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La Rosa GRM, Scapellato S, Cicciù M, Pedullà E. Antimicrobial Activity of Antibacterial Sutures in Oral Surgery: A Scoping Review. Int Dent J 2024; 74:688-695. [PMID: 38429145 PMCID: PMC11287137 DOI: 10.1016/j.identj.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVE The aim of this scoping review was to explore and synthesise the current evidence on the antimicrobial activity of antibacterial suture materials used in oral surgery. METHODS The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. A bibliographic search was carried out in the PubMed and Scopus databases to retrieve all human clinical studies that investigated the antimicrobial efficacy of antibacterial-coated sutures used in oral surgery. Included studies were screened and extracted independently by 2 examiners. Data were tabulated and qualitatively described. RESULTS The search initially returned 150 articles and resulted in 5 included studies after the duplicates' removal and the full-text screening. Selected studies were published from 2014 to 2019. Three studies (60%) were randomised clinical trials, whilst the remaining studies did not report information on randomisation. The antimicrobial agents for coated sutures included triclosan and chlorhexidine. In almost all the studies, antibacterial-coated sutures exhibited lower bacterial retention compared to those without coating. CONCLUSIONS Within limitations, the antimicrobial-coated sutures employed in oral surgery exhibited good results in terms of their microbicidal activity when compared with sutures that were not coated. Considering the high variability and confounding factors identified in the included studies, more high-quality research is needed to confirm these results. Antimicrobial-coated sutures could represent a promising and clinically valid strategy to reduce microbial colonisation in oral surgery. The reduced bacterial adherence is likely to improve the clinical success of the surgical procedures. Yet, the cost-benefit ratio of antimicrobial-coated sutures should be assessed in larger clinical trials to confirm their efficacy over conventional noncoated sutures.
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Affiliation(s)
- Giusy Rita Maria La Rosa
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.
| | - Simone Scapellato
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Marco Cicciù
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Eugenio Pedullà
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
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Graziani F, Izzetti R, Perić M, Marhl U, Nisi M, Gennai S. Early periodontal wound healing after chlorhexidine rinsing: a randomized clinical trial. Clin Oral Investig 2024; 28:354. [PMID: 38833009 PMCID: PMC11150287 DOI: 10.1007/s00784-024-05643-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/30/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVES This single-center randomized, parallel design, clinical trial with a 2-week follow-up involved patients affected by periodontitis undergoing periodontal surgery. The aim was to evaluate periodontal surgical wound healing with the use of chlorhexidine-based mouth rinses versus an untreated control group. MATERIALS AND METHODS Periodontal surgery was performed following a standardized protocol. Patients were randomly prescribed i) chlorhexidine (CHX) + anti-discoloration system (ADS) + hyaluronic acid (HA), ii) CHX + ADS or iii) no treatment (control group). Plaque score, gingival inflammation, and Early Healing Index (EHI), assessing the degree of wound closure and the presence of fibrin and necrosis, were evaluated at 3, 7 and 14 days after surgery. RESULTS In total, 33 patients were enrolled. Patients were comparable at baseline for all measured clinical parameters. At 3-days wound healing was significantly improved in all patients treated with CHX + ADS-based mouth rinses with a lower EHI score at the interdental papillae compared with control group (p < 0.01). CHX + ADS + HA group presented improved healing across all time points in terms of EHI, plaque containment, and gingival inflammation when compared to control group (p < 0.01). CONCLUSIONS The usage of CHX-ADS following periodontal surgery improved early wound healing, reduced plaque accumulation and gingival inflammation. During the early post-operative period the adjunct of HA further improved soft tissue closure. CLINICAL RELEVANCE This study aims at evaluating the response of gingival tissues to mouth rinsing with chlorhexidine and anti-discoloration system (CHX + ADS) or CHX + ADS + hyaluronic acid (CHX + ADS + HA) versus no rinse in terms of healing of the periodontal surgical wound. CHX + ADS mouth rinses enhanced early soft tissue closure after periodontal surgery and contributed to the reduction in plaque accumulation and gingival inflammation. The adjunct of HA may be beneficial especially in the early post-operative period. CHX + ADS administration following periodontal surgery may improve soft tissue healing in the first two post-operative weeks.
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Affiliation(s)
- Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.
| | - Rossana Izzetti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Marina Perić
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia
| | - Urška Marhl
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- Community Healthcare Centre Dr. Adolf Drolc Maribor, Ulica Talcev 9, 2000, Maribor, Slovenia
| | - Marco Nisi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Stefano Gennai
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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Oliveira JA, da Silveira MI, de Oliveira Alves R, Bezerra FJB, de Oliveira GJPL, Pigossi SC. Effect of a gel containing green tea extract and hyaluronic acid on palate pain scores and wound healing after free gingival graft: a quasi-randomized controlled clinical trial. Clin Oral Investig 2023; 27:6735-6746. [PMID: 37775584 DOI: 10.1007/s00784-023-05282-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/24/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the effect of a gel containing green tea extract and hyaluronic acid (HA) on pain scores and wound healing in donor sites after free gingival graft (FGG). MATERIALS AND METHODS Forty-two patients requiring FGG were included in three groups: (1) control group (n = 14), no material was placed in the donor area; only the clot was kept in position by sutures; (2) placebo group (n = 14), vehicle gel applied 3 times a day for 7 days; and (3) test group (n = 14), gel containing green tea extract and HA applied 3 times a day for 7 days. The wound size by clinical measurement (WS-CM) and photographic image (WS-PI), complete wound epithelialization (CWE), and palatal mucosa color were evaluated after 3 days and 1, 2, and 4 weeks postoperatively. The visual analog scale (VAS) for pain and analgesic consumption were used to assess participant's perception in the same postoperative periods. RESULTS A similar progressive reduction in the wound size, associated with an improvement in the color pattern, was observed in all groups (p > 0.05). No significant differences were found for CWE and pain assessment between the examined groups (p > 0.05). CONCLUSION The gel containing green tea extract and HA application in palatal wounds after FGG removal does not provide clinical healing benefits using this investigated protocol. CLINICAL RELEVANCE This is the first clinical study evaluating the effect of gel containing green tea extract and HA on the palate postoperative pain control and wound healing after FGG. TRIAL REGISTRATION http://clinicaltrials.gov : NCT05270161.
