Evaluation of clinical efficacy of Punica granatum epicarp extract, seed and whole fruit juice concentrate loaded thermo-reversible hydrogel as local drug delivery system in the treatment of Stage I and Stage II Periodontitis

The primary goal of periodontal therapy is removal of the biofilm deposits and create an environment conducive for the shift of microbiome from pathobionts to symbionts. This is often achieved by the gold standard- scaling and root planning (SRP) procedure, alone or with adjunctive administration of systemic or local antimicrobial agents, and surgical periodontal therapy, if required. However, use of systemic antimicrobials were shown to have adverse effects such as drug toxicity, acquired bacterial resistance, poor patient compliance and unwanted drug interactions. To tackle these limitations, local delivery of antibacterial agents into periodontal pocket is being extensively used. The benefits of using local drug delivery include better patient compliance, enhanced pharmacokinetic response, greater access and ability to position the drug adjacent to the disease and ability to lower total dosage of the drug at a more controlled concentration.

Similarly, phytotherapy has long been a source of medicinal products and over the years there have been many attempts to use herbal medicines for the treatment of chronic periodontitis, with the advantage of few side effects and cost-effectiveness.Natural products are the drugs of choice due to novelty in their chemical structure and mechanism of action. Ayurvedic medicine frequently refers to Punica granatum, sometimes known as pomegranate, as "a pharmacy unto itself" because of its prophylactic, anthelmintic, styptic, laxative, diuretic, bactericidal, and antifungal qualities. Peel (the inedible portion) makes up about half of the weight of the fruit; the remaining 50% is made up of seeds (10%), juice (40%) and arils (the edible portion). Bioactive substances include punicalagins, flavones, flavanones, anthocyanins, ascorbic acid, ellagic acid, gallic acid, caffeic acid, catechin, epigallocatechin, quercetin, tannins, and rutin are abundant in the peel and juice.

The remarkable antioxidant, anti-inflammatory, anti-atherosclerotic, antihypertensive, anti-mutagenic and wound-healing qualities of P. granatum fruit are attributed to these substances.Due to its unique properties it is used extensively in the treatment of periodontitis.Taking the above facts into account, the present study is planned prepare and evaluate the clinical efficacy of pomegranate fruit extract loaded thermo-reversible hydrogel as an adjunct to scaling and root planning in the management of Stage I and stage II Periodontitis.