Short-term anti-plaque effect of two chlorhexidine varnishes

Comparison of clinical effectiveness of single and multiple applications of 1% chlorhexidine varnish (Cervitec Plus) along with scaling and root planing in patients with chronic periodontitis

Background:

Local drug delivery is most commonly used as an adjunct to scaling and root planing (SRP) for the treatment of periodontal disease. Varied success rates have been documented for various vehicles used for intrasite delivery of active therapeutic agents. Recently, varnishes acting as a reservoir of chlorhexidine have shown potential for the management of chronic periodontitis patients. The aim of the present investigation was a comparative evaluation of the clinical effectiveness of single and multiple applications of 1% chlorhexidine and thymol varnish (Cervitec Plus) along with SRP in patients with chronic periodontitis.

Materials and Methods:

The present study included 30 patients with chronic periodontitis divided into three groups based on the number of subgingival applications of chlorhexidine varnish single application (Group A), two applications at a week's interval (Group B), and three applications with 7-day interval in between two applications (Group C). Clinical parameters, namely plaque index (PI), sulcus bleeding index, probing pocket depth (PPD), and relative attachment level (RAL) were recorded at baseline, 1 month and 3 months in all three groups to compare the clinical efficacy.

Results:

A statistically significant reduction was observed in PI, sulcus bleeding index, PPD, and RAL at 1 and 3 months in all the three groups. Greater (though statistically nonsignificant) improvements were observed in Groups B and C.

Conclusion:

Within limitations of the study, it can be concluded that multiple applications of 1% chlorhexidine and thymol varnish (Cervitec Plus) have an added benefit over the single application in the treatment of chronic periodontitis.

Glass fibre reinforced versus multistranded bonded orthodontic retainers: a 2 year prospective multi-centre study

The objective of this study was to compare glass fibre reinforced (GFR) with multistranded bonded orthodontic retainers in terms of success rate and periodontal implications. A 2 year parallel study was conducted of 184 patients scheduled to receive bonded retainers in the upper and lower anterior segments. In three centres, the patients (mean age 14 years; 90 males and 94 females) were sequentially assigned to receive GFR retainers containing 500 unidirectional glass fibres (GFR500), 1000 unidirectional glass fibres (GFR1000), or multistranded retainers (gold standard). Retainer failures and periodontal conditions were monitored every 6 months. In a control group of 90 subjects without retainers, periodontal conditions were examined (negative control). Of the 274 recruited patients, 15 dropped out during the 2 year study period. Kaplan-Meier plots were drawn to assess survival of the different retainers. The Mantel-Cox log-rank test was used to identify significant differences in survival functions among the groups. Repeated measures analysis of variance and appropriate post hoc tests were adopted to evaluate periodontal conditions over time. GFR retainers showed unacceptably high failure rates in comparison with multistranded retainers (51 versus 12 per cent). The most significant periodontal conditions were found in patients with GFR retainers with no significant differences between the GFR500 and the GFR1000 group for any parameter at any time point. Subjects without retainers showed significantly lower levels of gingival inflammation and plaque accumulation when compared with patients in any retainer group. Multistranded retainers should remain the gold standard for orthodontic retention, although periodontal complications are common. The use of GFR retainers should be discouraged in daily practice.

Subgingival Chlorhexidine Varnish Administration as an Adjunct to Same-Day Full-Mouth Root Planing. I. Clinical Observations

BACKGROUND

Chemo-mechanical treatment concepts have been developed to improve the outcome of non-surgical periodontal therapy. Recently, the clinical additive value of a supersaturated chlorhexidine varnish was shown when used as an adjunct to staged scaling and root planing. The aim of this study was to investigate the clinical effects of a treatment strategy for chronic periodontitis based on a combination of same-day full-mouth root planing and subgingival chlorhexidine varnish administration.

METHODS

A randomized, controlled, single-blind, parallel trial was conducted on 33 non-smoking chronic periodontitis patients. The control group received oral hygiene instructions and same-day full-mouth root planing. The test group received the same instructions and treatment; however, all pockets were disinfected using a chlorhexidine varnish. Clinical response parameters were recorded at baseline and after 1, 3, and 6 months.

