Comparative Efficacy of Amitriptyline and Chlorhexidine Gels in Managing Periodontitis: A Randomized Controlled Trial
DOI:
https://doi.org/10.52206/jsmc.2024.14.3.918Keywords:
mitriptyline, chlorhexidine, local drug delivery, periodontitisAbstract
Background: Amitriptyline is a tricyclic antidepressant which also has anti-inflammatory and analgesic activity. But it has not been applied as a local delivery drug in patients with periodontitis.
Objective: To compare the effectiveness of 1 % amitriptyline gel with conventional 1% chlorhexidine gel as a local drug delivery,
adjunctive to scaling and root planning in patients with periodontitis.
Materials and Methods: This randomized clinical control trial was done in Department of Pharmacology, University of Karachi, Sindh, Pakistan and HEJ research institute of Chemistry, University of Karachi, from 1st December 2022 to 31st July 2023. A total of 30 patients both male and female were equally divided into 3 groups. Control group: received only scaling and root planning (SRP). Study group 1: treated with SRP followed by the application of 1% chlorhexidine (CHX) gel. Study group 2: treated with SRP followed by the application of 1% amitriptyline gel. Clinical parameters including pocket depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), tooth mobility (TM), plaque index (PI), gingival index (GI), as well as biochemical parameters, tumor necrosis factor- alpha (TNF-á) levels, were evaluated using ELISA kit. Statistical analysis was done by One way ANOVA followed by Tuckey's HSD for comparisons among groups.
Results: Reduction in PD, CAL, BOP, PI, GI and TNF-á was observed by both amitriptyline and CHX gel groups as compared to control group (p<0.001) But reduction in PD (p<0.001), CAL (p<0.001) and TM (p<0.05) was greater in amitriptyline group as
compared to CHX group.
Conclusion: Unconventional 1% amitriptyline gel is more effective in reducing the clinical and inflammatory biomarkers as
compared to conventional 1% CHX gel in treating the periodontal disease via local drug delivery method (LDD).
Keywords: Amitriptyline, Chlorhexidine, Local drug delivery, Periodontitis
References
Baranov N, Popa M, Atanase LI, Ichim DL. Polysaccharide-Based Drug Delivery Systems for the Treatment of Periodontitis Molecules (review). 2021;26(9):27-35. DOI: https://doi.org/10.3390/molecules26092735
Waqar SM, Razi A, Qureshi SS, Saher F, Zaidi SJA, Kumar C.Comparative evaluation of propolis mouthwash with 0.2% chlorhexidine mouthwash as an adjunct to mechanical therapy in improving the periodontitis among perimenopausal women: a randomized controlled trial. BMC Oral Health. 2024;24(1):26. DOI: https://doi.org/10.1186/s12903-023-03768-4
Fischer RG, Junior RL, Retamal-Valdes B, Cristina de Figueiredo L, Malheiros, Stewart B, et al. Periodontal disease and its impact on general health in Latin America. Section V: Treatment of periodontitis. Review Braz Oral Res. 2020;34 (supp1 1): e026. DOI: https://doi.org/10.1590/1807-3107bor-2020.vol34.0026
Zhao H, Hu J, Zhao L. Adjunctive subgingival application of Chlorhexidine gel in nonsurgical periodontal treatment for chronic periodontitis: a systematic review and meta-analysis. BMC Oral Health. 2020;20(1):34. DOI: https://doi.org/10.1186/s12903-020-1021-0
Brookes Z LS, Besco R, Belfield LA, Ali K, Roberts A. Current uses of chlorhexidine for management of oral disease: a narrative review. Review J Dent. 2020; 103:1034-97. DOI: https://doi.org/10.1016/j.jdent.2020.103497
