Antimicrobial Efficacy of Aloe Vera, Chlorhexidine, Hyaluronic Acid, and Diode Laser Against Periodontopathogenic Bacteria: A Mixed-Methods Study

Abstract

INTRODUCTION: This study aimed to assess and compare the antibacterial properties of aloe vera, chlorhexidine (CHX), hyaluronic acid (HA), and diode lasers against periodontal pathogens across various time intervals. The goals included evaluating the effectiveness of aloe vera, CHX, HA, and a diode laser at 0.5, 1, 2, and 5 minutes against periodontal pathogenic bacteria, with a focus on determining their antimicrobial efficacy. MATERIALS AND METHODS: This mixed-methods study included 25 patients with chronic periodontitis (probing depth ≥ 5 mm at five or more sites with clinical attachment loss and ≥ 20 teeth). Subgingival plaque was collected from four quadrants per patient and randomized into four experimental groups (n = 25): 100% aloe vera gel (locally sourced, formulated with carboxymethylcellulose; Merck/MilliporeSigma, Burlington, Massachusetts, United States), 0.2% CHX mouthwash (Corsodyl; GSK plc, London, United Kingdom), 10% dilution of 0.8% high-molecular-weight HA (1.5 MDa) (Gengigel®; Ricerfarma S.r.l., Milan, Italy), and a 980 nm diode laser (Picasso; AMD Lasers, Indianapolis, Indiana, United States). In the control group (n =25), subgingival plaque was randomly collected from any quadrant. Viable colonies were counted on blood agar plates (HiMedia Laboratories Private Limited, Thane, Maharashtra, India) after 48 hours of incubation. The saline control (0.9%) (Baxter India Pvt. Ltd., Gurgaon, India) was processed similarly. Data were log-transformed and analyzed using multivariate analysis of variance (MANOVA) and Tukey's test (p < 0.05). RESULTS: Diode laser treatment demonstrated the highest antibacterial efficacy, achieving complete pathogen eradication within two minutes. CHX showed rapid and sustained reductions, followed by HA, with significant effects at longer exposure times. Aloe vera exhibited the lowest efficacy, with notable reductions observed after two minutes. Saline did not exhibit antimicrobial effects. Treatment, time, and their interactions significantly influenced bacterial reduction (p < 0.001). CONCLUSION: The 980 nm diode laser exhibited superior antibacterial efficacy for acute periodontal interventions, followed by CHX, HA, and aloe vera. These findings support the tailored use of adjunctive therapies based on exposure time and clinical needs for chronic periodontitis management.