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Affiliation(s)
- Jovânia Alves Oliveira
- School of Dentistry, Alfenas Federal University (Unifal-MG), Alfenas, Minas Gerais, Brazil
| | | | - Roberta de Oliveira Alves
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia-UFU, School of Dentistry, Umuarama Campus, Bloco UMU4L, Pará Avenue, 1720, Uberlandia, MG, 38405-320, Brazil
| | | | - Guilherme José Pimentel Lopes de Oliveira
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia-UFU, School of Dentistry, Umuarama Campus, Bloco UMU4L, Pará Avenue, 1720, Uberlandia, MG, 38405-320, Brazil
| | - Suzane Cristina Pigossi
- Department of Periodontology and Implantodontology, School of Dentistry, Federal University of Uberlandia-UFU, School of Dentistry, Umuarama Campus, Bloco UMU4L, Pará Avenue, 1720, Uberlandia, MG, 38405-320, Brazil.
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Romero-Olid MDN, Bucataru E, Ramos-García P, González-Moles MÁ. Efficacy of Chlorhexidine after Oral Surgery Procedures on Wound Healing: Systematic Review and Meta-Analysis. Antibiotics (Basel) 2023; 12:1552. [PMID: 37887254 PMCID: PMC10604691 DOI: 10.3390/antibiotics12101552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
Our objective was to evaluate qualitatively and quantitatively, through a systematic review and meta-analysis, available evidence on the efficacy of chlorhexidine (CHX) when applied after oral surgery on wound healing and related clinical parameters. MEDLINE/PubMed, Embase, CENTRAL, Web of Science, and Scopus were searched for studies published before January 2023. The quality of the methodology used in primary-level studies was assessed using the RoB2 tool; meta-analyses were performed jointly with heterogeneity and small-study effect analyses. Thirty-three studies and 4766 cases were included. The results point out that the application of CHX was significantly more effective, compared to controls where CHX was not employed, providing better wound healing after oral surgery (RR = 0.66, 95% CI = 0.55-0.80, p < 0.001). Stratified meta-analyses confirmed the higher efficacy of 0.20% CHX gel vs. other vehicles and concentrations (p < 0.001, respectively). Likewise, the addition of chitosan to CHX significantly increased the efficacy of surgical wound healing (p < 0.001). The use of CHX has also been significantly beneficial in the prevention of alveolar osteitis after any type of dental extraction (RR = 0.46, 95% CI = 0.39-0.53, p < 0.001) and has also been effective when applied as a gel for a reduction in pain after the surgical extraction of third molars (MD = -0.97, 95% CI = -1.26 to -0.68, p < 0.001). In conclusion, this systematic review and meta-analysis demonstrate on the basis of evidence that the application of CHX exerts a beneficial effect on wound healing after oral surgical procedures, significantly decreasing the patient's risk of developing surgical complications and/or poor wound healing. This benefit was greater when CHX was used at 0.20% in gel form with the addition of chitosan.
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Affiliation(s)
- María de Nuria Romero-Olid
- School of Dentistry, University of Granada, 18071 Granada, Spain; (M.d.N.R.-O.); (E.B.); (M.Á.G.-M.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Elena Bucataru
- School of Dentistry, University of Granada, 18071 Granada, Spain; (M.d.N.R.-O.); (E.B.); (M.Á.G.-M.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Pablo Ramos-García
- School of Dentistry, University of Granada, 18071 Granada, Spain; (M.d.N.R.-O.); (E.B.); (M.Á.G.-M.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Miguel Ángel González-Moles
- School of Dentistry, University of Granada, 18071 Granada, Spain; (M.d.N.R.-O.); (E.B.); (M.Á.G.-M.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
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Figuero E, Serrano J, Arweiler NB, Auschill TM, Gürkan A, Emingil G. Supra and subgingival application of antiseptics or antibiotics during periodontal therapy. Periodontol 2000 2023. [PMID: 37766668 DOI: 10.1111/prd.12511] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/17/2023] [Accepted: 06/22/2023] [Indexed: 09/29/2023]
Abstract
Periodontal diseases (gingivitis and periodontitis) are characterized by inflammatory processes which arise as a result of disruption of the balance in the oral ecosystem. According to the current S3 level clinical practice guidelines, therapy of patients with periodontitis involves a stepwise approach that includes the control of the patient's risk factors and the debridement of supra and subgingival biofilm. This debridement can be performed with or without the use of some adjuvant therapies, including physical or chemical agents, host modulating agents, subgingivally locally delivered antimicrobials, or systemic antimicrobials. Therefore, the main aim of this article is to review in a narrative manner the existing literature regarding the adjuvant application of local agents, either subgingivally delivered antibiotics and antiseptics or supragingivally applied rinses and dentifrices, during the different steps in periodontal therapy performed in Europe.
