Effect of punica granatum extract gel on gingival crevicular fluid levels of interleukin-1β, interleukin-8 and CCL28 levels: Randomised controlled clinical trial

Introduction: Pomegranate (Punica granatum) fruit extract has anti-inflammatory, anti-bacterial, anti-oxidant and immune-modulatory features. Due to increased bacterial resistance to synthetic agents Pomegranate Extract Gel (PEG) could become a natural remedy for the treatment of periodontal disease. Aim: To compare topically applied PEG, chlorhexidine (CHX) gel, ornidazole-chlorhexidine (ORN-CHX) gel and Placebo Gel (PG) on clinical parameters and on gingival crevicular fluid (GCF) levels of interleukin-1β (IL-1β) and IL-8 and chemokine (C-C motif) ligand 28 (CCL28) levels in a two week human experimental gingivitis model. Materials and Methods: Eighty systemically healthy subjects were randomly assigned to one of the four groups; Group I: PEG, Group II: CHX gel, Group III: ORN-CHX gel, and Group IV: PG. On the selected quadrant the subjects refrained from routine hygiene procedure and solely used the topical gel. The primary outcome measured were IL-1β, IL-8 and CCL28 levels from GCF at baseline and 14 days. Gingival Index (GI), Plaque Index (PI), Bleeding On Probing (BOP) and Probing Depth (PD) were secondarily assessed at baseline, 14 and 60 days. Paired t-test and one-way ANOVA followed by post-hoc Tukey’s test was used for intra and intergroup comparisons with p-value of 0.05 as significant. Results: The PEG had an inhibitory effect on pro-inflammatory cytokines and chemokine. PEG showed significantly less increase in IL-1β, IL-8 (p=0.003, 0.002) while CCL28 levels showed no difference from baseline (p=0.15) when compared to other three groups (p<0.001). The BOP and GI among subjects using PEG showed less increase (p=0.01, 0.05) compared to other three gels (p<0.001) after 14 days. PEG and CHX-ORD gel were similar (p=0.96) in exhibiting lowered PI. Conclusion: Pomegranate extract gel was effective in reducing the inflammatory markers and can be used as an adjunct to mechanical therapy for the treatment of gingivitis.