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.

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.