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Affiliation(s)
- Elena Figuero
- Department of Dental Clinical Specialties, Etiology and Therapy of Periodontal and Peri-implant Research Group, Faculty of Dentistry, University Complutense of Madrid, Madrid, Spain
- Etiology and Therapy of Periodontal and Peri-implant Research Group, University Complutense of Madrid, Madrid, Spain
| | - Jorge Serrano
- Etiology and Therapy of Periodontal and Peri-implant Research Group, University Complutense of Madrid, Madrid, Spain
| | - Nicole Birgit Arweiler
- Department of Periodontology and Peri-implant Diseases, Philipps University of Marburg, Marburg, Germany
| | - Thorsten Mathias Auschill
- Department of Periodontology and Peri-implant Diseases, Philipps University of Marburg, Marburg, Germany
| | - Ali Gürkan
- Department of Peridontology, Ege University School of Dentistry, Bornova, Turkey
| | - Gülnur Emingil
- Department of Peridontology, Ege University School of Dentistry, Bornova, Turkey
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Plata JC, Díaz-Báez D, Delgadillo NA, Castillo DM, Castillo Y, Hurtado CP, Neuta Y, Calderón JL, Lafaurie GI. Hypochlorous Acid as a Potential Postsurgical Antimicrobial Agent in Periodontitis: A Randomized, Controlled, Non-Inferiority Trial. Antibiotics (Basel) 2023; 12:1311. [PMID: 37627732 PMCID: PMC10451621 DOI: 10.3390/antibiotics12081311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Hypochlorous acid (HOCl) is an antimicrobial agent with high affinity to Gram-negative bacteria of the subgingival biofilm. It could have an equivalent or no inferiority effect to chlorhexidine (CHX) to avoid recolonization of these microorganisms after the post-surgical period. OBJECTIVE The objective is to compare the reduction of plaque index (PI), gingival index (GI), pocket depth (PD), gain of clinical attachment level (CAL), and bacterial recolonization of periodontopathic microorganisms in subgingival biofilm at 7, 21, and 90 days after Open Flap Debridement (OFD) under two antimicrobial protocols: (A) HOCl 0.05% followed by HOCl 0.025% and (B) CHX 0.2%/CHX 0.12% used per 21 days without regular oral hygiene during the post-surgical period. MATERIAL AND METHODS A no-inferiority randomized controlled trial was carried out. Thirty-two patients were randomly divided to receive each antiplaque protocol after OFD in patients with periodontitis. Clinical indexes and bacterial recolonization were assessed using qPCR for up to 90 days. Data were analyzed using repeated measures ANOVA, mixed effects models adjusted for treatment, time, and the Chi-squared/Fisher test. A no-inferiority analysis was also performed using the Hodges-Lehmann hypothesis test for non-inferiority. RESULTS HOCl was not inferior to CHX in reducing PI. Both groups showed a comparable reduction of recolonization for Porphyromonas gingivalis, Tannerella forsythia, and Eubacterium nodatum. However, the HOCl protocol was non-inferior to the CHX protocol for Treponema denticola and Aggregatibacter actinomicetemcomitans. CONCLUSIONS HOCl improved periodontal healing. HOCl showed an impact in reducing the recolonization of periodontopathic bacteria in the postoperative period.
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Affiliation(s)
- Julio Cesar Plata
- Master’s Program in Dental Sciences, School of Dentistry, Universidad El Bosque, Bogotá P.O. Box 110121, Colombia;
- School of Dentistry, Universidad Cooperativa de Colombia, Bucaramanga P.O. Box 680001, Colombia;
| | - David Díaz-Báez
- Unit of Oral Basic Investigation-UIBO, School of Dentistry, Universidad El Bosque, Bogotá P.O. Box 110121, Colombia; (D.D.-B.); (N.A.D.); (D.M.C.); (Y.C.); (Y.N.); (J.L.C.)
| | - Nathaly Andrea Delgadillo
- Unit of Oral Basic Investigation-UIBO, School of Dentistry, Universidad El Bosque, Bogotá P.O. Box 110121, Colombia; (D.D.-B.); (N.A.D.); (D.M.C.); (Y.C.); (Y.N.); (J.L.C.)
| | - Diana Marcela Castillo
- Unit of Oral Basic Investigation-UIBO, School of Dentistry, Universidad El Bosque, Bogotá P.O. Box 110121, Colombia; (D.D.-B.); (N.A.D.); (D.M.C.); (Y.C.); (Y.N.); (J.L.C.)
| | - Yormaris Castillo
- Unit of Oral Basic Investigation-UIBO, School of Dentistry, Universidad El Bosque, Bogotá P.O. Box 110121, Colombia; (D.D.-B.); (N.A.D.); (D.M.C.); (Y.C.); (Y.N.); (J.L.C.)
