Efficacy of chlorhexidine rinses after periodontal or implant surgery: a systematic review

Abstract

BACKGROUND: Biofilm management and infection control are essential after periodontal and implant surgery. In this context, chlorhexidine (CHX) mouth-rinses are frequently recommended post-surgically. Despite its common use and many studies in this field, a systematic evaluation of the benefits after periodontal or implant surgery is-surprisingly-still missing. OBJECTIVES: To evaluate the benefits of chlorhexidine rinsing after periodontal or implant surgery in terms of plaque and inflammation reduction potential. Furthermore, to screen whether the concentration changes or additives in CHX solutions reduce side effects associated with its use. MATERIALS AND METHODS: A systematic literature search was performed for clinical trials, which compared CHX rinsing after periodontal or implant surgery with rinsing using placebo, non-staining formulations, or solutions with reduced concentrations of the active compound. Four databases (Medline, PubMed, Embase, Cochrane) were searched up to June 2018. Two reviewers independently identified and screened the literature. RESULTS: From 691 titles identified, only eleven publications met the inclusion criteria and were finally included. Mainly early publications assessed the benefits of CHX over placebo rinsing, whereas more recent publications focused more on the evaluation of new formulations with regard to effectiveness and side effects. The use of CHX after surgery showed in general significant reduction in plaque (means of 29-86% after 1 week) and bleeding (up to 73%) as compared to placebo. No consensus, however, was found regarding the most beneficial CHX formulation avoiding side effects. CONCLUSION: Chlorhexidine rinsing helps to reduce biofilm formation and gingival inflammation after surgery. However, no additional reduction of periodontal probing depth over any given placebo or control solution could be found irrespective of whether CHX was used or not. The use of additives such as antidiscoloration systems (ADS) or herbal extracts may reduce side effects while retaining efficacy. CLINICAL RELEVANCE: Within the limitations of this review, it can be concluded that CHX may represent a valuable chemo-preventive tool immediately after surgery, during the time period in which oral hygiene capacity is compromised. To reduce the side effects of CHX and maintain comparable clinical effects, rinsing with less concentrated formulations (e.g., 0.12%) showed the most promising results so far.

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

“…With respect to dental implants, chlorhexidine has indications at several different stages: Pre-surgical mouth rinse (0.12% or 0.2% Chlorhexidine) to reduce oral microbial load for 7-10 days prior to surgery and immediately prior to surgery [ 64 , 65 ]; Post-operative protocols involving application of pressure for 30 minutes with gauze soaked in chlorhexidine [ 65 ] and rinse and during 7-14 days after surgery to aid healing [ 66 , 67 ] and for treatment of post-operative infections; Reduction of implant biofilm formation post-surgery [ 68 ] this may not necessarily relate to long improved outcomes in terms of preventing or managing longer term infections such as peri-implantitis As a mouth rinse during implant maintenance and for treatment of peri-implant disease, where high levels of plaque control are important. Including, irrigation with 0.12-0.2% chlorhexidine, plus topical chlorhexidine gel for 10 days, as an adjunct to mechanical debridement, may be beneficial [ 69 ].…”

Effects of a chlorhexidine mouthwash on clinical parameters of gingivitis, dental plaque and oral polymorphonuclear leukocytes [PMN]

“…This double-blind study investigated the preventative effect of a well-established oral therapeutic i.e. CHX [ [3] , [4] , [5] , [21] ] with regards to mitigating gingival inflammation and included an estimation of oral neutrophils as an objective measure of inflammation. This study utilized commercially available formulations and enrolled adult subjects of either gender with gingivitis from the general population who were not seeking any medical or dental care.…”

“…Chlorhexidine [CHX], a cationic bisbiguanide with antiseptic features is extensively used in medicine and surgery [ 3 , 4 ]. Based on the available evidence, CHX is widely regarded as a gold-standard.…”

Limited antimicrobial efficacy of oral care antiseptics in microcosm biofilms and phenotypic adaptation of bacteria upon repeated exposure

“…In the oral cavity, formation of biofilms ("dental plaque") occurs on tooth or dental material surfaces, which is on the one hand essential for the physiology of the oral cavity, but can also result in clinical signs of dental caries or gingivitis, driven by emergence of dysbiosis in the oral microbiota [7]. While mechanical removal or disruption of oral biofilms and concomitant use of fluorides remain the cornerstones of contemporary oral hygiene concepts [8][9][10], this may not be sufficient for high-risk groups such as patients with mental disabilities [11], patients with fixed orthodontic appliances [12] or after periodontal or implant surgical procedures [13], or elderly patients in general [14]. In these cases, the use of antiseptic mouthwashes can be recommended as adjunct to mechanical biofilm removal, e.g., for managing gingivitis [15,16] or in caries-active subjects [17,18].…”