Effect of ascorbic acid on cellular respiration with mitochondrial reductase in gingival fibroblast.

Vitamin C or L-ascorbic acid has diverse functions in the body, especially healing promotion in tissue injury via participating in the hydroxylation reactions required for collagen formation. Systemic administration of vitamin C plays an important role on gingival fibroblast proliferation and functions. Whether local or rinsing administration of vitamin C alters gingival fibroblast wound healing behavior remains unclear. Therefore, it is of interest to investigate the effect of vitamin C on gingival fibroblast behavior utilizing cell culture. Primary human gingival fibroblasts isolated from gingival tissue were rinsed with medium containing various concentrations of vitamin C. Cell migration, cell viability was assessed using MTT assay. The viability assay showed >95% live cells, and no significant (P > 0.05) difference in these values was observed at different concentrations at 24 hrs. The levels of cell proliferation were not significantly different among the control and experimental groups in 24 hrs experimental time-points (p > 0.05). Vitamin C is nontoxic and can be used for further experiments to validate for clinical application. This was further confirmed with morphological examination after 24hrs incubation on control and experimental group drugs observed under the phase contrast microscope.

Sleep disorders and work-related stress with oral hygiene among Indian shift workers.

Construction workers are mostly migrants from isolated villages and are not vigilant about health care measures besides poor language skills. Majority of the population works in shifts across the globe. As a result of poor sleep architecture, excessive sleepiness or insomnia, the construction labourers working in shifts have approximately twice the risk of OSA when compared with those working in the daytime. Likewise, the performance and the productivity of employees in construction sites are impeded by added stress. Therefore, it is of interest to investigate the sleep disorders, work-related stress and its impact on oral hygiene among the construction workers in Chennai. A cross sectional study was conducted among 518 workers in various construction sites at Chennai, South India. The study incorporated BerlinQuestionnaire to evaluate disordered breathing during sleep, the Work Ability Index that contains questions concerning work, working ability and health and the Oral Hygiene Index Simplified (Greene and Vermillion, 1964) that was used for recording the oral hygiene status. Pearson correlation between education and OHI-S was statistically significant (r=-0.108). Multiple linear regression analysis revealed that mean WAI score had a positive significant association with work experience (B=0.059, SE=0.030, p=0.05), habits (B=0.032, SE=0.017, p=0.05) and marital status (B=0.135, SE=0.54, p=0.01). In contrast, education (B=-0.0.052, SE=0.023, p=0.02) and work schedule (B=0.022, SE=0.037, p=0.54) were inversely associated with the mean score. Based on the current findings, it is imperative to restore work ability for those with poor work ability thereby enhancing productivity in the migrant workers. As shift work may be extremely detrimental to poor sleep quality, the employers should arrange shift schedules in accordance with sleep physiology. Additionally, dental awareness and interventions are required to improve oral hygiene among migrant workers.

Working hours impact on the sleep quality and oral health status among migrant construction workers in Chennai.

Background: Nowadays, a shift in our lifestyle which espouses long working hours and low sleep quality can have a direct impact on the general health and oral health status. Sleep deprivation results from intense long working hours. Aim: To recognize the impact of long working hours, on sleep and oral health assessments of migrant construction workers. Materials and Methods: This is a cross-sectional study conducted among migrant construction workers working in Chennai comprised of 1,521 participants. The sleep quality was assessed using the Insomnia Severity Scale-7 and the working hours was found using the Google forms and their oral health status was assessed using the Oral hygiene index- Simplified (OHIS-S) and the Decayed Missing and Filled teeth (DMFT) index. The data were analysed using IBM SPSS Statistical Software version 23.0. Statistical tests like the Chi-square association and one-way Analysis of variance (ANOVA) (normally distributed) were used for the analysis of three group comparisons. Results: From the study results, most of the participants were between 25 and 35 years, smokers, had negligence on oral health and had poor sleep quality due to their long working hours. On the association between the working hours per week and OHIS, DMFT and Insomnia Severity Scale total score, a statistically significant relationship was found using the one-way ANOVA. Conclusion: The results from our study brought neglected oral health care of the construction workers into the limelight which will help us in our future efforts to improve the oral health of the construction workers.

Comparative Evaluation of Bone Formation between PRF and Blood Clot Alone as the Sole Sinus-Filling Material in Maxillary Sinus Augmentation with the Implant as a Tent Pole: A Randomized Split-Mouth Study.