| | - Claudia Patricia Hurtado
- School of Dentistry, Universidad Cooperativa de Colombia, Bucaramanga P.O. Box 680001, Colombia;
| | - Yineth Neuta
- Unit of Oral Basic Investigation-UIBO, School of Dentistry, Universidad El Bosque, Bogotá P.O. Box 110121, Colombia; (D.D.-B.); (N.A.D.); (D.M.C.); (Y.C.); (Y.N.); (J.L.C.)
| | - Justo Leonardo Calderón
- Unit of Oral Basic Investigation-UIBO, School of Dentistry, Universidad El Bosque, Bogotá P.O. Box 110121, Colombia; (D.D.-B.); (N.A.D.); (D.M.C.); (Y.C.); (Y.N.); (J.L.C.)
| | - Gloria Inés Lafaurie
- Unit of Oral Basic Investigation-UIBO, School of Dentistry, Universidad El Bosque, Bogotá P.O. Box 110121, Colombia; (D.D.-B.); (N.A.D.); (D.M.C.); (Y.C.); (Y.N.); (J.L.C.)
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The In Vitro Effect of Laser Irradiation (Er:YAG and CO 2) and Chemical Reagents (Hydrogen Peroxide, Sodium Hypochlorite, Chlorhexidine, or Sodium Fluoride) Alone or in Combination on Reducing Root Caries Bacteria. Int J Mol Sci 2022; 23:ijms232415732. [PMID: 36555374 PMCID: PMC9779214 DOI: 10.3390/ijms232415732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
(1) Lasers have been used for the treatment of dentinal hypersensitivity and bacterial reductions in periodontology. The purpose of this in vitro study was to evaluate the effect of Carbon Dioxide (CO2) and Erbium-doped Yttrium Aluminum Garnet (Er:YAG) lasers with chlorhexidine (CHX), hydrogen peroxide (H2O2), sodium hypochlorite (NaOCl), or sodium fluoride (NaF) on the viability of oral bacteria associated with root caries. (2) Streptococcus mutans, Streptococcus sanguinis, and Enterococcus faecalis were grown in Brain Heart Infusion (BHI) broth, diluted to an OD660 of 0.5, and treated with antiseptics with or without simultaneous irradiation with the Er:YAG and CO2 lasers for 30 s repeated three times. The treatment groups consisted of 1: no treatment, 2: 0.5% H2O2 alone, 3: 0.5% NaOCl alone, 4: 0.12% CHX alone, 5: 2% NaF alone, 6: laser alone, 7: laser with 0.5% H2O2, 8: laser with 0.5% NaOCl, 9: laser with 0.12% CHX, and 10: laser with 2% NaF for both lasers. The microbial viability was determined through plating and viable colonies were counted, converted into CFU/mL, and transformed into log form. The statistical analysis was performed using a two-tailed paired t-test. (3) The use of CO2 and Er:YAG lasers alone failed to show statistically significant antibacterial activity against any of the bacteria. The only effective monotreatment was CHX for S. mutans. The combined treatment of 0.5% NaOCl with Er:YAG produced the greatest reduction in overall viability. (4) The combination of the Er:YAG laser with 0.5% NaOCl resulted in the largest reduction in bacterial survival when compared to monotherapies with antimicrobial solutions or lasers.
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Batra C, Alalshaikh M, Gregory RL, Windsor LJ, Blanchard SB, Hamada Y. An in-vitro comparison of four antibacterial agents with and without nicotine and their effects on human gingival fibroblasts. J Periodontol 2021; 93:e24-e33. [PMID: 34854484 DOI: 10.1002/jper.21-0262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/10/2021] [Accepted: 08/13/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND To compare anti-bacterial activity of 0.12% Chlorhexidine (CHX), 10% Povidone Iodine (PVD), Vega Oral Care Gel (VEGA) and Antioxidant Gel (AO) on Streptococcus mutans, Streptococcus sanguis, Fusobacterium nucleatum and Porphyromonas gingivalis with and without nicotine and to evaluate their effects on human gingival fibroblasts (HGFs). METHODS S. mutans, S. sanguis, P. gingivalis and F. nucleatum were incubated with serial dilutions (1/4, 1/8, 1/16, 1/32 and 1/64) of anti-bacterial agents in media (with and without nicotine). Minimum inhibitory and minimum bactericidal concentrations (MIC/MBC) were measured, and confocal microscopy was performed. HGFs were exposed to serial dilutions (1/10, 1/100, 1/1000 and 1/10,000) of antibacterial agents with media. Water-soluble tetrazolium-1 (WST-1) assay and lactate dehydrogenase (LDH) assay were used to assess proliferation and cytotoxicity towards HGFs. RESULTS CHX and PVD significantly inhibited growth of all bacterial species (p<0.0001) at all dilutions. AO and VEGA inhibited growth of all bacterial species up to only the 1/4 dilution. CHX and PVD decreased HGF proliferation at 1/10 and 1/100 dilution, while AO at all dilutions (p<0.05). CHX and AO were cytotoxic at all dilutions (p<0.05). VEGA was not cytotoxic to HGFs and did not affect HGF proliferation at any dilution (p>0.05). An increased bacterial growth was seen for all species except P. gingivalis with addition of nicotine. CONCLUSION CHX and PVD demonstrate superior antibacterial properties, but significantly reduce HGF proliferation. AO is bacteriostatic at lower dilutions but is highly toxic to HGFs. VEGA was bacteriostatic and demonstrated no detrimental effects on HGF's. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Chandni Batra
- Periodontics resident, Department of Periodontology, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - Marwa Alalshaikh
- Periodontics resident, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Richard L Gregory
- Director-Ph.D. Program, Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - L Jack Windsor
- Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - Steven B Blanchard
- Department of Periodontology, Indiana University School of Dentistry, Indianapolis, IN, USA.,Director, Advanced Education in Periodontics, Department of Periodontology, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - Yusuke Hamada
- Department of Periodontology, Indiana University School of Dentistry, Indianapolis, IN, USA.,Director, Advanced Education in Periodontics, Department of Periodontology, Indiana University School of Dentistry, Indianapolis, IN, USA
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Caruso SR, Yamaguchi E, Portnof JE. Update on Antimicrobial Therapy in Management of Acute Odontogenic Infection in Oral and Maxillofacial Surgery. Oral Maxillofac Surg Clin North Am 2021; 34:169-177. [PMID: 34728145 DOI: 10.1016/j.coms.2021.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This article focuses on the antimicrobial therapy of head and neck infections from odontogenic origin. Odontogenic infections are among the most common infections of the oral cavity. They are sourced primarily from dental caries and periodontal disease (gingivitis and periodontitis). Many odontogenic infections are self-limiting and may drain spontaneously. However, these infections may drain into the anatomic spaces adjacent to the oral cavity and spread along the contiguous facial planes, leading to more serious infections. Antibiotics are an important aspect of care of the patient with an acute odontogenic infection. Antibiotics are not a substitute for definitive surgical management.