RESULTS

Both groups showed significant reductions in probing depth following therapy (P <0.001). There was no significant difference in full-mouth probing depth between the groups at any examination point. However, when a site-specific comparison was made, additive effects were found in the test group; an extra pocket reduction of 0.93 mm (P = 0.044) for initially deep pockets (>or=7 mm) was found at study termination. Additive clinical attachment gains seemed to be temporary. Impermanent extra pocket reductions and clinical attachment gains were found for initially medium-deep pockets (4 to 6 mm).

CONCLUSION

The outcome of same-day full-mouth root planing may benefit from the subgingival administration of a highly concentrated chlorhexidine varnish, at least in terms of pocket reduction in initially deep sites (>or=7 mm).

Clinical Benefits of Subgingival Chlorhexidine Varnish Application as an Adjunct to Same-Day Full-Mouth Root Planing: A Pilot Study

BACKGROUND

Although scaling and root planing are considered the therapeutic standard for periodontitis, weakly responding sites often occur. To improve treatment outcome, several chemomechanical treatment concepts have been developed. Recently, the clinical surplus value of a highly concentrated chlorhexidine varnish has been shown when used as an adjunct to sequential scaling and root planing. The aim of this study was to explore the clinical effects of a treatment strategy for chronic periodontitis based on a combination of same-day full-mouth root planing and subgingival chlorhexidine varnish administration.

METHODS

A randomized, controlled, single-blind, parallel trial was conducted on 12 chronic periodontitis patients. The control group received oral hygiene instructions and same-day full-mouth root planing. The test group received the same instructions and treatment; however, all pockets were additionally disinfected using a chlorhexidine varnish. Clinical response parameters were recorded at baseline and subsequently after 1 and 3 months.

RESULTS

Both treatment strategies showed significant reductions in probing depth at both follow-up visits in comparison with baseline levels (P <or=0.029). Yet, at 3 months, initially diseased sites of the test group showed significant additional pocket reductions between 0.70 and 1.37 mm (P <or=0.021). Furthermore, a significant additive clinical attachment gain of 1.17 mm (P = 0.049) for initially deep pockets (>or=7 mm) was found favoring the test group.

CONCLUSION

These preliminary findings suggest that the outcome of same-day full-mouth root planing may benefit from the subgingival administration of a highly concentrated chlorhexidine varnish.

Long-Term Clinical Effects of a Chlorhexidine Varnish Implemented Treatment Strategy for Chronic Periodontitis

BACKGROUND

Scaling and root planing in combination with oral hygiene monitoring are still considered the therapeutic standards for periodontitis. Although this treatment concept customarily results in satisfactory clinical improvements, treatment outcome may become less favorable predominantly when full access to periodontal defects is compromised, thereby leaving accretions behind. The purpose of this study was to investigate, over a 9-month period, the clinical benefits of a treatment strategy for chronic periodontitis based on a combination of sequential scaling and root planing and subgingival chlorhexidine varnish administration.

METHODS

This randomized controlled, single blind, parallel trial included 26 volunteers with chronic periodontitis. The control group received oral hygiene instructions and was scaled and root planed in two sessions. The test group received the same instructions and treatment; however, all pockets were additionally disinfected using a highly concentrated chlorhexidine varnish. Clinical response parameters were recorded at baseline and at 1, 3, 6, and 9 months. The impact of the initial strategy on the decision-making process for supplementary therapy at 9 months was investigated based on treatment decisions made by five independent clinicians.

RESULTS

Both treatment strategies showed significant reductions in probing depth and gains in clinical attachment at study termination in comparison with baseline (P<0.001). However, combination therapy resulted in a significant additional pocket reduction of 0.62 mm (P<0.001). Initially deep pockets (>or=7 mm) around multirooted teeth seemed to benefit most from the combination strategy, resulting in an additive pocket reduction of 1.06 mm (P=0.009) and a clinical attachment gain of 0.54 mm (P=0.048) in comparison to scaling and root planing alone. A trend toward a reduction of surgical treatment needs following the varnish-implemented strategy was found (P=0.076).

CONCLUSION

These findings suggest that the outcome of initial periodontal therapy may benefit from the adjunctive subgingival administration of a highly concentrated chlorhexidine varnish.