The lack of bone volume in the posterior maxillary region can be augmented with sinus elevation. Since the elevated sinus is a closed cavity, a blood clot that fills the sinus space itself can aid in bone formation. The aim of this study was to compare bone formation in the elevated maxillary sinus between platelet-rich fibrin (PRF) and blood clot alone as the sole sinus-filling material with the implant as a tent pole. The study was a randomized controlled trial with a split-mouth design involving seven patients. An implant was placed on one side only and blood was allowed to fill the elevated sinus cavity; on the other side, PRF plugs were inserted. The sinus window was covered by nonresorbable titanium-reinforced membrane. The results showed that there was no statistically significant difference between the two groups, but the PRF group showed increased bone gain in the mesial, buccal, and palatal regions, and increased average height and bucco-palatal width at the height of the old and new sinus floor. A greater increase in distal bone height was seen in the control group. It was concluded that PRF may be more effective as a sole sinus-filling material in the elevated sinus cavity with an implant as a tent pole.

Comparison of Serum Levels of Endothelin-1 in Chronic Periodontitis Patients Before and After Treatment.

INTRODUCTION: Endothelin-1 (ET-1) is a potent vasoconstrictive peptide with multi functional activity in various systemic diseases. Previous studies indicate the detection of ET-1 in gingival tissues and gingival crevicular fluid. AIM: The aim of this study was to estimate the serum ET-1 levels in clinically healthy subjects and subjects with chronic periodontitis, before and after treatment, and correlate it with the clinical parameters. MATERIALS AND METHODS: A total of 44 patients were included in the study. Group I comprised of 20 subjects with clinically healthy periodontium. Group II comprised of 24 subjects with chronic periodontitis. Group III comprised of same Group II subjects following periodontal management. Serum samples were collected from the subjects and an Enzyme Linked Immunosorbent Assay (ELISA) was done to estimate the ET-1 levels. The ET-1 levels were then correlated among the three groups with the clinical parameters namely, Plaque Index (PI), Sulcus Bleeding Index (SBI), probing pocket depth, clinical attachment loss and Periodontally Inflamed Surface Area (PISA). The independent t-test and paired t-test were used for comparison of clinical parameters and Pearson's correlation coefficient test was used for correlating the ET-1 levels. RESULTS: ET-1 levels in chronic periodontitis subjects were significantly higher compared to healthy subjects (p<0.001). However, the clinical parameters did not statistically correlate with the ET-1 levels. There was a significant decrease in ET-1 levels following treatment (p<0.001). CONCLUSION: Serum ET-1 is increased in chronic periodontitis and reduces after periodontal therapy. Further studies are required to establish ET-1 as a biomarker for periodontal disease.

Role of endothelin-1 in periodontal diseases: A structured review.

BACKGROUND AND OBJECTIVE: Endothelin-1 (ET-1) is a 21-amino acid peptide and is a potent vasoconstrictor produced by endothelial cells. It plays a role in the development of diseases such as hypertension and atherosclerosis. Previous studies have identified ET-1 in gingival tissues obtained from patients affected by chronic periodontitis or gingival overgrowth. Thus, there is a need to appraise the role of ET-1 in periodontal disease. MATERIALS AND METHODS: The electronic search strategy included the databases such as PubMed, PubMed Central, LILACS, MEDLINE, ScienceDirect, MeSH, Cochrane database of systematic reviews, and EMBASE databases. Hand search of relevant journals was also carried out until September 2013. The included studies were both cross-sectional and longitudinal performed in vivo/in vitro, which measures the expression of ET-1 from various cells of the periodontium and in periodontal disease. Further, studies assessing the factors which influence ET-1 expression were included in the study. RESULTS: A total of 15 articles were found relevant and fulfilled the inclusion criteria posed in this review. Ten studies discussed the concentration of ET-1 in periodontal disease, whereas eight studies investigated the cells expressing ET-1. Nine studies assessed the factors influencing ET-1 expression and two studies evaluated the influence of ET-1 on inflammatory mediators and other cytokines. The results suggested that ET-1 is elevated in periodontal diseases and is influenced by inflammatory cytokines and periodontal pathogens. CONCLUSION: ET-1 was found to have a role in periodontal disease, but further research will be required to substantiate its use as a biomarker.

The Effect of Periodontitis on Expression of Interleukin-21: A Systematic Review.

