6. / BRIEF RESUME OF THE INTENDED WORK :
6.1 Need for the study :
The inflammatory periodontal diseases are widely accepted as being caused by bacteria associated with dental plaque. Increasing knowledge of anaerobic bacteria as predominant periodontopathic agents has led to new treatment strategies aiming primarily at its suppression or elimination. Mechanical therapy itself may not reduce or eliminate the anaerobic infection at base of pocket. Moreover recolonization of disease associated bacteria occur from the residual reservoir in dentinal tubules causing renewal of inflammatory state. To override this, addition of antimicrobials both systemically and locally would enhance a treatment protocol and serve as adjuncts to mechanical therapy. Interest is gathering momentum as researchers are becoming more interested in alternative therapy utilizing natural products versus synthetic agents. In recent years attempt have been made to test plant and plant products for their effectiveness.
Aloe vera barbadensis, a popular houseplant has a long history as a multipurpose folk remedy. Aloe vera gel, a clear jelly like substance has 8 essential amino acids, enzymes, lignin, minerals, mono and polysaccharides, salicylic acid, saponins, sterols and vitamins.
Various studies have demonstrated the powers of Aloe vera on moisturizing; wound healing−fibroblast activity, collagen proliferation, angiogenesis; anti inflammatory3; antibacterial, antifungal, antiviral; antioxidant effects.1 Aloe vera has been shown to enhance defence mechanisms and has a variety of components to help combat periodontal disease and other oral conditions. It is extremely helpful in the treatment of gingival disease, it reduces the bleeding of gums, it is a powerful antiseptic in periodontal pockets and its antifungal properties help greatly in the problem of denture stomatitis.2
Here an attempt is made to assess the effectiveness of pure Aloe vera gel (98%) in the treatment of periodontal pocket along with scaling and root planing.
6.2 Review of literature :
A study was conducted to assess the microbiological effects of professionally performed periodic subgingival Aloe vera irrigation in fourteen otherwise healthy adult patients. DNA probe technology was used to detect Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis
and Prevotella intermedia. Results derived were (a)subgingival Aloe alone significantly reduced
P.gingivalis for atleast 4 weeks; (b)scaling and root planing alone and scaling and root planing
combined with subgingival Aloe vera irrigation significantly reduced P.gingivalis levels for atleast 24 weeks; (c)both Aloe gel and scaling and root planing did not significantly reduce A.actinomycetemcomitans or P.intermedia.3
A randomized double blind clinical trial was conducted to evaluate the effect of Aloe vera on reduction of plaque and gingivitis. Subjects were allocated to test group (n=15) – dentifrice Aloe vera and control group (n=15) – fluoridated toothpaste. Plaque index and Gingival Bleeding index were assessed. There was significant reduction on plaque and gingivitis in both groups but no statistically significant difference was observed among them.4
A study was conducted to treat periodontosis with Aloe extract. 92 patients were completely examined after 1ml Aloe injections given daily for more than a month (total 30 injections). Observations made were ; 3−4 injections reduced bleeding from gums, itching of gums disappears; 6−8 injections result in disappearance of secretions from pockets, the unpleasant taste and odour in mouth disappear. After 12−15 injections, a sensation of freshness in oral cavity and feeling of stability of teeth is observed.5
A study was conducted to evaluate the spectrum of anti-inflammatory activity of Aloe vera in a number of models of inflammation in the hind paw of the experimental rat induced by kaolin, carrageen, albumin, dextran, gelatin and mustard. The authors found that Aloe vera was active in all models of inflammation. The various irritant induced edema models provided a broad spectrum of anti-inflammatory activity for Aloe vera.6
A study was conducted to determine the effects of Aloe, a potential wound healing agent on wound contraction in excisional wounds treated with topical antimicrobials on Sprague-Dawley rats. Aloe solution significantly accelerated wound contraction. This effect appears to be due to an increased collagen activity, which is enhanced by lectin, consequently improving the collagen matrix and enhancing the breaking strength.7
6.3 Objectives of the study :
  • To evaluate the efficacy of topical application of pure Aloe vera extract on clinical parameters and periodontal pathogens in chronic periodontitis with scaling and root planing.
