Assessing the effectiveness of locally delivered chlorhexidine in the treatment of periodontitis

Use of chlorhexidine chip after scaling and root planning on periodontal disease: A systematic review and meta-analysis

Objective

This systematic review aims to assess the efficacy chlorhexidine chip as an adjunctive therapy of scaling and root planning on periodontal disease treatment.

Material and methods

This study follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) and was registered in the PROSPERO database (CRD42019148221). The search was performed in PubMed/MEDLINE, Scopus, and Cochrane databases until April 2020. The PICO question was: “Is the chlorhexidine chip (CHX) effective as an adjunctive therapy of scaling and root planning on periodontal disease treatment?”. Inclusion criteria involved: randomized controlled clinical trials, with a minimum of 15 patients included on the sample and each patient has two sites of probing depth of ≥5 mm; The minimum follow up was at least 1 months of follow-up and the outcomes present in the studies probing depth (PD), plaque index (PI) and clinical attachment level (CAL) after scaling and root planning (SRP).

Results

After searching the databases, 13 articles were selected for qualitative and 8 for quantitative analysis. Were included 427 patients, with a mean age of 45.6 years. The results shown that the association of chlorhexidine chips to scaling and root planning reduce periodontal pocket depths (P < 0.00001; MD −0.77 [CI −1.0 to −0.55]; I² = 23%, P = 0.24), gain on the clinical attachment level (P < 0.0001; MD −0.57 [CI −0.86 to −0.27]; I² = 33%, P = 0.18P < 0.0001) and reduction on plaque index (P = 0.04; MD −0.23 [CI −0.45 to −0.01]; I² = 91%, P < 0.00001).

Conclusions

Thus, we can conclude that chlorhexidine chip when used associated to scaling and root planning promoted a significant improvement the reduction of periodontal diseases.

Comparing the Effect of Combination of 1% Ornidazole and 0.25% Chlorhexidine Gluconate (Ornigreat™) Gel and Aloe vera Gel in the Treatment of Chronic Periodontitis: A Randomized, Single-Blind, Split-Mouth Study

Aim and Objective:

The aim of this study is to compare the efficiency of subgingivally delivered 1% ornidazole and 0.25% chlorhexidine (CHX) gluconate (Ornigreat™ gel) and Aloe vera (AV) gel in the treatment of chronic periodontitis.

Materials and Methods:

Twenty chronic periodontitis patients with pocket depths ranging from 4 to 6 mm bilaterally at least in one site were included in the study. After a thorough nonsurgical periodontal therapy, 1% ornidazole and 0.25% CHX gluconate (Ornigreat™ gel) and AV gel were subgingivally delivered into the pocket sites, and the clinical parameters such as plaque index (PI), gingival index (GI), bleeding index (BI), and clinical attachment level (CAL) were evaluated at baseline and after 4 weeks.

Results:

In both the groups, a reduction in PI, GI, and probing depth readings was evidenced after 4 weeks. A significant improvement was noticed in the BI in the AV group when compared with that of Ornigreat™ group. Taking CAL into consideration, though improvement was there in both the groups, it was not appreciable.

Conclusion:

AV which is an herbal derivative when subgingivally delivered in the pocket site could be an equally effective and affordable substitute for Ornigreat™ gel.

A Systematic Review on the Effects of the Chlorhexidine Chip When Used as an Adjunct to Scaling and Root Planing in the Treatment of Chronic Periodontitis

BACKGROUND

Several local antimicrobial agents, such as a bioabsorbable chlorhexidine chip, have been developed to enhance the outcome of non-surgical periodontal therapy.

METHODS

Electronic (MEDLINE and Cochrane Oral Health Group Specialized Trials Register) and manual searches were performed to detect studies concerning the use of the chlorhexidine chip as an adjunct to scaling and root planing in the treatment of chronic periodontitis. Only full-text randomized controlled trials published in English up to June 2005 were included.

RESULTS

Five studies were finally selected following independent screening by two reviewers. Due to considerable heterogeneity in study design, a qualitative data analysis was performed. Multicenter studies have indicated significantly higher pocket reductions and clinical attachment gains following a combination of mechanical debridement and repeated chlorhexidine chip administration in comparison to scaling and root planing alone. However, some recent studies failed to confirm the additional value of the chlorhexidine chip. A number of interstudy disparities with respect to methodological quality and study design may account for this lack of accordance.

CONCLUSIONS

The clinical and microbiological data currently available on the chlorhexidine chip are limited and conflicting. More research is needed to elucidate the additional value of the chlorhexidine chip when used as an adjunct to scaling and root planing.

Controlled and targeted drug delivery strategies towards intraperiodontal pocket diseases

Advances in the understanding of the aetiology, epidemiology, pathogenesis and microbiology of periodontal pocket flora have revolutionized the strategies for the management of intraperiodontal pocket diseases. Intra-pocket, sustained release, drug delivery devices have been shown to be clinically effective in the treatment of periodontal infections. Several degradable and non-degradable devices are under investigation for the delivery of antimicrobial agents into the periodontal pocket including non-biodegradable fibres, films (biodegradable and non-biodegradable), bio-absorbable dental materials, biodegradable gels/ointments, injectables and microcapsules. With the realization that pocket bacteria accumulate as biofilms, studies are now being directed towards eliminating/killing biofilm concentrations rather than their planktonic (fluid phase) counterparts. Intraperiodontal pocket drug delivery has emerged as a novel paradigm for the future research. Similarly, bioadhesive delivery systems are explored that could significantly improve oral therapeutics for periodontal disease and mucosal lesions. A strategy is to target a wide range of molecular mediators of tissue destruction and hence arrest periodontal disease progression. Research into regenerating periodontal structures lost as a result of disease has also shown substantial progress in the last 25 years.