Evaluation of Herbal Chip as an Adjunct to Scaling and Root Planing in the Management of Chronic Periodontitis: A Systematic Review

Abstract

Background: Chronic periodontitis represents a biofilm-mediated inflammatory disease characterized by the slow and continuous destruction of periodontal supporting tissues. Scaling and root planing (SRP) is the primary approach in nonsurgical periodontal treatment, however, complete eradication of subgingival pathogens is often not achieved. Herbal chips have emerged as a promising adjunctive local drug delivery system offering antimicrobial benefits.

Aim: To assess efficacy of herbal chips as adjuncts to SRP in improving clinical periodontal parameters compared to SRP alone.
Methods This systematic review was carried out following the PRISMA 2020 statement and the Cochrane Hand book guidelines. Electronic and manual searches were conducted across Pub Med, Scopus, Google Scholar, and Cochrane Library databases to identify randomized controlled trials (RCTs) evaluating herbal chips as adjuncts to SRP. The outcomes assessed were Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth (PPD), and Clinical Attachment Level (CAL) with primary importance for PPD and CAL.  The risk of bias for the included studies was appraised using the Cochrane Risk of Bias 2.0 tool. 
Results: 356 RCTs published between 2010 and 2025 are recorded, out of which 10 RCTs were included. Across all studies, adjunctive use of herbal chips demonstrated marked reductions in Plaque Index (PI), Gingival Index (GI), and Probing Pocket Depth (PPD), along with gains in Clinical Attachment Level (CAL), relative to SRP alone. 
Conclusion: Herbal chips improve the clinical efficacy of  Scaling and root planning. Neem-based chips were the most extensively studied and showed consistent clinical benefits. Other herbal agents such as Turmeric, Thymoquinone,  Mimusops elengi, Salvadora persica  Achyranthes aspera also demonstrated favourable results.