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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 5  |  Issue : 2  |  Page : 70-73

Efficacy of fresh Aloe vera extract in postoperative healing following periodontal surgery in patients with chronic periodontitis: A randomized clinical trial


Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar, Odisha, India

Date of Web Publication25-Oct-2016

Correspondence Address:
Anurag Satpathy
Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Khandagiri Square, Bhubaneswar - 751 003, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-4696.192972

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  Abstract 

Background: Aloe vera is known for its wound healing and anti-inflammatory properties which may be used for periodontal healing. Early healing of the gingival and periodontal wounds promotes the favorable treatment outcome. Aim: To evaluate the efficacy of Aloe vera on wound healing following periodontal flap surgery. Materials and Methods: Fifteen patients with chronic periodontitis requiring periodontal flap surgery were included in this double-blinded, split mouth, randomized, and controlled clinical trial. Sixty interproximal sites were divided into test and control groups. The test sites received an application of fresh Aloe vera extract postoperatively. Postoperative healing was assessed using early healing index (EHI) after the first week and HI after first, second, and third weeks following therapy by a blinded examiner. Results: All patients completed the study (nine male and six female, age range: 30–50 [34.15 ± 3.46] years). Better healing was observed in test sites in comparison to control sites in the first postoperative week as recorded by EHI (P < 0.001) and HI (P = 0.02). However, there were no significant differences between the test and control sites in the second (P = 0.10) and third (P = 0.53) weeks. Conclusion: The application of fresh Aloe vera extract was effective in significantly improving healing scores in the first postoperative week.

Keywords: Aloe vera, early healing index, flap surgery, periodontitis, randomized clinical trial


How to cite this article:
Shamim R, Satpathy A, Nayak R, Mohanty R, Panda S. Efficacy of fresh Aloe vera extract in postoperative healing following periodontal surgery in patients with chronic periodontitis: A randomized clinical trial. J Dent Allied Sci 2016;5:70-3

How to cite this URL:
Shamim R, Satpathy A, Nayak R, Mohanty R, Panda S. Efficacy of fresh Aloe vera extract in postoperative healing following periodontal surgery in patients with chronic periodontitis: A randomized clinical trial. J Dent Allied Sci [serial online] 2016 [cited 2021 Jun 18];5:70-3. Available from: https://www.jdas.in/text.asp?2016/5/2/70/192972


  Introduction Top


Chronic periodontitis is an inflammatory disease of the oral cavity resulting from a complex interaction between pathogenic microbes and the host immune responses.[1] A surgical therapy is sometimes deemed necessary in the treatment of chronic periodontitis. Ensuring faster healing after periodontal surgery is one of the essential features of surgical success.[2] Reduced patient discomfort and enhanced compliance help in faster rehabilitation of a surgical patient.[3] For a surgical wound to heal successfully, hemostasis, inflammation, proliferation, and remodeling must occur in the proper sequence and time frame.[4] Many factors can interfere with one or more phases of this process, thus causing improper or impaired wound healing.[5]

Aloe vera is a medicinal plant with immense properties of therapeutic benefits. It is widely known for its wound healing, analgesic, anti-inflammatory, antibacterial, antiviral, antifungal, antioxidant, and antitumor properties.[6] Different mechanisms have been proposed for the wound-healing effects of Aloe vera, which include keeping the wound moist, increasing epithelial cell migration, more rapid maturation of collagen, and reduction in inflammation.[7]

It has been used in several forms in oral care such as mouthwash and dentifrice as it helps to reduce bleeding, inflammation, and swelling of the gums and is useful in the treatment of periodontal diseases.[8],[9] It has been also used in the treatment of denture stomatitis, aphthous ulcers, and cracked and split corners of the mouth.[10] However, no studies have yet been reported on the efficacy of Aloe vera on periodontal postoperative healing. Therefore, the aim of this study was to evaluate the efficacy of Aloe vera on wound healing following periodontal flap surgery.


