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 systematic review and metaanalysis justifying 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: Seventeen 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 ≥ 4 mm 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: 0.15 mm). However, no difference was found in CAL gain. Moreover, no significant difference was observed in PPD and CAL at both 3 and 6 months posttreatment between FMD and FMSRP. Conclusion: Adjunctive subgingival administration of XAN-CHX gel at individual selected sites in NSPT appears to provide slight benefits in PPD reduction compared to NSPT alone for CP. Due to the lack of high-quality studies, further studies with larger sample sizes and strict standards are needed to confirm the conclusions.

Salvadora persica: Nature’s Gift for Periodontal Health

“…Furthermore, routine periodontal therapy combined with an adjunctive therapeutic mediator has been shown to greatly improve patient outcomes as compared to mechanical debridement only [ 10 , 13 ]. Modern chemotherapeutic agents showed impressive efficacy in the treatment of periodontal disease, but they also had a variety of intolerable side effects, including strong taste changes, tongue and tooth discoloration, unwanted antibacterial resistance, and higher product prices [ 14 , 15 ].…”

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“…Furthermore, it has been reported that regular periodontal treatment along with the use of an adjunctive therapeutic mediator can improve patient outcomes significantly compared to mechanical treatment alone [ 10 , 13 ]. Modern day chemotherapeutic mediators exhibited significant effectiveness in the treatment of periodontal disease, but display a number of objectionable adverse effects such as taste alteration, tooth and tongue discoloration, antimicrobial resistance and the higher prices of these compounds [ 14 , 15 ]. Thus, the application of natural and herbal products as NS and TQ for periodontal treatment has garnered increased attention recently and could provide great benefits, especially to populations of lower socioeconomic status around the globe [ 4 , 16 ].…”

Recent Development of Active Ingredients in Mouthwashes and Toothpastes for Periodontal Diseases

“…Another study showed that when used as an adjunct to non-surgical periodontal treatment in patients with chronic periodontitis, a xanthan-based CHX gel containing 1.5% CHX significantly reduced periodontal pocket depths at selected sites (Mesiodistal: 0.15 mm). The use of CHX alone was not effective due to the high clearance of CHX within the pockets [ 46 ].…”