Purpose. Inflammation and tissue breakdown are led by an array of inflammatory destructive mediators associated with initiation and progression of inflammatory diseases like periodontitis. Current evidence shows that these inflammatory mediators have a definitive role in the pathogenesis of various systemic diseases with an inflammatory component. Interleukin-21 (IL-21) has been associated with systemic diseases like rheumatoid arthritis and Crohn's disease that follow a chronic inflammatory cascade. Similarly recent studies have associated Interleukin-21 levels with periodontitis. This systematic review was aimed to assess the levels of IL-21 in subjects with periodontitis. Methods. A complete literature search was done in PubMed, Medline, Science Direct, and Cochrane databases and Google Scholar based on the inclusion/exclusion criteria. Six relevant articles were procured. Full text was read individually by two reviewers and data extraction was done based on STROBE statement. Results. After data extraction five observational and one interventional study were obtained. All the studies showed an increased expression of IL-21 in periodontitis and the interventional study showed reduction in IL-21 levels after nonsurgical periodontal therapy (NSP). Conclusion. Interleukin-21 levels are higher in periodontitis than controls. With this limited evidence further longitudinal studies are required to consider this as a definitive inflammatory marker.

Estimation of salivary tumor necrosis factor-alpha in chronic and aggressive periodontitis patients.

INTRODUCTION: Periodontitis is a chronic bacterial infection characterized by persistent inflammation, connective tissue breakdown and alveolar bone destruction mediated by pro-inflammatory mediators. Tumor necrosis factor-alpha (TNF-α) is an important pro-inflammatory mediator that produced causes destruction of periodontal tissues. OBJECTIVE: The aim of the study is to estimate the salivary TNF-α in chronic and aggressive periodontitis and control participants and further correlate the levels with clinical parameter such as gingival index (GI), plaque index (PI), probing pocket depth (PPD) and clinical attachment loss. MATERIALS AND METHODS: The study population consisted of 75 subjects age ranging from 25 to 55 years attending the outpatient section of Department of Periodontics, Saveetha Dental College and Hospital. The study groups included Groups 1, 2, and 3 with participants with healthy periodontium (n = 25), generalized chronic periodontitis (n = 25) and generalized aggressive periodontitis (n = 25), respectively. Salivary samples from the participants were used to assess the TNF-α levels using enzyme-linked immunosorbent assay. RESULTS: GI and PI were found to be significantly higher in chronic and aggressive periodontitis compared to the controls. The mean TNF-α value in chronic periodontitis patients (12.92 ± 17.21 pg/ml) was significantly higher than in control subjects (2.15 ± 3.60 pg/ml). Whereas, in aggressive periodontitis patients the mean TNF-α (7.23 ± 7.67) were not significantly different from chronic periodontitis or healthy subjects. Among periodontitis participants, aggressive periodontitis subjects exhibited a significant positive correlation between the salivary TNF-α and PPD. CONCLUSION: Salivary TNF-α levels are significantly higher in chronic periodontitis than in healthy subjects, but there was no significant correlation with the clinical parameters.

Platelet rich fibrin and xenograft in treatment of intrabony defect.

For complete periodontal regeneration, delivery of growth factors in the local environment holds a great deal in adjunct to bone grafts. Platelet rich fibrin (PRF) is considered as second generation platelet concentrate, consisting of viable platelets, releasing various growth factors such as platelet-derived growth factor, vascular endothelial growth factor, transforming growth factor, insulin-like growth factor, epidermal growth factor and basic fibroblast growth factor. Hence, this case report aims to investigate the clinical and radiological (bone fill) effectiveness of autologous PRF along with the use of xenogenic bone mineral in the treatment of intra bony defects. Intrabony defect was treated with autologous PRF along with the use of xenogenic bone mineral. A decrease in probing pocket depth, gain in clinical attachment level and significant bone fill was observed at end of 6 months. The result obtained with the use of PRF may be attributed to the sustained and simultaneous release of various growth factors over a period of 7 days. In this case report, the positive clinical impact of additional application of PRF with xenogenic graft material in the treatment of periodontal intrabony defect was seen.

Platelet rich fibrin and alloplast in the treatment of intrabony defect.

Periodontal regeneration is defined as the reproduction or reconstitution of a lost or injured part to restore the architecture and function of the periodontium. The ultimate goal of periodontal therapy is to regenerate the lost periodontal tissues caused by periodontitis. The most positive outcome of periodontal regenerative procedures in intra bony defect has been achieved with bone grafts. For complete regeneration, delivery of growth factors in a local environment holds a great deal in adjunct to bone grafts. Platelet rich fibrin (PRF) is considered as second generation platelet concentrate, consisting of viable platelets, releasing various growth factors. Hence, this case report aims to investigate the clinical and radiological (bone fill) effectiveness of autologous PRF along with the use of alloplastic bone mineral in the treatment of intra bony defects.