  Materials and Methods Top


Study design and patients

A randomized-controlled clinical trial with split-mouth study design was conducted to evaluate the efficacy of Aloe vera on wound healing and postoperative pain following periodontal flap surgery. Patients with periodontitis referred to the Department of Periodontology, Institute of Dental Sciences were screened for inclusion. Fifteen patients requiring periodontal flap surgery on at least two interproximal sites on either side of the maxillary arch were included in the study. One surgeon who was blinded performed the surgeries for each patient.

Patients with present or past systemic illnesses known to affect the outcomes of periodontal therapy, immunocompromised patients, smokers, and patients taking medications that may interfere with periodontal therapy were excluded from the study. Pregnant and lactating women were also excluded. Written informed consent was obtained from patients agreeing to participate in the study. The study protocol was approved by the Institutional Ethical Committee of Siksha 'O' Anusandhan University, Bhubaneswar [Figure 1].
Figure 1: Study design

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Prior to the start of the study, each patient received initial periodontal therapy consisting of thorough oral hygiene instructions and full-mouth scaling and root planing. Six weeks after completion of the initial therapy, a re-evaluation was performed to confirm that the patients met the inclusion criteria for the study. Patients with poor oral hygiene after the re-evaluation of phase I therapy (mean plaque index ≥1.5) were excluded from the study. The selected sites were allocated into the test and control groups by a blinded allocator (RN) using simple randomization (coin toss).

Clinical procedure

In both the groups, access periodontal flap surgery [11] was performed and the flaps were repositioned and secured in place using 3–0 nonabsorbable black silk surgical suture (Ethicon, Johnson and Johnson, Somerville, NJ, USA). No periodontal packs were applied after the surgery.[12] Only the test group patients were asked to gently apply fresh Aloe vera extracts supplied to them topically with their finger at the surgical site (interproximal areas) where sutures were placed thrice daily for 1 week. They were instructed to only dab the Aloe vera gel gently and not to massage the surgical sites, keep it applied for 10–15 min, and rinse with water. A blinded examiner educated and demonstrated the method of application of Aloe vera gel to all patients in the test group.

Aloe vera extract was obtained from the plant leaf pulp as a thick glue-like gel. All surgeries were performed by the same surgeon (RS) who was blinded to the allocation of test and control sides. Furthermore, no information was given to the patients about the benefits of Aloe vera in order to eliminate its psychological effect.

Postoperative care

Postoperatively, all patients were prescribed with an antimicrobial (amoxicillin, 500 mg, 8 hourly for 5 days) and an analgesic (aceclofenac sodium 100 mg, 12 hourly for 2 days). Sutures were removed 1 weeks postoperatively. Surgical wounds were gently cleansed with normal saline. Thereafter, a gentle brushing with a soft toothbrush was recommended.

Data collection

Postoperative healing was assessed using early healing index (EHI)[13] after the first week and HI [14] after the first, second, and third week following therapy by a blinded examiner.

Statistical analysis

All statistical tests were done using a statistical software package (version 20, SPSS, Inc., Chicago, IL, USA) and P ≤ 0.05 was considered statistically significant. To compare the mean values between groups, Student's t-test for independent samples was applied. To compare the mean values within groups, one-way ANOVA and t-test for paired samples were used.


  Results Top


A priori analysis of 5% significance level, power value of 85%, and effect size of 0.5 estimated the total sample size to be 48. Since it was a split-mouth study design with two groups each having at least two interproximal surgical sites 15 subjects were planned to be included in the study with a total of sixty sites accounting for a probable 20% loss in follow-up.

All patients completed the study (nine male and six female, age range: 30–50 [34.15 ± 3.46] years). Overall, sixty sites were studied for postoperative healing. Thirty sites were from the test group where Aloe vera extract was applied [Figure 1].