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Affiliation(s)
- Sam R Caruso
- Department of Oral & Maxillofacial Surgery, Broward Health Medical Center, Nova Southeastern University College of Dental Medicine, 1600 S. Andrews Avenue, Fort Lauderdale, FL 33301, USA.
| | - Elena Yamaguchi
- Private Practice, Infectious Diseases, 13550 South Jog Rd, Suite 202A, Delray, FL 33446, USA
| | - Jason E Portnof
- Department of Oral & Maxillofacial Surgery, Nova Southeastern University College of Dental Medicine, 3200 S. University Dr., Davie, FL 33314, USA; Private Practice, Oral & Maxillofacial Surgery, Surgical Arts of Boca Raton, 9980 North Central Park Bvld, Suite #113, Boca Raton, FL 33428, USA
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10
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Pilloni A, Ceccarelli S, Bosco D, Gerini G, Marchese C, Marini L, Rojas MA. Effect of Chlorhexidine Digluconate in Early Wound Healing of Human Gingival Tissues. A Histological, Immunohistochemical and Biomolecular Analysis. Antibiotics (Basel) 2021; 10:antibiotics10101192. [PMID: 34680773 PMCID: PMC8532903 DOI: 10.3390/antibiotics10101192] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/19/2021] [Accepted: 09/29/2021] [Indexed: 01/18/2023] Open
Abstract
Chlorhexidine digluconate (CHX) is considered the gold standard for oral cavity antiseptic treatment. Nevertheless, several in vitro studies have reported detrimental effects in oral tissue repair. The aim of the present study was to evaluate the in vivo effect of post-surgical CHX mouth rinse on gingival tissue (G) 24 h after injury. G biopsies were obtained in three patients 24 h after surgery with the indication of post-surgical 0.12% CHX use and were compared with those obtained from the same patients without any antiseptic use. Changes in collagen production, cell proliferation, and apoptosis were examined by histological and Ki-67/P53 immunohistochemical analysis. Fibrotic markers (COL1A1, αSMA), proapoptotic protein (BAX) expression, and wound healing-related gene modulation (RAC1, SERPINE1, TIMP1) were analyzed by quantitative real-time PCR analysis. CHX was able to reduce cellular proliferation and increase collagen deposition, proapoptotic molecule and fibrotic marker expression, and myofibroblast differentiation, reduce expression of RAC1 and trigger expression of SERPINE1 and TIMP1, showing “scar wound healing response” pattern. This study assessed for the first time the in vivo effects of CHX on gingival tissue. The demonstration of a CHX-induced fibrotic transformation, leading to scar repair, supports the need for new post-surgical clinical protocols based on a strategic and personalized use of CHX.
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Affiliation(s)
- Andrea Pilloni
- Department of Oral and Maxillofacial Sciences, Section of Periodontics, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.P.); (L.M.)
| | - Simona Ceccarelli
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (S.C.); (G.G.); (C.M.)
| | - Daniela Bosco
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy;
| | - Giulia Gerini
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (S.C.); (G.G.); (C.M.)
| | - Cinzia Marchese
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (S.C.); (G.G.); (C.M.)
| | - Lorenzo Marini
- Department of Oral and Maxillofacial Sciences, Section of Periodontics, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.P.); (L.M.)
| | - Mariana A. Rojas
- Department of Oral and Maxillofacial Sciences, Section of Periodontics, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy; (A.P.); (L.M.)
