An 8-week, randomized, controlled, clinical study of the use of a 0.1% chlorhexidine mouthwash by chronic periodontitis patients

Stainability of different ceramic materials against mouth rinses and effect of polishing after staining

STATEMENT OF PROBLEM

Mouth rinses are known to stain tooth surfaces. However, their staining effect on different ceramics after prolonged use and the effect of polishing after staining are still unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the stainability of different ceramic materials against different mouth rinses and the effect of polishing on staining.

MATERIAL AND METHODS

Forty disk-shaped specimens were prepared from each material (total of 160 specimens): lithium disilicate (IPS e.max CAD), zirconia-reinforced lithium disilicate (VITA SUPRINITY PC), leucite-reinforced feldspar (GC Initial LRF), and resin matrix ceramic (CERASMART). Baseline color measurements (T0) were recorded with a clinical spectrophotometer (VITA Easyshade V). The specimens were immersed in chlorhexidine gluconate (CHX) 0.2% mouth rinse (Klorhex), (KLO) chlorhexidine gluconate 0.1% mouth rinse (Eludril) (ELU), a daily mouth rinse (LISTERINE Cool Mint) (LIS), artificial saliva (CON) continuously for 7 days (T1), 14 days (T2), and 28 days (T3). Discoloration values (ΔE) between the immersion time points (T0,T1,T2,T3) were calculated by using the following formula: ΔE= ([ΔL∗]² + [Δa∗]² + [Δb∗]²)^1/2. After the immersion process, specimens were polished and ΔE values remeasured. The Kruskal-Wallis and Mann-Whitney U tests were performed (α=.05) and were adjusted by postanalysis Bonferroni testing.

RESULTS

KLO caused the highest ΔE values in all groups. IPS e.max CAD had the lowest ΔE values, and CERASMART showed the highest ΔE values against all of the solutions (P<.05). However, polishing caused a decrease in the ΔE values in all groups.

CONCLUSIONS

Prolonged use of mouth rinses may cause color change in different ceramic materials. Polishing affected the color change and resulted in a decrease in ΔE values. Mouth rinses containing CHX should be recommended with caution for daily use.

Glycemic fluctuation exacerbates inflammation and bone loss and alters microbiota profile around implants in diabetic mice with experimental peri-implantitis

BACKGROUND

The impact of glycemic fluctuation under diabetic condition on peri-implantitis in diabetic patients remains unclear. We hypothesized that glycemic fluctuation has greater adverse effect on experimental peri-implantitis, compared with sustained high blood glucose in diabetes.

RESULTS

Maxillary left first and second molars of diabetic db/db mice were extracted and were replaced with one dental implant in the healed edentulous space. Glycemic control or fluctuation were managed by constant or interrupted oral administration of rosiglitazone to these mice. Meanwhile, experimental peri-implantitis was induced by ligation around implants. After 14 weeks, inflammatory responses, and peri-implant bone loss, together with oral microbiota profile were analyzed. Diabetic mice with glycemic fluctuation showed greater peri-implant bone loss, inflammatory cell infiltration, and osteoclastogenesis, compared with mice with sustained hyperglycemia. Compared to sustained hyperglycemia, glycemic fluctuation led to further increase in IL-1β, TNFα, RANKL, TLR2/4, IRAK1, and TRAF6 mRNA expression in peri-implant gingival tissues. Both rosiglitazone-induced glycemic control and glycemic fluctuation caused microbiota profile change in diabetic mice compared to that in uncontrolled hyperglycemic mice.

CONCLUSIONS

This study suggests that glycemic fluctuation may aggravate peri-implantitis inflammation and bone loss, which may be associated with a shift in peri-implant microbial profile towards dysbiotic changes and the activation of TLR2/4-IRAK1-TRAF6 signaling.

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

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.