Estimation of pentraxin-3 levels in the gingival tissues of chronic and aggressive periodontitis participants: an in vivo study.

BACKGROUND: Pentraxins are acute-phase proteins that belong to a family of evolutionarily conserved proteins, and they are considered markers of inflammation. Pentraxin-3 (PTX3) is a prototype of the long pentraxin group. It is suggested to play an important role in innate resistance against pathogens, regulation of inflammation, and clearance of apoptotic cells. The aim of this study is to estimate the level of PTX3 in gingival tissues of individuals with chronic (CP) and aggressive (AgP) periodontitis and control participants and further correlate the level of PTX3 with clinical parameters. METHODS: The study population consisted of 50 participants ranging in age from 20 to 55 years and attending the outpatient section of Department of Periodontics, Saveetha Dental College and Hospital, Chennai, India. The study groups included the following: 1) group A, patients with generalized CP (n = 20); 2) group B (n = 20), patients with generalized AgP (GAgP); and 3) group C (n = 10), healthy controls. Tissue samples from participants were assayed for PTX3 levels using enzyme-linked immunosorbent assay. RESULTS: Gingival tissues from patients with GAgP (8.349 ± 5.076 ng/mL) had a higher mean concentration of PTX3 than tissues from patients with generalized CP (5.068 ± 3.274 ng/mL) and controls (0.251 ± 0.277). The PTX3 levels in the gingival tissues correlated positively with clinical parameters in all the groups. Among the parameters, probing depth was the most significant predictor variable associated with PTX3 in cases with periodontitis. CONCLUSIONS: PTX3 concentration in gingival tissues of patients with GAgP was higher than in tissues from patients with CP, and the levels correlated positively with clinical parameters. Hence, tissue PTX3 level can be considered a marker of inflammation in periodontal disease.

Effect of maxillary sinus floor augmentation without bone grafts.

OBJECTIVE: The objective of the present review was to determine the effectiveness of maxillary sinus floor augmentation without bone grafts using lateral window technique. MATERIALS AND METHODS: PubMed and Cochrane databases were searched for relevant articles. We also included articles by hand search until June 2012. The analysis included both human and animal studies which satisfied the following criteria: Minimum of 6 months follow-up, no use of bone grafts, and lateral window approach to the sinus. RESULTS: We included 22 articles in the review. A descriptive analysis of the constructed evidence tables indicated that there is evidence of predictable a mount of bone formation in the maxillary sinus augmentation without the use of bone grafts. CONCLUSION: Within the limits of the articles and data available, maxillary sinus augmentation without bone graft might be considered effective inpredictable bone formation.

Analysis of association of TaqI VDR gene polymorphism with the chronic periodontitis in Dravidian ethnicity.

AIM: The aim of this study is to analyze the association of TaqI vitamin D receptor (VDR) gene polymorphism with the chronic periodontitis (CP) in Dravidian ethnicity. MATERIALS AND METHODS: A total of 120 subjects were recruited for this study, which included 60 CP and 60 healthy controls. TaqI VDR gene polymorphism was analyzed using specific primers and amplified by polymerase chain reaction (PCR) and visualized under 2% agarose gel. RESULTS: Our study results showed that Tt and tt genotype had a higher frequency of occurrence in CP compared with controls. Similarly, t allele was found to be associated with CP. CONCLUSION: Our study concludes that TaqI VDR gene polymorphism is associated with CP in Dravidian ethnicity.

Comparative analysis of presence of Cytomegalovirus (CMV) and Epsteinbarr virus -1 (EBV-1) in cases of chronic periodontitis and aggressive periodontitis with controls.

