Comparative Efficacy of Amitriptyline and Chlorhexidine Gels in Managing Periodontitis: A Randomized Controlled Trial

Background: Amitriptyline is a tricyclic antidepressant which also has anti-inflammatory and analgesic activity. But it has not been applied as a local delivery drug in patients with periodontitis. Objective: To compare the effectiveness of 1 % amitriptyline gel with conventional 1% chlorhexidine gel as a local drug delivery, adjunctive to scaling and root planning in patients with periodontitis. Materials and Methods: This randomized clinical control trial was done in Department of Pharmacology, University of Karachi, Sindh, Pakistan and HEJ research institute of Chemistry, University of Karachi, from 1st December 2022 to 31st July 2023. A total of 30 patients both male and female were equally divided into 3 groups. Control group: received only scaling and root planning (SRP). Study group 1: treated with SRP followed by the application of 1% chlorhexidine (CHX) gel. Study group 2: treated with SRP followed by the application of 1% amitriptyline gel. Clinical parameters including pocket depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), tooth mobility (TM), plaque index (PI), gingival index (GI), as well as biochemical parameters, tumor necrosis factor- alpha (TNF-á) levels, were evaluated using ELISA kit. Statistical analysis was done by One way ANOVA followed by Tuckey's HSD for comparisons among groups.Results: Reduction in PD, CAL, BOP, PI, GI and TNF-á was observed by both amitriptyline and CHX gel groups as compared to control group (p<0.001) But reduction in PD (p<0.001), CAL (p<0.001) and TM (p<0.05) was greater in amitriptyline group as compared to CHX group. Conclusion: Unconventional 1% amitriptyline gel is more effective in reducing the clinical and inflammatory biomarkers as compared to conventional 1% CHX gel in treating the periodontal disease via local drug delivery method (LDD).Keywords: Amitriptyline, Chlorhexidine, Local drug delivery, Periodontitis