[Table 1] shows the comparison of postoperative healing scores between test and control groups. Better healing was observed in test sites in comparison to control sites in the first postoperative week as recorded by EHI (P < 0.001) and HI (P = 0.02). However, there were no significant differences between the test and control sites in second (P = 0.10) and third (P = 0.53) weeks. Moreover, a significant improvement in healing scores was observed for the test and the control sites from the first to third postoperative week [Table 2].
Table 1: Comparison of healing scores between test and control groups

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Table 2: Comparison of healing scores between first, second, and third postoperative weeks in test and control groups

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  Discussion Top


The aim of this study was to evaluate the effectiveness of fresh Aloe vera extract on postoperative healing following periodontal surgery in patients with chronic periodontitis. The result of this randomized-controlled clinical trial demonstrated that application of fresh Aloe vera extract was effective in achieving better wound healing after 1 week as compared to control group.

Davis et al.[15] found that mannose-6-phosphate present in Aloe vera is considered responsible for promoting wound healing. In addition, acemannan composed of a long chain of acetylated mannose is a complex carbohydrate which has the potential to activate macrophages and stimulates the release of fibrogenic cytokines that promote healing.[16] Acemannan can also directly bind to growth factors that increase collagen cross-linking accelerating wound contraction leading to increased breaking strength of the scar tissue.[17] Carboxypeptidase in Aloe vera inactivates bradykinin and relieves pain.[18],[19] C-glucosyl chromone an anti-inflammatory compound was found in Aloe vera gel that has the potential to inhibit the cyclooxygenase pathway and reduce the production of prostaglandin E2 (PGE2) from arachidonic acid.[20]Aloe vera also has an antioxidant action which is by the presence of three aloesin derivatives, isorabaichromone, feruoylaloesin, and p-coumaroylalosin.[21]

To the best of our knowledge, this is the first study on the effect of Aloe vera on periodontal surgical wounds. For adequate documentation of periodontal wound healing, two healing indices were used. EHI not only differentiates different degrees of exposure but also records the amount of fibrin formation when the complete closure is present. Early and uneventful healing is associated with no or minimal fibrin formation as this occurs when trauma to the surgical site has been reduced to a minimum. The present study did not find substantial healing complications in both groups modalities assessed by healing indices.

Although our study found significant improvement in the periodontal surgical wound healing, the limitations associated with natural herbal products such as difficulty in standardization, titration, and assay cannot be ignored. Hence, more studies are needed to ascertain the use of Aloe vera in periodontal surgical wounds.

We had prescribed analgesics for the first two postoperative days and none of the patients reported an alternative number of used analgesics. Aloe vera is also known to have pain-relieving properties on wounds and skin surgical traumas.[22] A detailed investigation on the assessment of postoperative pain may be carried out in future to validate this property of Aloe vera in periodontal surgeries.


  Conclusion Top


Within the limitations of this study, application of fresh Aloe vera extract was effective in significantly improving healing scores in the first postoperative week. Therefore, fresh Aloe vera may be an effective and inexpensive therapeutic agent for enhancement of periodontal wound healing.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Satpathy A, Ravindra S, Thakur S, Kulkarni S, Porwal A, Panda S. Serum interleukin-1ß in subjects with abdominal obesity and periodontitis. Obes Res Clin Pract 2015;9:513-21.  Back to cited text no. 1
    
2.
Yaghini J, Abed AM, Mostafavi SA, Roshanzamir N. The effect of diclofenac mouthwash on periodontal postoperative pain. Dent Res J (Isfahan) 2011;8:146-9.  Back to cited text no. 2
    
3.
Griffin TJ, Cheung WS, Zavras AI, Damoulis PD. Postoperative complications following gingival augmentation procedures. J Periodontol 2006;77:2070-9.  Back to cited text no. 3
    
4.
MacKay D, Miller AL. Nutritional support for wound healing. Altern Med Rev 2003;8:359-77.  Back to cited text no. 4
    
5.
Guo S, Dipietro LA. Factors affecting wound healing. J Dent Res 2010;89:219-29.  Back to cited text no. 5
    
6.
Hajhashemi V, Ghannadi A, Heidari AH. Anti-inflammatory and wound healing activities of Aloe littoralis in rats. Res Pharm Sci 2012;7:73-8.  Back to cited text no. 6
    