AIM: The aim of the present study was to evaluate the presence of Cytomegalovirus (CMV) and Epsteinbarr virus -1 (EBV-1)viruses in sub gingival plaque of chronic periodontitis (groupA), aggressive periodontitis patients (group B), periodontally healthy controls (group C) and to compare the clinical parameters between virus negative and positive sites in each of these groups. MATERIALS AND METHODS: Sixty subjects were included in the study and equally divided into the 3 groups (group A - 20, group B - 20, group C - 20). Sub gingival plaque samples were obtained from the 3 deepest periodontal pocket sites in case of subjects suffering from periodontitis, and from one random bleeding site per quadrant in healthy groups. Clinical parameters like plaque index (PI), gingival index (GI), pocket depth (PD) and clinical loss of attachment (CAL) were recorded. Viral Deoxyribonucleic acid (DNA) was extracted using Proteinase-K DNA Extraction method, and the presence of CMV and EBV-1 was detected by polymerase chain reaction and 2% agarose gel. RESULTS: Results of our study showed a 45% prevalence of CMV and EBV-1 in Aggressive periodontitis cases. Prevalence of CMV in chronic periodontitis and healthy subjects was 20% and 10%, respectively; while for EBV-1 it was 25% and 0%, respectively. In terms of comparison of the clinical parameters with virus presence, both CMV and EBV-1 positive sites showed a significantly higher mean pocket depth compared to virus negative sites. CONCLUSION: Our studyshowed that the prevalence of EBV1 was higher in chronic and aggressive periodontitis subjects compared to controls and the prevalence of CMV was higher in aggressive periodontitis patients. The virus positive sites showed higher pocket depth compared to virus negative sites.

Treatment of human periodontal infrabony defects with hydroxyapatite + ß tricalcium phosphate bone graft alone and in combination with platelet rich plasma: a randomized clinical trial.

BACKGROUND: The present study was aimed at comparing the clinical effectiveness of two regenerative techniques - platelet rich plasma (PRP) + bone graft (HA + ß TCP) versus bone graft (HA + ß TCP) + normal saline in the treatment of periodontal intrabony defects. MATERIALS AND METHODS: Ten patients diagnosed with chronic periodontitis were enrolled in a randomized split mouth clinical trial. Following phase I therapy the sites were randomly assigned to the test group - PRP + bone graft (HA + ß TCP) and control group - saline + bone graft (HA + ß TCP). Clinical parameters recorded at baseline and 6 months included plaque index, probing pocket depth, relative attachment levels, and relative gingival margin levels. Hard tissue evaluation was done using digital radiography to evaluate the image intensity and therefore the radioopacity of a desired region of interest in the intrabony defect. Pre- and postoperative comparisons were made between the treatment groups at 6 months. RESULTS: Test group sites showed a significantly higher reduction in pocket depth compared to control group sites. Test group sites showed a significantly higher amount of radioopacity in the regions of interest, indicative of better graft remodeling, compared to control group sites. CONCLUSION: (HA + ß TCP) bone graft appears to be a beneficial material in the treatment of human periodontal intrabony defects. When combined with platelet-rich plasma there is a significantly higher reduction in probing pocket depth, higher gain in attachment levels and higher amount of radio-density seen in the intrabony defects.

Analysis of association between TLR-4 Asp299Gly and Thr399Ile gene polymorphisms and chronic periodontitis in a sample of south Indian population.

BACKGROUND: To analyze the association between TLR-4 Asp299Gly and Thr399Ile gene polymorphisms and chronic periodontitis in a sample of south Indian population. MATERIALS AND METHODS: Genomic DNA was obtained from peripheral blood of 60 patients with chronic periodontitis and 60 periodontally healthy subjects. TLR-4 Asp299Gly and Thr399Ile gene polymorphisms were genotyped by a polymerase chain reaction-restriction fragment length polymorphism method. The data were analyzed by a χ(2)-test and by relative risk estimation. RESULTS: Thr399Ile alleles were found in 4% of chronic periodontitis patients and in 1% of periodontally healthy subjects. The prevalence of a Thr399Ile heterozygote was found to be 5% in the chronic periodontitis group and 1.67% in the periodontally healthy group, respectively. Homozygosity for TLR-4 Thr399Ile was seen in chronic periodontitis patients only, which was 1.67%. The TLR-4 Asp299Gly gene polymorphism was not detected in either chronic periodontitis or periodontally healthy groups. CONCLUSION: There is no significant association between TLR-4 Thr399Ile polymorphism and chronic periodontitis in a sample of south Indian population.

