Subgingival chlorhexidine irrigation for scaling and root planing adjunctive therapy in chronic periodontitis: a systematic review
Abstract
BACKGROUND Scaling and root planing (SRP) is a conventional treatment for chronic periodontitis; however, it has limitations in treating deep pockets. To enhance its efficacy, chlorhexidine (CHX) is proposed as adjunctive therapy with SRP due to its broad antimicrobial spectrum, low systemic toxic activity in humans, absence of oral microorganism resistance, and lack of teratogenic effects. This study aimed to know the efficacy of the adjunctive therapy of CHX.
METHODS A literature search was conducted using various databases including PubMed, LIVIVO, EBSCOhost, and Google Scholar, following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines within the last 10 years (2011–2021). Clinical parameters such as plaque index (PI), gingival index (GI), bleeding on probing (BOP), pocket depth (PD), and clinical attachment level (CAL) were recorded. The risk of bias in the selected studies was assessed using Cochrane Collaboration’s Handbook version 5.2.0.
RESULTS Of 368 studies, 10 met the inclusion criteria, with 8 of them having a higher quality. Higher reduction of PI, GI, BI, PD, and CAL were observed in SRP with CHX irrigation compared with SRP alone.
CONCLUSIONS Overall, adding CHX to SRP appeared to have additional clinical benefits compared with SRP alone in the treatment of chronic periodontitis.
References
Li A, Chen L, Thomas RZ, van der Velden U, Amaliya A, van der Sluis LWM, et al. Periodontal breakdown inter-tooth relationships in estimating periodontitis-related tooth loss. J Dent. 2021;112:103755. https://doi.org/10.1016/j.jdent.2021.103755
Caton JG, Armitage G, Berglundh T, Chapple ILC, Jepsen S, Kornman KS, et al. A new classification scheme for periodontal and peri-implant diseases and conditions - Introduction and key changes from the 1999 classification. J Clin Periodontol. 2018;45 Suppl 20:S1-8. https://doi.org/10.1111/jcpe.12935
Heitz-Mayfield LJ, Trombelli L, Heitz F, Needleman I, Moles D. A systematic review of the effect of surgical debridement vs non-surgical debridement for the treatment of chronic periodontitis. J Clin Periodontol. 2002;29 Suppl 3:92-102; discussion 160-2. https://doi.org/10.1034/j.1600-051X.29.s3.5.x
Musurlieva N, Stoykova M. Evaluation of the impact of chronic periodontitis on individual's quality of life by a self-developed tool. Biotechnol Biotechnol Equip. 2015;29(5):991-5. https://doi.org/10.1080/13102818.2015.1058189
Wolf HF, Rateitschak EM, Rateitschak KH, Hassel TM. Color atlas of dental medicine: periodontology. 3rd ed. Rateitschak KH, Wolf HF, editors. Stuttgart: Thieme; 2004. https://doi.org/10.1055/b-0034-59058
Komara I, Sopiatin S, Hendiani A, Rusminah N, Susanto A. Effect of carbonate apatite membrane as adjunctive therapy of scaling and root planing on gingival crevicular fluid matrix metalloproteinase-8 in chronic periodontitis patient. J Int Dent Med Res. 2021;14(4):1517-22.
Garcia Canas P, Khouly I, Sanz J, Loomer PM. Effectiveness of systemic antimicrobial therapy in combination with scaling and root planing in the treatment of periodontitis: a systematic review. J Am Dent Assoc. 2015;146(3):150-63. https://doi.org/10.1016/j.adaj.2014.12.015
Issac AV, Mathew JJ, Ambooken M, Kachappilly AJ, Pk A, Johny T, et al. Management of chronic periodontitis using subgingival irrigation of ozonized water: a clinical and microbiological study. J Clin Diagn Res. 2015;9(8):ZC29-33. https://doi.org/10.7860/JCDR/2015/14464.6303
Ramanauskaite E, Machiulskiene V. Antiseptics as adjuncts to scaling and root planing in the treatment of periodontitis: a systematic literature review. BMC Oral Health. 2020;20(1):143. https://doi.org/10.1186/s12903-020-01127-1
Lecic J, Cakic S, Janjic Pavlovic O, Cicmil A, Vukotic O, Petrovic V, et al. Different methods for subgingival application of chlorhexidine in the treatment of patients with chronic periodontitis. Acta Odontol Scand. 2016;74(6):502-7. https://doi.org/10.1080/00016357.2016.1206964
Nandini N, Vidya D, Komal A. Comparative evaluation of 1 % curcumin solution and 0.2 % chlorhexidine irrigation as an adjunct to scaling and root planing in management of chronic periodontitis: a clinico-microbiological study. J Pharm Biomed Sci. 2012;14(03):1-7.
Nagarathna DV, Shastry A, Sabhachandani NR. Comparative evaluation of the efficacy of ozonated water and chlorhexidine irrigation along with scaling and root planing and scaling and root planing alone in chronic periodontitis patients a clinico-microbiological study. Int J Innov Sci Res Technol. 2018;4(5):889-96.