7.
Aggarwal BB, Prasad S, Reuter S, Kannappan R, Yadev VR, Park B, et al. Identification of novel anti-inflammatory agents from Ayurvedic medicine for prevention of chronic diseases: “Reverse pharmacology” and “bedside to bench” approach. Curr Drug Targets 2011;12:1595-653.  Back to cited text no. 7
    
8.
Grindlay D, Reynolds T. The Aloe vera phenomenon: A review of the properties and modern uses of the leaf parenchyma gel. J Ethnopharmacol 1986;16:117-51.  Back to cited text no. 8
    
9.
Satpathy A, Ravindra S, Porwal A, Das AC, Kumar M, Mukhopadhyay I. Effect of alcohol consumption status and alcohol concentration on oral pain induced by alcohol-containing mouthwash. J Oral Sci 2013;55:99-105.  Back to cited text no. 9
    
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Bhat G, Kudva P, Dodwad V. Aloe vera: Nature's soothing healer to periodontal disease. J Indian Soc Periodontol 2011;15:205-9.  Back to cited text no. 10
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11.
Kirkland O. The suppurative periodontal pus pocket; its treatment by the modified flap operation. J Am Dent Assoc 1931;18:1462-70.  Back to cited text no. 11
    
12.
Greensmith AL, Wade AB. Dressing after reverse bevel flap procedures. J Clin Periodontol 1974;1:97-106.  Back to cited text no. 12
    
13.
Wachtel H, Schenk G, Böhm S, Weng D, Zuhr O, Hürzeler MB. Microsurgical access flap and enamel matrix derivative for the treatment of periodontal intrabony defects: A controlled clinical study. J Clin Periodontol 2003;30:496-504.  Back to cited text no. 13
    
14.
Landry RG, Turnbull RS, Howley T. Effectiveness of benzydamyne HCl in the treatment of periodontal postsurgical patients. Res Clin Forum 1988;10:105-18.  Back to cited text no. 14
    
15.
Davis RH, Donato JJ, Hartman GM, Haas RC. Anti-inflammatory and wound healing activity of a growth substance in Aloe vera. J Am Podiatr Med Assoc 1994;84:77-81.  Back to cited text no. 15
    
16.
Ishii Y, Tanizawa H, Takino Y. Studies of Aloe. III. Mechanism of cathartic effect. (2). Chem Pharm Bull (Tokyo) 1990;38:197-200.  Back to cited text no. 16
    
17.
Reynolds T, Dweck AC. Aloe vera leaf gel: A review update. J Ethnopharmacol 1999;68:3-37.  Back to cited text no. 17
    
18.
Fujita K, Teradaira R, Nagatsu T. Bradykinase activity of Aloe extract. Biochem Pharmacol 1976;25:205.  Back to cited text no. 18
    
19.
Bautista-Pérez R, Segura-Cobos D, Vázquez-Cruz B.In vitro antibradykinin activity of Aloe barbadensis gel. J Ethnopharmacol 2004;93:89-92.  Back to cited text no. 19
    
20.
Haller JS Jr. A drug for all seasons. Medical and pharmacological history of Aloe. Bull N Y Acad Med 1990;66:647-59.  Back to cited text no. 20
    
21.
Yagi A, Kabash A, Okamura N, Haraguchi H, Moustafa SM, Khalifa TI. Antioxidant, free radical scavenging and anti-inflammatory effects of aloesin derivatives in Aloe vera. Planta Med 2002;68:957-60.  Back to cited text no. 21
    
22.
Hashemi SA, Madani SA, Abediankenari S. The review on properties of Aloe vera in healing of cutaneous wounds. Biomed Res Int 2015;2015:714216.  Back to cited text no. 22
    


    Figures

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    Tables

  [Table 1], [Table 2]



 

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