scaling and root planning (SRP) in the treatment of periodontitis. For the meta-analysis, we calculated standardized mean difference (SMD) and 95%CI comparing green tea and control (only SRP). We subgrouped by types of application forms of green tea. The certainty of the evidence was assessed through GRADE.

RESULTS

Nine studies were included. The follow-up time of treatments varied from 21 days to 6 months. The subgroup meta-analysis showed that the green tea as sachet reduced probing bleeding (SMD = -0.71; 95%CI) and the gingival index (SMD = -0.78; 95%CI) compared to SRP with very low certainty of evidence. The sachet (SMD = -0.29; 95%CI) and dentifrice (SMD = -1.31; 95%CI) reduced plaque index with very low certainty compared to the control. All forms of application of green tea showed very low certainty of evidence (SMD = -0.27; 95% CI) in reducing the probing depth, as well as for the loss of clinical insertion (SMD = -0.42; 95% CI) with low certainty of evidence.

CONCLUSION

There was not a difference in the effectiveness of green tea isolated or in combination with SRP to reduce probing depth. Green tea adjunct to periodontal therapy showed very low certainty of effectiveness for the treatment of periodontal disease.

Sustained-release delivery of antimicrobial drugs for the treatment of periodontal diseases: Fantasy or already reality?

Periodontal diseases are prevalent in humans. Conventional means of combating these diseases involve basic oral hygiene, mostly toothbrushing, use of mouthwashes, and flossing. Supplementary means of treatment, either clinical or pharmaceutical, are often necessary. The use of sustained-release delivery systems, applied locally to the periodontal pocket, seems to be one feasible approach: local sustained-release delivery of antibacterial agents to treat periodontal diseases is conceivable. The use of local (intrapocket) sustained-release delivery systems has numerous clinical, pharmacologic, and toxicologic advantages over conventional treatments for periodontal diseases. Sustained-release technology has been proven to be effective over the last few decades. Films, gels, and fibers are the three main classical intrapocket pharmaceutical delivery systems. Research today is more focused on improving drug delivery, and less on introducing new drugs. New approaches, eg, those making use of nanotechnology, are emerging for local drug-delivery systems. The local sustained-release delivery system concept is innovative and a few products are already commercially available.

The effect of green tea as an adjunct to scaling and root planing in non-surgical periodontitis therapy: a systematic review

OBJECTIVE

To provide a systematic overview on the efficacy of green tea catechin as an adjunct to scaling and root planing (SRP) in terms of probing pocket depth (PPD).

MATERIALS AND METHODS

A systematic literature search was performed using electronic databases in PubMed, Scopus, Medline, Cochrane, CINAHL, and Web of Science on randomized clinical trials up to January 2017. The research question was posed in accordance with PRISMA guidelines.

RESULTS

The search provided 234 studies. After analyzing the full texts, five studies were included, with four studies qualifying for meta-analysis. Mean PPD reduction was significantly higher (α = 0.05) when green tea catechin was used as an adjunct to SRP (test group) than with SRP alone (control group). The difference in the reduction was 0.74 mm [0.35-1.13; 95% CI].

CONCLUSION

The local application of green tea catechin as an adjunct to SRP may result in a beneficial reduction in PPD. Due to the highly heterogeneous data and some risk of bias, however, this data still needs to be interpreted with caution.

CLINICAL RELEVANCE

The finding suggests that green tea catechin may be a topical adjunct to SRP without negative side effects.