- Correspondence:
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11
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Bertoldi C, Generali L, Cortellini P, Lalla M, Luppi S, Tomasi A, Zaffe D, Salvatori R, Bergamini S. Influence of Tooth-Brushing on Early Healing after Access Flap Surgery: A Randomized Controlled Preliminary Study. MATERIALS 2021; 14:ma14112933. [PMID: 34072369 PMCID: PMC8198661 DOI: 10.3390/ma14112933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 01/10/2023]
Abstract
In the present study, the clinical outcomes obtained using three different protocols of post-operative plaque control for the 4 weeks after surgery were compared. Thirty healthy subjects, presenting at least one periodontal pocket requiring resective surgery, were selected and randomly distributed to three different groups corresponding to respective post-surgical protocols: (A) toothbrushes + chlorhexidine + anti-discoloration system (ADS + CHX); (B) toothbrushes + chlorhexidine (CHX); (C) only toothbrushes. The full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing pocket depth (PPD), recession depth (REC), clinical attachment level (CAL), and bleeding on probing (BoP) were measured in six aspects per tooth (mesio-buccal (MB), buccal (B), disto-buccal (DB), disto-lingual (DL), lingual (L), and mesio-lingual (ML)) at baseline, 3 months, and 6 months after surgery. FMPS and FMBS did not significantly change (p > 0.05), whereas PPD and CAL significantly decreased, and REC significantly increased in all groups during the study (p < 0.05). Clinical results were satisfactory in all cases, with no significant differences between groups 3 months after surgery. Six months after surgery, only PPD-MB was significantly different in the three groups (p < 0.05). Nevertheless, this value was not clinically relevant because the value of PPD-B (about 2 mm) in group C was physiologic. The mechanical plaque control was proven to be fundamental and sufficient in all the six aspects per tooth to guarantee an excellent clinical outcome without the need of chemical plaque control.
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Affiliation(s)
- Carlo Bertoldi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, 41124 Modena, Italy; (A.T.); (S.B.)
- Correspondence: (C.B.); (L.G.); (D.Z.)
| | - Luigi Generali
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, 41124 Modena, Italy; (A.T.); (S.B.)
- Correspondence: (C.B.); (L.G.); (D.Z.)
| | - Pierpaolo Cortellini
- The European Research Group on Periodontology (ERGOPerio), 3855 Brienz-Bern, Switzerland;
| | - Michele Lalla
- Department of Economics Marco Biagi, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Sofia Luppi
- Independent Researcher, 41124 Modena, Italy;
| | - Aldo Tomasi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, 41124 Modena, Italy; (A.T.); (S.B.)
| | - Davide Zaffe
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Correspondence: (C.B.); (L.G.); (D.Z.)
| | - Roberta Salvatori
- Biomaterials Laboratory, Department of Medical and Surgical Sciences of Children and Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Stefania Bergamini
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, 41124 Modena, Italy; (A.T.); (S.B.)
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12
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Katsaros T, Mayer E, Palaiologou A, Romero-Bustillos M, Evans GH, Lallier TE, Maney P. Effect of different concentrations of commercially available mouthwashes on wound healing following periodontal surgery: a randomized controlled clinical trial. Clin Oral Investig 2020; 24:3587-3595. [PMID: 32076866 DOI: 10.1007/s00784-020-03232-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 01/29/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the effect of chlorhexidine and essential oils containing mouth rinses on oral wound healing after periodontal flap surgery. MATERIALS AND METHODS Eighty subjects participated in the study and were randomly assigned to use water, 0.12% chlorhexidine (CHX), essential oils (EO), 5% CHX, and 10% EO. Subjects were examined at 1, 2, and 3 weeks postoperatively. Plaque index (PI) and the modified gingival index (GI) were recorded, while wound epithelialization was measured to evaluate the healing process. Numerical data were analyzed with parametric test for multiple comparisons (ANOVA) with Bonferroni correction. Categorical data were analyzed using Chi-square test/fisher exact test. RESULTS All groups demonstrated a gradual GI reduction from first to third visit. Patients in the CHX group presented statistically significant lower PI scores than patients in the water group at the all-time points of the study. Wound epithelialization analysis demonstrated that 100% of the sites in the CHX group were healing by secondary intention at visit 1. This finding was statistically significant. CONCLUSION Full strength concentrations of CHX and EO did not show any detrimental effects on healing after traditional periodontal surgery at the end of the observation period. CLINICAL RELEVANCE The use of chlorhexidine and EO containing mouthwashes does not appear to delay wound healing. Diluting these commercial mouthwashes may present an approach that could possibly reduce the adverse effects (such as tooth staining) associated with their use, while maintaining their antibacterial properties.
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Affiliation(s)
- Theodoros Katsaros
- Department of Periodontics, University of Iowa College of Dentistry and Dental Clinics, 801 Newton Rd., S447, Iowa City, IA, 52241, USA.