Nambiar S, Malothu S, Karmakar S, Varkey A, Chandra D, Chava VK. Comparison of Ozonated Olive Oil and Chlorhexidine Gel as an Adjunct to Nonsurgical Periodontal Therapy for the Treatment of Chronic Periodontitis: A Randomized Controlled Clinical Trial. J Pharm Bioallied Sci. 2022;14 (Suppl 1): S94-S98. DOI: https://doi.org/10.4103/jpbs.jpbs_565_21
Goswami V, Yeltiwar RK, Kujur S, Agrawal P, Bodhi S, Bhatnagar S. Evaluation of efficacy of subgingival administration of 1% chlorhexidine gel as an adjunct to scaling and root planning in the treatment of chronic periodontitis - A clinical and microbiological study. Indian J Dent Res. 2022;33(2):174-179. DOI: https://doi.org/10.4103/ijdr.ijdr_936_21
Killeen AC, Krell LE, Bertels M, Christiansen MM, Anderson L, Hattervig RL, et al. Effect of locally applied simvastatin on clinical attachment level and alveolar bone in periodontal maintenance patients: A randomized clinical trial. J Periodontol. 2022; 93(11):1682-1690. DOI: https://doi.org/10.1002/JPER.21-0708
Pradeep AR, Patnaik K, Nagpal K, Karvekar S, Guruprasad CN, Kumaraswamy KM. Efficacy of 1% Metformin Gel in Patients with Moderate and Severe Chronic Periodontitis: A Randomized Controlled Clinical Trial. J Periodontol. 2017;88(10):10231029. DOI: https://doi.org/10.1902/jop.2017.150096
Kremer M, Yalcin I, Goumon Y, Wurtz X, Nexon L, Daniel D, et al. A Dual Noradrenergic Mechanism for the Relief of Neuropathic Allodynia by the Antidepressant Drugs Duloxetine and Amitriptyline. J Neurosci. 2018;38(46):9934-9954. DOI: https://doi.org/10.1523/JNEUROSCI.100418.2018
Bey A, Ahmad SS, Azmi SA, Ahmed S. Effect of antidepressants on various periodontal parameters: A case-control study. J Indian Soc Periodontol. 2020;24(2):122-126. DOI: https://doi.org/10.4103/jisp.jisp_210_19
Maru S, Ongarora DSB, Njoroge RW. Formulation and in vitro Evaluation of a Mucoadhesive Metronidazole Dental Gel for Oral Application. East and Central African Journal of Pharmaceutical Sciences. 2019;22:52-56.
Balouiri M, Sadiki M, Ibnsouda SK. Methods for in vitro evaluating antimicrobial activity: A review. J Pharm Anal. 2016;6(2):71-79. DOI: https://doi.org/10.1016/j.jpha.2015.11.005
Rahman S, Gayathri Gv, Mehta DS. A clinico-microbiological and biochemical study evaluating the adjunctive use of antimicrobial photodynamic therapy and local drug delivery of 1.2 % simvastatin gel compared to scaling and root planing alone. Photodiagnosis Photodyn Ther. 2020:32:102017. DOI: https://doi.org/10.1016/j.pdpdt.2020.102017
Silva Cirino CC, Felipe do Vale H, Zaffalon Casati M, Antonio Sallum E, Corrêa Viana Casarin R, Wilson Sallum A. Clinical and Microbiological Evaluation of Surgical and Nonsurgical Treatment of Aggressive Periodontitis. Braz Dent J. Nov-Dec 2019;30(6):577-586. DOI: https://doi.org/10.1590/0103-6440201902930
Helal O, Göstemeyer G, Krois J, Fawzy El Sayed K, Graetz C, Schwendicke F. Predictors for tooth loss in periodontitis patients: Systematic review and meta-analysis. J Clin Periodontol. 2019;46(7):699-712. DOI: https://doi.org/10.1111/jcpe.13118
Mauri-Obradors E, Merlos A, Estrugo-Devesa A, Jané-Salas E, López-López J, Viñas M. Benefits of non-surgical periodontal treatment in patients with type 2 diabetes mellitus and chronic periodontitis: A randomized controlled trial. J Clin Periodontol. 2018;45(3):345-353. DOI: https://doi.org/10.1111/jcpe.12858 Epub 2018 Jan 19.