Prevalence of TT Virus in patients with chronic periodontitis, patients with aggressive periodontitis and healthy controls: a pilot study

Torque teno virus (TTV), a novel DNA virus resides in peripheral blood mononuclear cells and replicates when these cells get activated. The TTV replication shifts the immunobalance. Aim: To determine the presence of TTV in the gingiva of patients with aggressive periodontitis, patients withchronic periodontitis, and healthy controls, and to correlate the presence of TTV with probing pocket depth and clinical attachment level. Methods: Forty-two subjects (22 males and 20 females)aged 21 to 55 years were recruited for this study. Subjects were stratified into aggressive periodontitis (Group I), chronic periodontitis (Group II) and healthy controls (Group III). Gingival tissue biopsy was taken from all the subjects and the presence of TTV was analyzed using PCR and 2% agarose gel electrophoresis. Results: TTV was identified in half of the subjects and more number of subjects with periodontitis have TT virus compared to controls. There was significant association between presence of TT virus and pocket depth, clinical attachment level. Conclusions: The findings from the present study shows that there was no significant association between TT virus and periodontitis, even though it was isolated from more number of subjects with aggressive periodontitis, and TTV was associated with pocket depth and clinical attachment level. These findings need to be investigated in further studies.

Management of mucous membrane pemphigoid with dapsone plus weekly steroid injections in a young patient: a case report / Tratamento de penfigóide membranoso mucoso com dapsona e injeções semanais de esteróide em um paciente jovem: relato de caso

Purpose: Mucous Membrane Pemphigoid (MMP) is an autoimmune subepithelial blistering disorder usually affecting older individuals. This paper describes the pharmacological management of MMP in a young patient. Case description: A 23 year-old woman showed erythematous ulcerative gingiva in the maxillary palatal region and around the retromolar region. A perilesional excisional biopsy was done, and the histologic and immunohistochemical analysis confirmed the clinical diagnosis of MMP as the cause of desquamative gingivitis in this patient. The patient was treated with topical steroids plus daily Dapsone 100 mg and weekly steroid injections (40 mg). The lesions began to resolve after 12 weeks of therapy. Conclusion: This case of MMP in a young female patient was effectively managed with a combination therapy of topical steroids, Dapsone and steroid injections.

Objetivo: O penfigóide membranoso mucoso (PMM) é uma desordem autoimume subeptelial bolhosa que geralmente afeta indivíduos mais velhos. Este relato de caso descreve a abordagem farmacológica do PMM em uma paciente jovem. Descrição do caso: Uma paciente do sexo feminino, com 23 anos de idade, apresentava a gengiva eritematosa e ulcerada na região palatina e na região retromolar. A biópsia excisional total foi realizada e as análises histológica e de imuno-histoquímica confirmaram o diagnóstico clínico de PMM como causa da gengivite descamativa nesta paciente. A paciente foi tratada com esteróides tópicos, Dapsona 100 mg diariamente e injeções de esteróides mensais (40 mg). A resolução das lesões se iniciou após 12 semanas de terapia medicamentosa. Conclusão: Este caso de PMM em uma paciente jovem foi efetivamente tratado com uma terapia combinada de esteróides tópicos, Dapsona e injeções de esteróides.

Systemic lupus erythematosus.

Desquamative gingival lesions are non-plaque induced inflammatory gingival lesions. It is a clinical description and not a diagnosis. These desquamative lesions represent oral manifestations of various dermatoses. Systemic lupus erythematous (SLE), one of the rare dermatoses shows desquamative lesions as the oral manifestation. We here with report a case of SLE with oral lesions involving gingiva of a 36 year old female patient. The clinical presentation, histological features, and investigatory findings are discussed.

Evaluation of the inhibitory effect of triphala on PMN-type matrix metalloproteinase (MMP-9).

BACKGROUND: This study evaluated the inhibitory activity of triphala on PMN-type matrix metalloproteinase (MMP-9) expressed in adult periodontitis patients and compared its activity with another ayurvedic drug, kamillosan, and doxycycline, which has known inhibitory activity. METHODS: Matrix metalloproteinases (MMPs) were extracted from gingival tissue samples from 10 patients (six males, four females) with chronic periodontitis. Tissue extracts were treated with the drug solutions, the inhibition was analyzed by gelatin zymography, and the percentage of inhibition was determined by a gel documentation system. RESULTS: The activity of MMPs was significantly decreased with the use of the drugs. Triphala showed a 76.6% reduction of MMP-9 activity, whereas kamillosan showed a 46.36% reduction at a concentration of 1,500 microg/ml (crude extract) and doxycycline showed a 58.7% reduction at a concentration of 300 microg/ml (pure drug). CONCLUSION: The present study showed the strong inhibitory activity of triphala on PMN-type MMPs involved in the extracellular matrix (ECM) degradation during periodontitis.