| | - Elizabeth Mayer
- Department of Periodontics, Louisiana State University Health Sciences Center School of Dentistry, New Orleans, LA, USA
| | - Archontia Palaiologou
- Department of Periodontics, UT Health San Antonio School of Dentistry, San Antonio, TX, USA
| | - Miguel Romero-Bustillos
- Department of Periodontics, University of Iowa College of Dentistry and Dental Clinics, 801 Newton Rd., S447, Iowa City, IA, 52241, USA
| | - Gerald H Evans
- Department of Periodontics, Louisiana State University Health Sciences Center School of Dentistry, New Orleans, LA, USA
| | - Thomas E Lallier
- Department of Cell Biology and Anatomy, Louisiana State University Health Sciences Center, New Orleans, LA, 70119, USA
| | - Pooja Maney
- Department of Periodontics, Louisiana State University Health Sciences Center School of Dentistry, New Orleans, LA, USA
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Effectiveness of Different Commercial Chlorhexidine-Based Mouthwashes After Periodontal and Implant Surgery: A Systematic Review. IMPLANT DENT 2019; 28:74-85. [PMID: 30648980 DOI: 10.1097/id.0000000000000854] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of the present study was to review the effectiveness, side effects, and patient acceptance of different concentrations and formulation of chlorhexidine-based mouthwashes used after periodontal and implant surgery. MATERIALS AND METHODS The PRISMA guideline was adopted in the search strategy using electronic databases PubMed and MEDLINE to identify randomized and case-control prospective studies on humans written in English language and published up to September 2017. RESULTS A total of 10 articles were selected for a total of 344 patients. Because of the significant heterogeneity of the outcome measures, meta-analysis was not performed, and the data were summarized in a table. A positive relationship between the use of chlorhexidine and reduction of plaque was found, demonstrating the effectiveness of the substance in terms of antisepsis and decrease of inflammation after periodontal and implant surgery. CONCLUSION Chlorhexidine is recognized as the primary agent for plaque control and the gold standard in preventing infection, although the presence of largely known side effects would affect patient compliance. Future research should be directed at finding chlorhexidine formulation with negligible adverse effects, without compromising or even increasing its effectiveness as the antiseptics and antiplaque agent.
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Sijari Z, Romano F, Ciardo G, Martella V, Maggiora M, Bottone M, Aimetti M. Effect of two post‐surgical cleansing protocols on early periodontal wound healing and cytokine levels following osseous resective surgery: A randomized controlled study. Int J Dent Hyg 2019; 17:300-308. [DOI: 10.1111/idh.12395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/12/2019] [Accepted: 03/17/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Ziad Sijari
- Postgraduate Program in Periodontology University of Turin Turin Italy
| | - Federica Romano
- Department of Surgical Sciences, C.I.R. Dental School University of Turin Turin Italy
| | | | | | - Marina Maggiora
- Department of Clinical and Biological Sciences University of Turin Turin Italy
| | - Mario Bottone
- Department of Surgical Sciences, C.I.R. Dental School University of Turin Turin Italy
| | - Mario Aimetti
- Department of Surgical Sciences, C.I.R. Dental School University of Turin Turin Italy
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Efficacy of chlorhexidine rinses after periodontal or implant surgery: a systematic review. Clin Oral Investig 2018; 23:21-32. [PMID: 30535817 DOI: 10.1007/s00784-018-2761-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/27/2018] [Indexed: 01/20/2023]
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.
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Trombelli L, Simonelli A, Pramstraller M, Guarnelli ME, Fabbri C, Maietti E, Farina R. Clinical efficacy of a chlorhexidine-based mouthrinse containing hyaluronic acid and an antidiscoloration system in patients undergoing flap surgery: A triple-blind, parallel-arm, randomized controlled trial. Int J Dent Hyg 2018; 16:541-552. [PMID: 30101416 DOI: 10.1111/idh.12361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/16/2018] [Accepted: 07/20/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the postsurgery gingival healing as well as plaque, gingival inflammation and staining levels following the use of a 0.2% chlorhexidine (CHX) solution with or without antidiscoloration system (ADS) and 0.2% hyaluronic acid (HA). METHODS Patients undergoing flap surgery at sites with an intact or reduced but healthy periodontium participated in a parallel-arm RCT. After surgery, patients used the assigned mouthrinse (CHX + HA + ADS or CHX) for 21 days. At days 7 and 21, the healing process was evaluated at experimental teeth using a composite index, namely the Gingival Healing Index (GHI). GHI score was obtained as the sum of the scores related to the severity of wound dehiscence (score 1-3) and the profile of the buccal and oral aspects of the papilla (score 1-3). Therefore, GHI ranged from 2 (worst quality of healing) to 6 (optimal quality of healing). Plaque Index (PlI), Gingival Index (GI), angulated bleeding score (AngBS), and tooth and tongue staining were also assessed. RESULTS In both groups, GHI assumed values of 5 or 6 at both days 7 and 21 in ≥50% of patients, and low median values of PlI, GI, AngBS and staining were observed during the 21-day period. Except for a significantly lower GI in CHX group at day 7, no other significant intergroup differences were found. CONCLUSIONS Postsurgery plaque control based on either CHX or CHX + HA + ADS mouthrinses results in optimal plaque control and quality of early gingival healing along with limited tooth and tongue staining.
