Effect of Supragingival Irrigation with Aerosolized 0.5% Hydrogen Peroxide on Clinical Periodontal Parameters, Markers of Systemic Inflammation, and Morphology of Gingival Tissues in Patients with Periodontitis

Abstract

BackgroundVarious studies have shown that non-surgical periodontal treatment is correlated with reduction in clinical parameters and plasma levels of inflammatory markers. The aim of this study was to evaluate the effect of long-term weekly supragingival irrigations with aerosolized 0.5% hydrogen peroxide as maintenance therapy followed by non-surgical periodontal treatment on clinical parameters, plasma levels of inflammatory markers, and morphological changes in gingival tissues of patients with periodontitis.Material/MethodsIn total, 43 patients with chronic periodontitis were randomly allocated to long-term maintenance therapy. The patients’ periodontal status was assessed using clinical parameters of approximal plaque index, modified gingival index, bleeding index, pocket probing depth, and plasma levels of inflammatory markers (high-sensitivity C-reactive protein and white blood cell count) at baseline and after 1, 2, and 3 years. The morphological status of gingival tissues (immediately after supragingival irrigation) was assessed microscopically.ResultsComplete data were obtained on 34 patients. A highly statistically significant and consistent reduction was observed in all long-term clinical parameters and plasma levels of inflammatory markers. Morphological data showed abundant spherical bubbles in gingival tissues.Conclusions1. The present study showed that non-surgical periodontal treatment with long-term weekly supragingival irrigations with aerosolized 0.5% hydrogen peroxide improved clinical periodontal status and plasma levels of inflammatory markers and may be a promising method in periodontology. 2. We found that supragingival irrigation with aerosolized 0.5% hydrogen peroxide created large numbers of spherical bubbles in gingival tissues.

Clinical and Microbiological Effects of Weekly Supragingival Irrigation with Aerosolized 0.5% Hydrogen Peroxide and Formation of Cavitation Bubbles in Gingival Tissues after This Irrigation: A Six-Month Randomized Clinical Trial

“…Recently, it is shown that in oral biofilms, commensal species suppress the amount of pathobionts by H 2 O 2 production [17]. Literature indicates and our recent study can confirm that a sprayer for liquid aerosolization is a good method for the delivery of H 2 O 2 into the subgingival pocket [14,18]. At the same time, good results can be achieved by using lower drug concentrations [18].…”

“…Consequently, the abovementioned phenomenon might clarify an increased bactericidal efficacy of aerosolized H 2 O 2 solutions. The data of our recent study demonstrate that supragingival irrigation with aerosolized H 2 O 2 solution can create cavitation bubbles which penetrate into periodontal tissues and may increase bactericidal effects of aerosolized H 2 O 2 [14].…”

“…Treatment procedure was performed according to Žekonis et al (2016). For the supragingival irrigation procedure, the dental unit Knight Asepsis (Midmark Corp., Versailles, OH, USA) angular air and water dental syringe was used along with a reservoir for hydrogen peroxide solution, which could be adjusted for the pressure of about 80 psi and water outflow of 100 mL/min [14]. We selected 0.5% concentration of hydrogen peroxide because irrigation with higher concentrations of the aerosolized H 2 O 2 solution caused gingival pain in the pilot study patients.…”

“…Research has begun to evaluate the use of low-cost antimicrobial agents as additions to conventional periodontal therapy [12,13]. In our recent work, we have successfully tested hydrogen peroxide (H 2 O 2 ) [14]. H 2 O 2 has been used for a long time as an effective antimicrobial agent with a broad spectrum of activity (including bacterial spores and viruses) [15] and is widely used in cases where it is important to decompose it into nontoxic by-products (water and oxygen) [16].…”

“…Thus, the future of supragingival irrigation is promising, and it should provide a more predictable adjunct for the treatment and maintenance of periodontitis patients [14,29]. However, whether this intervention may have an impact on periodontal parameters still needs to be assessed [14,30].…”