Efficacy of mangosteen as local drug delivery for improving periodontal health in adults with periodontitis: a systematic review and meta-analysis of randomized controlled trials
-
Konathala SV Ramesh
,
Koruprolu Ramalaxmi
Abstract
Mangosteen (Garcinia mangostana L.) has garnered attention for its diverse health benefits, including antibacterial, antioxidant, anti-proliferative, anti-carcinogenic, and anti-inflammatory properties. These therapeutic effects play a central role in the pathophysiology of many conditions. Periodontal disease, a chronic inflammatory disorder of the tooth-supporting structures, is primarily caused by biofilm-forming bacteria. This systematic review focuses on the effectiveness of mangosteen in local drug delivery (LDD) for the management of periodontitis. An electronic search was conducted across multiple databases, including PubMed, LILACS, Web of Science, and Scopus. Cohen’s Kappa coefficient was used to evaluate inter-rater agreement, and the risk of bias was assessed. A random-effects model and heterogeneity were examined using I2 statistics, while funnel plots were used to detect publication bias. Clinical outcomes, including periodontal pocket depth (PPD) and clinical attachment level (CAL), were extracted from RCTs comparing Mangosteen LDD to placebo or conventional therapies. The analysis revealed a significant reduction in PPD (effect size = −1.08, 95 % CI: −1.40, −0.77) and CAL (effect size = −0.96, 95 % CI: −1.80, −0.13) in the mangosteen-treated group. These findings suggest that mangosteen gel as an LDD can offer substantial clinical benefits by reducing PPD and CAL, thereby improving overall periodontal health.
PROSPERO registration link https://www.crd.york.ac.uk/PROSPERO/view/CRD42024618658.
-
Research ethics: Not applicable.
-
Informed consent: Not applicable.
-
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
-
Use of Large Language Models, AI and Machine Learning Tools: None declared.
-
Conflict of interests: The authors state no conflict of interest.
-
Research funding: None declared.
-
Data availability: All data generated or analyzed during this study are included in this published article.
References
1. Andani, R, Fajrina, A, Asra, R, Eriadi, A. Antibacterial activity test of mangosteen plants (Garcinia mangostana L.): a review. Asian J Pharmaceut Res Dev 2021;9:164–71. https://doi.org/10.22270/ajprd.v9i1.927.Search in Google Scholar
2. Ridwan, RD, Kusumaningsih, T, Devina, T, Saputra, D. Inhibitory effect of mucoadhesive gingival patch of mangosteen peel extract against periodonto pathogen bacteria. J Int Dent Med Res 2020;13:843–8.Search in Google Scholar
3. Hendiani, I, Fitriani, TD, Prasetyo, BC, Bawono, CA, Pribadi, IM. The effectiveness of herbal mouthwash with mangosteen peel extract in inhibiting dental plaque formation. Europe J Gen Dent 2024. https://doi.org/10.1055/s-0044-1791502.Search in Google Scholar
4. Ramesh, K, Joshna, I, Penmetsa, GS, Sruthima, GN, Kumar, PM, Anusha, B, et al.. Mangosteen peel extract vs tetracycline gel in treatment of periodontal abscess in type-2 diabetes – a randomized clinical trial. J Dent Indones 2024;31:17–25. https://doi.org/10.14693/jdi.v30i3.1511.Search in Google Scholar
5. Manjunatha, VA, Vemanaradhya, GG, Gowda, TM. Clinical and antioxidant efficacy of 4% mangosteen gel as a local drug delivery in the treatment of chronic periodontitis: a placebo controlled, split-mouth trial. Dent Med Probl 2022;59:111–19. https://doi.org/10.17219/dmp/139198.Search in Google Scholar PubMed