Vitt A, Gustafsson A, Ramberg P, Slizen V, Kazeko LA, Buhlin K. Polyhexamethylene guanidine phosphate irrigation as an adjunctive to scaling and root planing in the treatment of chronic periodontitis. Acta Odontol Scand. 2019;77(4):290-5. https://doi.org/10.1080/00016357.2018.1541099
Sağlam M, Arslan U, Buket Bozkurt Ş, Hakki SS. Boric acid irrigation as an adjunct to mechanical periodontal therapy in patients with chronic periodontitis: a randomized clinical trial. J Periodontol. 2013;84(9):1297-308. https://doi.org/10.1902/jop.2012.120467
Gottumukkala SN, Koneru S, Mannem S, Mandalapu N. Effectiveness of sub gingival irrigation of an indigenous 1% curcumin solution on clinical and microbiological parameters in chronic periodontitis patients: a pilot randomized clinical trial. Contemp Clin Dent. 2013;4(2):186-91. https://doi.org/10.4103/0976-237X.114874
Tumer H, Berberoglu A, Caygur A, Yilmaz HG. Clinical evaluation of chlorhexidine and essential oils' adjunctive effects in subgingival ultrasonic instrumentation on periodontal parameters and halitosis. J Essent Oil Bear Pl. 2019;22(1):169-75. https://doi.org/10.1080/0972060X.2019.1585967
Ravindrareddy N, Madhubabu DS, Mahendraraju C, Himasilpa C, Kiran K. Clinical effects of professional antimicrobial subgingival pulsated jet irrigation [WaterPik®] in patients with chronic periodontitis: a comparative study. J NTR Univ Health Sci. 2012;1(1):38-45. https://doi.org/10.4103/2277-8632.94174
Tewari S, Grover S, Sharma RK, Singh G, Sharma A. Emblica officinalis irrigation as an adjunct to scaling and root planing: a randomized controlled clinical trial. J Dent Indones. 2018;25(1):15-23. https://doi.org/10.14693/jdi.v25i1.1152
Vaish S, Dodwad V, Mahajan A, Gupta S. Evaluation of clinical efficacy of 0.2% chlorhexidine irrigation, 1.5% chlorhexidine gel and 2.5mg biodegradable chlorhexidine chip as an adjunct to scaling and root planing in the management of chronic periodontitis. J Dent Spec. 2016;4(2):142-6. https://doi.org/10.18231/2393-9834.2016.0009
Newman MG, Takei HH, Klokkevold PR, Carranza FA. Clinical periodontology. 2015. 872 p.
Petersilka GJ, Ehmke B, Flemmig TF. Antimicrobial effects of mechanical debridement. Periodontol 2000. 2002;28:56-71. https://doi.org/10.1034/j.1600-0757.2002.280103.x
Amaliya A, Ramadhanti R, Hadikrishna I, Maulina T. The effectiveness of 0.2% chlorhexidine gel on early wound healing after tooth extraction: a randomized controlled trial. Eur J Dent. 2022;16(3):688-94. https://doi.org/10.1055/s-0041-1739544
Houri-Haddad Y, Halabi A, Soskolne WA. Inflammatory response to chlorhexidine, minocycline HCl and doxycycline HCl in an in vivo mouse model. J Clin Periodontol. 2008;35(9):783-8. https://doi.org/10.1111/j.1600-051X.2008.01290.x
Alleyn CD, O'Neal RB, Strong SL, Scheidt MJ, Van Dyke TE, McPherson JC. The effect of chlorhexidine treatment of root surfaces on the attachment of human gingival fibroblasts in vitro. J Periodontol. 1991;62(7):434-8. https://doi.org/10.1902/jop.1991.62.7.434
Huth KC, Quirling M, Lenzke S, Paschos E, Kamereck K, Brand K, et al. Effectiveness of ozone against periodontal pathogenic microorganisms. Eur J Oral Sci. 2011;119(3):204-10. https://doi.org/10.1111/j.1600-0722.2011.00825.x
Lander PE, Newcomb GM, Seymour GJ, Powell RN. The antimicrobial and clinical effects of a single subgingival irrigation of chlorhexidine in advanced periodontal lesions. J Clin Periodontol. 1986;13(1):74-80. https://doi.org/10.1111/j.1600-051X.1986.tb01417.x
de Freitas CV, Galdez LP, Dias HL, Cirelli JA, Souza EM, da Silva VC. Effect of subgingival irrigation with different substances in the treatment of periodontal disease. a histometric study in rats. J Int Acad Periodontol. 2016;18(1):2-6.
Varoni E, Tarce M, Lodi G, Carrassi A. Chlorhexidine (CHX) in dentistry: state of the art. Minerva Stomatol. 2012;61(9):399-419.
Copyright (c) 2023 Agus Susanto, Nunung Rusminah, Yohana Putri Pertiwi
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.