  • To evaluate efficacy of only topical application of pure Aloe vera extract on clinical parameters and periodontal pathogens in chronic periodontitis without scaling and root planing.
  • To assess the changes in periodontopathogens using anaerobic culture method.

7. / MATERIALS AND METHODS :
7.1 Source of data :
Patients of this study would be selected from the outpatient department of Periodontics, College of Dental Sciences, Davangere. Both the sexes of age between 20-55 years will be included.
7.2 Method of Collection of Data (including sampling procedure, if any) :
Sample size :
30 sites in 10 patients (3 in each patient) with periodontal pockets between 5mm≥7mm would be selected.
Study period :
The duration of this cross sectional study is one year from January 2009 to January 2010.
Clinical parameters :
Following clinical parameters will be recorded at baseline, three weeks and six weeks.
  1. Plaque Index (Silness P. and Loe H., 1964)
  2. Gingival Index (Loe H. and Silness J., 1963)
  3. Bleeding on probing (Ainamo and Bay, 1975)
  4. Probing pocket depth
  5. Relative attachment level (using custom acrylic stents)
Microbial assessment :
The efficacy of Aloe vera gel would be evaluated through anaerobic culture method for detection of periodontopathogens like Porphyromonas gingivalis, Fusiform nucleatum and Tanerella forsythia.
Sample collection :
The subgingival plaque sample will be collected with a sterile curette at baseline, three weeks and six weeks and sent to the laboratory within 24 hours.
Selection criteria:
Inclusion criteria:
Patients with chronic periodontitis diagnosed clinically and radiologically with atleast 3 sites having pocket depth between 5mm≥7mm.
Exclusion criteria :
  1. Patients with systemic diseases.
  2. Subjects taking antibiotics within last 3 months.
  3. Patients who have undergone periodontal therapy in past 6 months.
  4. Patients who are pregnant and lactating mothers.
  5. Smokers.
In each patient, three sites will be randomly assigned as follows :
Control Site C : Scaling and root planing alone.
Experimental Site A : Intrapocket application of Aloe vera gel alone.
Experimental Site B : Intrapocket application of Aloe vera gel with scaling and root planing.
Statistical Analysis :
Multiple group comparisons will be done by One Way ANOVA and paired Student t test for post treatment changes. For microbial analysis , non-parametric methods like Kruskal Wallis ANOVA and Mann Whitney test will be done.
7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.
Yes. This study involves the use of pure Aloe vera extract (98%) in periodontal pockets in human beings.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes.
8. / LIST OF REFERENCES :
  1. Richard L. Wynn, PhD. Aloe vera gel: Update for dentistry. Pharmacology Today Jan-Feb 2005.
  1. Richard Sudworth. The Use of Aloe vera in Dentistry. Public Health Online Issue 20- June/July 1997.
  1. Mark L. Mangelson, D.D.S. Effects of Aloe vera irrigation on pathogenic microorganisms associated with moderate to advanced adult periodontitis. University of OklahomaCollege of Dentistry, Graduate Periodontics Program.
  1. Silvia Morgana Araujo de Oliveira, Ticiana Carneiro Torres, Sergio Luis da Silva Pereira, Olivia Morais de Lima Mota, Marlio Ximenes Carlos.Effect of a dentifrice containing aloe vera on plaque and gingivitis control. A double- blind clinical study in humans. J. Appl. Oral Sci. v.16 n.4 Bauru jul./ago.2008.
  1. S. Levenson and K.Somova. Periodontosis (disease of the bone holding teeth) treated with aloe extract. Therepeutic Stomatology, Irkutak Medical Institute,Russia.
  1. Davis RH, Leitner MG, Russo JM, Byrne ME. Anti-inflammatory activity of aloe vera against a spectrum of irritants. J Am Podiat Med Assoc 1989;79:263-276.
  1. Heggars JP, Kucukcelebi A, Listengarten D, Stabenau J, Ko F, Broemeling LD, Robson MC, Winters WD. Beneficial effects of aloe on wound healing in an excisional wound model. J Altern Complement Med 1996;2:271-277.