Impact of Antioxidant Mangosteen on Clinical and Biochemical Parameters of Periodontitis - A Systematic Review

Abstract

Periodontitis is a common chronic inflammatory disease that leads to the progressive destruction of periodontal tissues. Traditional treatments focus on mechanical debridement; however, antioxidants are increasingly being considered as adjuvant therapies to improve clinical outcomes. Mangosteen (Garcinia mangostana L.), a tropical fruit and chemically characterized natural source of xanthones, exhibits potent antioxidant, anti-inflammatory, and antimicrobial properties, making it a promising candidate in phytotherapeutic periodontal interventions. This systematic review aimed to assess the clinical and biochemical effects of mangosteen-based treatments in patients with periodontitis, compared to placebo or conventional therapies. Following PRISMA guidelines, a comprehensive search was conducted in PubMed, Web of Science, and Scopus. Eligible studies included randomized controlled trials, cohort studies, and clinical trials that evaluated the effects of mangosteen on periodontal parameters–probing pocket depth (PPD), plaque index (PI), gingival index (GI), clinical attachment level (CAL), and bleeding on probing (BOP)–as well as biochemical markers such as IL-6, TNF-α, MMP-8, MMP-9, total antioxidant capacity (TAOC), and oxidative stress indicators. Ten studies met the inclusion criteria, involving 422 patients. The use of 4% mangosteen gel as an adjuvant to scaling and root planing (SRP) showed significant clinical improvements in PPD, GI, CAL, and BOP. Biochemically, reductions in IL-6 and MMP-9 and increased TAOC were observed. However, heterogeneity in formulations and methodologies limited comparability.