الفهرس 
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Abstract
Treatment of periodontitis is targeted mainly towards the reduction of pathogens present in the subgingival biofilm. Non-surgical periodontal therapy (NSPT) includes the improvement of oral hygiene and the use of subgingival scaling and roots surface debridement for removing the soft and calcified biofilm deposits from the affected root surfaces. NSPT is considered the gold standard of periodontal treatment and its clinical efficacy is well documented. This mechanical debridement has been shown to improve probing probing depths (PPD) and clinical attachment levels (CAL).
Although NSPT continues to dominate other treatment approaches in the treatment of periodontal disease, its inability to completely eliminate periodontal pathogens from the soft and hard tissue surfaces may cause re-colonization leading to reinfection. To overcome these deficiencies in conventional periodontal therapy, adjunctive use of chemotherapeutic agents systemically, locally, or topically becomes a substantial treatment modality.
The rationale for using locally delivered drugs (LDD) in periodontal disease is to chemically kill or reduce the plaques within the biofilm in the pocket. This is achieved by applying high concentrations of an antibiotic or antiseptic in direct contact with the root surface without remarkable systemic effect, which may not be always possible with systemic antibiotics.
Ginger (Zingiber officinale Roscoe) has been commonly consumed as a spice, flavoring agent, and as herbal medicine for a long time which belongs to the Zingiberaceae family and the Zingiber genus. In traditional medicine, it was believed that ginger is administrated to cure movement inabilities, nausea, and vomiting dur¬ing pregnancy.
It has bioactive compounds such as terpene and phenolic compounds. The phenolic compounds are mainly gingerols, shogaols, and paradols, they mimic for different bioactivities of ginger. Ginger has been found to have biological activities such as antioxidant, anti-inflammatory, antimicrobial, and anticancer activities with no side effects.
GLcN is naturally biosynthesized in the human body. It is an amino sugar and a prominent precursor in the biochemical synthesis of glycosylated proteins and lipids. Since glucosamine is a precursor for glycosaminoglycan and glycosaminoglycan is a major component of joint cartilage, so it is commonly used to treat osteoarthritis (OA).
Studies have shown that GLcN possess a potent anti-inflammatory effect as it can control the pro inflammatory cytokines such as IL-1β, TNF-α, in addition to MMP-8 and -9 and so inhibition of further destruction to the cartilage and joints. Glucosamine sulphate (GS) has been proposed to act as a scavenger for oxygen free radicals aside with a pain-relieving effect. GLcN can downregulate the RANKL/OPG cascade therefore can be used as host modulation therapy which seems to be bneficial in periodontics since it is an inflammatory disesase.
The receptor activator of nuclear factor-K ligand (RANKL)/osteoprotegerin (OPG) ratio has been found to increase in inflamed periodontal tissues, either due to an increase in RANK or a decrease in OPG, or both. When gingival crevicular fluid from patients with chronic periodontitis or aggressive periodontitis is compared to that from gingivitis or healthy patients, the RANKL/OPG ratio is higher. These findings identify a promising therapeutic target and have prompted the development and use of drugs that modulate the RANKL/RANK/OPG axis, resulting in an increase in OPG and a decrease in RANKL, consistent with a state of equilibrium between bone formation and bone destruction.
The objective of the present study was to assess and compare the efficacy of locally delivered Ginger versus to Glucosamine gel on clinical parameters and on biochemical level of RANKL inflammatory mediator as an adjunct to non-surgical periodontal therapy in the treatment of localized stage (II, and III), and grade (A) periodontitis.
The current study conducted on thirty patients diagnosed with localized stage (II, and III), and grade (A) periodontitis. Patients were divided into two groups; group (I) included 15 patients treated with scaling and RSD followed by intra pocket application of Ginger gel. group (II) included 15 patients treated with scaling and RSD followed by GLcN gel application.
Clinical parameters including plaque index, mean sulcus bleeding index, probing depth, and clinical attachment level were recorded at baseline, one month and after 3 months follow-up period. Furthermore, GCF sample collection was done using perio-paper strips for biochemical assessment. It was done at baseline, one month and three months postoperatively.
Results showed no statistically significant difference between the test and control group regarding plaque index, mean sulcus bleeding index, probing depth, and clinical attachment level.
Regarding biochemical analysis, there was a statistically significant decrease in the mean percentage change of inflammatory marker level of RANKL in both groups. Regarding the difference between the two studied groups GLcN group showed a significant decrease of the RANKL level than Ginger group at the time interval (from baseline to 3 months).