Rathinasamy K, Ulaganathan A, Ramamurthy S, Ganesan R, Saket P, Alamelu S. Estimation of TNF-alpha Levels in Saliva and Serum of Patients with Periodontal Health and Chronic Periodontitis: A Case-control Study. J Contemp Dent Pract. 2020; 21(2):148-151.
Waqar SM, Razi A, Qureshi SS, Saher F, Zaidi SJA, Kumar C.Comparative evaluation of propolis mouthwash with 0.2% chlorhexidine mouthwash as an adjunct to mechanical therapy in improving the periodontitis among perimenopausal women: a randomized controlled trial. BMC Oral Health. 2024;24(1):26. DOI: https://doi.org/10.1186/s12903-023-03768-4
Anitha V, Rajesh P, Shanmugam M, Priya BM, Prabhu S, Shivakumar V. Comparative evaluation of natural curcumin and synthetic chlorhexidine in the management of chronic periodontitis as a local drug delivery: a clinical and microbiological study. Indian J Dent Res. 2015;26(1):53-6. DOI: https://doi.org/10.4103/0970-9290.156806
Branco-de-Almeida LS, Franco G, Castro M, Vieira M, Galvão-Moreira L, Cortelli S, et al. Protective effects of desipramine on alveolar bone in experimental periodontitis. J Periodontol. 2020;91(12):1694-1703. DOI: https://doi.org/10.1002/JPER.19-0569
Manjunatha VA, Vemanaradhya GG, Gowda TM. Clinical and antioxidant efficacy of 4% mangosteen gel as a local drug delivery in the treatment of chronic periodontitis: A placebo-controlled, split-mouth trial. Dent Med Probl. 2022;59(1):111-119. DOI: https://doi.org/10.17219/dmp/139198
Butera A, Gallo S, Pascadopoli M, Taccardi D, Scribante A. Home Oral Care of Periodontal Patients Using Antimicrobial Gel with Postbiotics, Lactoferrin, and Aloe Barbadensis Leaf Juice Powder vs. Conventional Chlorhexidine Gel: A Split-Mouth Randomized Clinical Trial. Antibiotics (Basel). 2022;11(1):118. DOI: https://doi.org/10.3390/antibiotics11010118
Taalab MR, Mahmoud SA, El Moslemany RM, Abdelaziz DM. Intrapocket application of tea tree oil gel in the treatment of stage 2 periodontitis. BMC Oral Health. 2021;21(1):239. DOI: https://doi.org/10.1186/s12903-021-01588-y
Lee SY, Nam EJ. Clinical Efficacy of 1% CHX Gluconate Gel and 0.12% CHX Solution: A Randomized Controlled Trial. Int J Environ Res Public Health. 2022;19(15):935-8. DOI: https://doi.org/10.3390/ijerph19159358
Chen X, Wang L, He Z, Zhao H, Cai Y, Song S, et al. Effects of xipayi mouth rinse combined with minocycline on localized aggressive periodontitis' therapeutic effect and the levels of CRP, TNF-á, IL-6 in serum. Ann Palliat Med. 2020;9(5):3410-3417. DOI: https://doi.org/10.21037/apm-20-1653
Hasan F, Ikram R, Abbas A, Asadullah K. Effectiveness of local drug delivery system using 1% metronidazole gel and mouthwash in treating periodontal diseases. Pak J Pharm Sci. 2020;33(5): 2053-2058. DOI: https://doi.org/10.36721/PJPS.2020.33.5.REG.2053-2058.1
Hasan F, Ikram R, Adel A, Abbas A, Ain Bukhari QU, Asadullah K. Treatment of periodontal diseases by the local drug delivery system using 1% chlorhexidine gel: A randomized clinical trial. J Pharm Sci. 2021;34(1):41-45. PMID: 342480001. DOI: https://doi.org/10.36721/PJPS.2021.34.1.REG.041-045.1
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