| Objective: Periodontal diseases are considered infection of the periodontium due to subgingival plaque. Advance in understanding the etiology and pathogenesis of periodontitis has led to widely study in the use of antibiotics and antimicrobials in therapy. Although there are some reports of successful outcomes for systemically or locally administered antibiotics, the use of these broad spectrum antibiotics for a long time has led to unpleasant side effects such as the risk of increasing the bacterial resistance to antibiotics or the bacterial unbalance. Therefore, there is increasing emphasis on safe and effective Chinese herbal medicine administered in locally periodontal pockets. Shuanghuangbu is a double-layered local delivery device which mainly includes Huang-chin, goldthread and rhizoma drynariae. This study compared the clinic effect of scaling and root planing combined with local application of Shuanghuangbu delivery device with that of scaling and root planing alone. The objective is to evaluate the effect of Shuanghuangbu on subgingival periodontopathic microflora and periodontitis and periodontal restoration.Methods: Thirty-one (31) systemically healthy adultswith moderate to advanced chronic periodontitis (male 15, female 16) participated in this study. To qualify, subjects were required to have at least one periodontal pocket with probing depth of 5 to 9mm which bled on gentle probing on each side of the mouth. This was a randomized, split mouth design study. The 120 target sites were randomized by left-side and right-side into one of the two groups (the test group and the control group). Subsequently each patient was scheduled for two appointments for the full-mouth supra-gingival scaling and oral hygiene instruction. At baseline all target sites were taken gingival crevicular fluid (GCF) for measuring the levels of alkaline phosphatase (ALP), aspartate aminotransferase (AST) and lactate dehydy-ogenase (LDH), and subgingival plaque was sampled from each of these sites for determining the percent of spirochetes (S%). Three clinical parameters including probing depth, attachment loss and bleeding on probing were examined for each site. At baseline all the patients received subgingival scaling and root planning. The test group was followed by 4-time applications of shuanghuangbu with three-day interval for totally two weeks, and no medicine was applied in the control group. On day 14, the examination was the same as the procedure of baseline. On day 41, the target sites were examined based on three clinical parameters and taken subgingival plaque.Results:At baseline, there were no statisticallysignificant differences between the test and the control group in clinical parameters (PD, AL, BOP), the levels of three enzymes in GCF(ALP, AST, LDH) and the percent of spirochetes (S%) ( P>0.05, paired-samples T test and chi-square test ). (2)The test and the control group showed a decrease in PD and AL on day 14(P<0.01, paired-samples T test), and the former produced a significant decrease in PD and AL compared to the latter (P<0.01). On day 41, the two groups continuously showed a decrease tendency in PD and AL, and the test group was significantly different from the control group (P<0.01). (3)On day 14 and 41 there was a significant decrease in BOP(+)% in the test group compared to that at baseline (P<0.01, chi-square test). Whereas BOP(+)% of day 14, 41 and baseline showed no statistically significant differences in the control group (P>0.05). (4)At 14 days the percent of coccoid cells significantly increased (PO.01, paired-samples T test), and the percent of spirochetes and rods was significantly less in the both groups (P<0.01). The test group exhibited greater differences than the control group (P<0.01). At 41 days S% maintained the level of day 14 in the test group, whereas S% in the control group rebounded.At 14 days the levels of GCF-AST, GCF-ALP and GCF-LDH were significantly lower than baseline in the two groups (P<0.01, paired-samples T test). And the decrease of the levels...
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