6. Gutierrez-Orozco, F, Failla, ML. Biological activities and bioavailability of mangosteen xanthones: a critical review of the current evidence. Nutrients 2013;5:3163–83. https://doi.org/10.3390/nu5083163.Search in Google Scholar PubMed PubMed Central
7. Li, L, Brunner, I, Han, AR, Hamburger, M, Kinghorn, AD, Frye, R, et al.. Pharmacokinetics of α-mangostin in rats after intravenous and oral application. Mol Nutr Food Res 2011;55:67–74. https://doi.org/10.1002/mnfr.201000511.Search in Google Scholar PubMed
8. Pinto, M, Sousa, M, Nascimento, MS. Xanthone derivatives: new insights in biological activities. Curr Med Chem 2005;12:2517–38. https://doi.org/10.2174/092986705774370691.Search in Google Scholar PubMed
9. Chin, Y, Kinghorn, AD. Structural characterization, biological effects, and synthetic studies on xanthones from mangosteen (Garcinia mangostana), a popular botanical dietary supplement. Mini Rev Org Chem 2008;5:355–64. https://doi.org/10.2174/157019308786242223.Search in Google Scholar PubMed PubMed Central
10. Obolskiy, D, Pischel, I, Siriwatanametanon, N, Heinrich, M, Garcinia mangostana, L. A phytochemical and pharmacological review. Phytother Res 2009;23:1047–65. https://doi.org/10.1002/ptr.2730.Search in Google Scholar PubMed
11. Shan, T, Ma, Q, Guo, K, Liu, J, Li, W, Wang, F, et al.. Xanthones from mangosteen extracts as natural chemo preventive agents: potential anticancer drugs. Curr Mol Med 2011;11:666–77. https://doi.org/10.2174/156652411797536679.Search in Google Scholar PubMed PubMed Central
12. Shahaban Op, S. A review: mangosteen an untapped source of bioactive. Pharm Innov 2023;SP-12:1619–28.Search in Google Scholar
13. Suttirak, W, Manurakchinakorn, S. In vitro antioxidant properties of mangosteen peel extract. J Food Sci Technol 2014;51:3546–58. https://doi.org/10.1007/s13197-012-0887-5.Search in Google Scholar PubMed PubMed Central
14. Ansori, ANM, Fadholly, A, Hayaza, S, Susilo, RJK, Inayatillah, B, Winarni, D, et al.. A review on medicinal properties of mangosteen (Garcinia mangostana L.). Res J Pharm Technol 2020;13:974–82. https://doi.org/10.5958/0974-360x.2020.00182.1.Search in Google Scholar
15. Nguyen, PT, Falsetta, ML, Hwang, G, Gonzalez-Begne, M, Koo, H. α-Mangostin disrupts the development of Streptococcus mutans biofilms and facilitates its mechanical removal. PLoS One 2014;9:e111312. https://doi.org/10.1371/journal.pone.0111312.Search in Google Scholar PubMed PubMed Central
16. Milovanova-Palmer, J, Pendry, B. Is there a role for herbal medicine in the treatment and management of periodontal disease? J Herb Med 2018;12:33–48. https://doi.org/10.1016/j.hermed.2018.02.004.Search in Google Scholar
17. Husna, M, Nasution, R, Ilyas, S, Wulandari, P, Syahputra, A. The effect of 4% mangosteen peel extract gel on interleukin-6 (il-6) levels and clinical parameters in stage iii grade b periodontitis patients. Int J Appl Dent Sci. 2022;8:531–4. https://doi.org/10.22271/oral.2022.v8.i1h.1473.Search in Google Scholar
18. Kulkarni, M, Vemanaradhya, GG, Mg, T. Evaluation of 4% mangosteen (MG) gel as a local drug delivery in adjunct to scaling and root planing on clinical parameters and GCF MMP-9 levels in chronic periodontitis patients-A split mouth randomized controlled trial. Eur J Respir Dis 2023;7:130–8.10.29228/erd.57Search in Google Scholar
