Adjunctive Subgingival application of Chlorhexidine gel in nonsurgical periodontal treatment for chronic periodontitis: A systematic review and meta-analysis

Abstract

Background Subgingival applications of chlorhexidine (CHX) gel are commonly used as an adjunct in nonsurgical periodontal treatment (NSPT) for chronic periodontitis (CP). However, there is lack of data supporting the effects of adjunctive CHX gel on clinical outcomes. The objective of this meta-analysis was to evaluate the efficacy of adjunctive subgingival administration of CHX gel in NSPT compared to NSPT alone for CP.Methods An electronic search of four databases and a manual search of four journals were conducted up to August 2019. Only randomized controlled trials reporting on the clinical outcomes of subgingival use of CHX gel adjunct to scaling and root planing (SRP), as compared to SRP alone or with placebo, for at least 3 months were included. Primary outcomes were probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain at 3 and 6 months, when data on at least three studies were obtained.Results 17 studies were included for qualitative analysis and seven studies for quantitative analysis (four studies for the application of CHX gel adjunct to SRP at selected sites with at least pocket depth≥4mm and three studies for comparison of full-mouth disinfection (FMD) with subgingival use of CHX gel and full-mouth scaling and root planing (FMSRP). For subgroups, the clinical outcomes between adjunctive use of Xanthan-based CHX gel (XAN-CHX gel) and CHX gel were analyzed. Results indicated a significant improvement of PPD reduction following local adjunctive administration of XAN-CHX gel for SRP at selected sites (MD: 0.15mm). However, no difference was found in CAL gain. Moreover, no significant difference was observed in PPD and CAL at both 3 and 6 months post-treatment between FMD and FMSRP.Conclusion Adjunctive subgingival administration of XAN-CHX gel at individual selected sites appears to provide slight benefits in PPD reduction. Due to the lack of high-quality studies, further studies with larger sample sizes and strict standards are needed to confirm the conclusions.

Current uses of chlorhexidine for management of oral disease: a narrative review

“…The EFP guidance suggests that ‘ adjunctive antiseptics may be considered, specifically CHX mouth rinses for a limited period of time, in periodontitis therapy, as adjuncts to mechanical debridement, in specific cases’ . Furthermore, the EFP document states ‘ locally administered sustained-release CHX as an adjunct to subgingival instrumentation in patients with periodontitis may be considered.’ This has been supported by systematic review from ten studies demonstrating that Periochip TM as an adjunct to root surface debridement, also caused small decreases in both periodontal pocketing and clinical attachment loss (<1 mm) [ [52] , [53] , [54] ].…”

Clarithromycin as an adjunct to periodontal therapy: a systematic review and meta‐analysis

“…When administered systemically, clarithromycin produces improvements in PPD and CAL greater than the improvements which have been observed when comparing amoxicillin or metronidazole (alone or in combination) with placebo 30,31 . When administered locally, clarithromycin produces improvements in clinical outcomes greater than those observed with locally administered chlorhexidine, metronidazole, doxycycline, minocycline or photodynamic therapy 32‐35 . Future trials directly comparing clarithromycin with other adjunctive agents would be useful in validating these findings.…”

Characterization of Chlorhexidine-Impregnated Cellulose-Based Hydrogel Films Intended for the Treatment of Periodontitis

“…Microbicide-loaded hydrogel films when inserted in the periodontal cavity demonstrate higher local concentrations of the active agent and reduce the risk of systemic side effects [9]. Chlorhexidine is an antiseptic agent that is employed in dental preparations due to its broad-spectrum activity against gram-positive and gram-negative bacteria and fungi [10]. Chlorhexidine was previously fabricated by Lim et al in a dual delivery system for the treatment of periodontitis.…”

“…The system was composed from a rapidly dissolving platform that led to complete drug release within 3 h, which implies the need of repeated administration of the films and eventually may lead to lack of patients' cooperation [11]. Moreover, the high rate of gingival fluid clearance leads to a rapid reduction in chlorhexidine therapeutic concentrations from the periodontal pocket and, thus, insufficient treatment effectiveness [10].…”