19. Rassameemasmaung, S, Sirikulsathean, A, Amornchat, C, Maungmingsook, P, Rojanapanthu, P, Gritsanaphan, W. Topical application of Garcinia mangostana L. pericarp gel as an adjunct to periodontal treatment. Compl Ther Med 2008;16:262–7. https://doi.org/10.1016/j.ctim.2007.12.004.Search in Google Scholar PubMed
20. Mahendra, J, Mahendra, L, Svedha, P, Cherukuri, S, Romanos, GE. Clinical and microbiological efficacy of 4% Garcinia mangostana L. pericarp gel as local drug delivery in the treatment of chronic periodontitis: a randomized, controlled clinical trial. J Invest Clin Dent 2017;8:e12262. https://doi.org/10.1111/jicd.12262.Search in Google Scholar PubMed
21. Tantra, I, Rizqiawan, A, Sumarta, NP. Alpha-mangostin as potent osteogenesis and anti-inflammation bioactive material-literature review. Nat Volatiles & Essent Oils 2021;8:4875–84.Search in Google Scholar
22. Mohamed, GA, Ibrahim, SR, Shaaban, MI, Ross, SA. Mangostana xanthones I and II, new xanthones from the pericarp of Garcinia mangostana. Fitoterapia 2014;98:215–21. https://doi.org/10.1016/j.fitote.2014.08.014.Search in Google Scholar PubMed
23. Torrungruang, K, Vichienroj, P, Chutimaworapan, S. Antibacterial activity of mangosteen pericarp extract against cariogenic Streptococcus mutans. Chulalongkorn Univ Dent J 2007;30:1–0. https://doi.org/10.58837/chula.cudj.30.1.1.Search in Google Scholar
24. Setiawan, AA, Budiman, J, Prasetyo, A. Anti-inflammatory potency of mangosteen (Garcinia mangostana L.): a systematic review. Open Access Maced J Med Sci 2023;11:58–66. https://doi.org/10.3889/oamjms.2023.8746.Search in Google Scholar
25. Savitt, ED, Socransky, SS. Distribution of certain subgingival microbial species in selected periodontal conditions. J Periodontal Res 1984;19:111–23. https://doi.org/10.1111/j.1600-0765.1984.tb00800.x.Search in Google Scholar PubMed
26. Umeda, M, Takeuchi, Y, Noguchi, K, Huang, Y, Koshy, G, Ishikawa, I. Effects of nonsurgical periodontal therapy on the microbiota. Periodontology 2000 2004;36. https://doi.org/10.1111/j.1600-0757.2004.03675.x.Search in Google Scholar PubMed
27. Vinayaka, AM, Gayathri, GV, Triveni, MG. Comparative evaluation of the efficacy of 4% mangosteen gel and 1% chlorhexidine digluconate gel in management of patients with chronic gingivitis: a randomized clinical trial. Int J Res Ayurveda Pharm 2021;12:6–11.10.7897/2277-4343.1206161Search in Google Scholar
28. Ridwan, RD, Yuliati, Y, Sidarningsih, S, Sholihah, FM, Aljunaid, M, Lashari, DM. A study of the mucoadhesive patches loaded with mangosteen peel extract in periodontitis. J Taibah Univ Med Sci 2021;16:864. https://doi.org/10.1016/j.jtumed.2021.06.011.Search in Google Scholar PubMed PubMed Central
29. Aljuanid, MA, Qaid, HR, Lashari, DM, Ridwan, RD, Budi, HS, Alkadasi, BA, et al.. Nano-emulsion of mangosteen rind extract in a mucoadhesive patch for periodontitis regenerative treatment: an in vivo study. J Taibah Univ Med Sci 2022;17:910e920. https://doi.org/10.1016/j.jtumed.2022.03.003.Search in Google Scholar PubMed PubMed Central
30. Jung, JS, Choi, GH, Lee, H, Ko, Y, Ji, S. The clinical effect of a propolis and mangosteen extract complex in subjects with gingivitis: a randomized, double-blind, and placebo-controlled clinical trial. Nutrients 2024;16:3000. https://doi.org/10.3390/nu16173000.Search in Google Scholar PubMed PubMed Central
© 2025 Walter de Gruyter GmbH, Berlin/Boston