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Affiliation(s)
- Leonardo Trombelli
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy.,Operative Unit of Dentistry, University-Hospital of Ferrara, Ferrara, Italy
| | - Anna Simonelli
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy
| | - Mattia Pramstraller
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy.,Operative Unit of Dentistry, University-Hospital of Ferrara, Ferrara, Italy
| | - Maria Elena Guarnelli
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy.,Operative Unit of Dentistry, University-Hospital of Ferrara, Ferrara, Italy
| | - Chiara Fabbri
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy.,Operative Unit of Dentistry, University-Hospital of Ferrara, Ferrara, Italy
| | - Elisa Maietti
- Center of Clinical Epidemiology, University of Ferrara, Ferrara, Italy
| | - Roberto Farina
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy.,Operative Unit of Dentistry, University-Hospital of Ferrara, Ferrara, Italy
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17
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Taba M. Postsurgical Care Following Recession Coverage Procedures. GINGIVAL RECESSION MANAGEMENT 2018:147-157. [DOI: 10.1007/978-3-319-70719-8_11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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James P, Worthington HV, Parnell C, Harding M, Lamont T, Cheung A, Whelton H, Riley P. Chlorhexidine mouthrinse as an adjunctive treatment for gingival health. Cochrane Database Syst Rev 2017; 3:CD008676. [PMID: 28362061 PMCID: PMC6464488 DOI: 10.1002/14651858.cd008676.pub2] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Dental plaque associated gingivitis is a reversible inflammatory condition caused by accumulation and persistence of microbial biofilms (dental plaque) on the teeth. It is characterised by redness and swelling of the gingivae (gums) and a tendency for the gingivae to bleed easily. In susceptible individuals, gingivitis may lead to periodontitis and loss of the soft tissue and bony support for the tooth. It is thought that chlorhexidine mouthrinse may reduce the build-up of plaque thereby reducing gingivitis. OBJECTIVES To assess the effectiveness of chlorhexidine mouthrinse used as an adjunct to mechanical oral hygiene procedures for the control of gingivitis and plaque compared to mechanical oral hygiene procedures alone or mechanical oral hygiene procedures plus placebo/control mouthrinse. Mechanical oral hygiene procedures were toothbrushing with/without the use of dental floss or interdental cleaning aids and could include professional tooth cleaning/periodontal treatment.To determine whether the effect of chlorhexidine mouthrinse is influenced by chlorhexidine concentration, or frequency of rinsing (once/day versus twice/day).To report and describe any adverse effects associated with chlorhexidine mouthrinse use from included trials. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 28 September 2016); the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8) in the Cochrane Library (searched 28 September 2016); MEDLINE Ovid (1946 to 28 September 2016); Embase Ovid (1980 to 28 September 2016); and CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1937 to 28 September 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We included randomised controlled trials assessing the effects of chlorhexidine mouthrinse used as an adjunct to mechanical oral hygiene procedures for at least 4 weeks on gingivitis in children and adults. Mechanical oral hygiene procedures were toothbrushing with/without use of dental floss or interdental cleaning aids and could include professional tooth cleaning/periodontal treatment. We included trials where participants had gingivitis or periodontitis, where participants were healthy and where some or all participants had medical conditions or special care needs. DATA COLLECTION AND ANALYSIS Two review authors independently screened the search results extracted data and assessed the risk of bias of the included studies. We attempted to contact study authors for missing data or clarification where feasible. For continuous outcomes, we used means and standard deviations to obtain the mean difference (MD) and 95% confidence interval (CI). We combined MDs where studies used the same scale and standardised mean differences (SMDs) where studies used different scales. For dichotomous outcomes, we reported risk ratios (RR) and 95% CIs. Due to anticipated heterogeneity we used random-effects models for all meta-analyses. MAIN RESULTS We included 51 studies that analysed a total of 5345 participants. One study was assessed as being at unclear risk of bias, with the remaining 50 being at high risk of bias, however, this did not affect the quality assessments for gingivitis and plaque as we believe that further research is very unlikely to change our confidence in the estimate of effect. Gingivitis After 4 to 6 weeks of use, chlorhexidine mouthrinse reduced gingivitis (Gingival Index (GI) 0 to 3 scale) by 0.21 (95% CI 0.11 to 0.31) compared to placebo, control or no mouthrinse (10 trials, 805 participants with mild gingival inflammation (mean score 1 on the GI scale) analysed, high-quality evidence). A similar effect size was found for reducing gingivitis at 6 months. There were insufficient data to determine the reduction in gingivitis associated with chlorhexidine mouthrinse use in individuals with mean GI scores of 1.1 to 3 (moderate or severe levels of gingival inflammation). Plaque Plaque was measured by different indices and the SMD at 4 to 6 weeks was 1.45 (95% CI 1.00 to 1.90) standard deviations lower in the chlorhexidine group (12 trials, 950 participants analysed, high-quality evidence), indicating a large reduction in plaque. A similar large reduction was found for chlorhexidine mouthrinse use at 6 months. Extrinsic tooth staining There was a large increase in extrinsic tooth staining in participants using chlorhexidine mouthrinse at 4 to 6 weeks. The SMD was 1.07 (95% CI 0.80 to 1.34) standard deviations higher (eight trials, 415 participants analysed, moderate-quality evidence) in the chlorhexidine mouthrinse group. There was also a large increase in extrinsic tooth staining in participants using chlorhexidine mouthrinse at 7 to 12 weeks and 6 months. Calculus Results for the effect of chlorhexidine mouthrinse on calculus formation were inconclusive. Effect of concentration and frequency of rinsing There were insufficient data to determine whether there was a difference in effect for either chlorhexidine concentration or frequency of rinsing. Other adverse effects The adverse effects most commonly reported in the included studies were taste disturbance/alteration (reported in 11 studies), effects on the oral mucosa including soreness, irritation, mild desquamation and mucosal ulceration/erosions (reported in 13 studies) and a general burning sensation or a burning tongue or both (reported in nine studies). AUTHORS' CONCLUSIONS There is high-quality evidence from studies that reported the Löe and Silness Gingival Index of a reduction in gingivitis in individuals with mild gingival inflammation on average (mean score of 1 on the 0 to 3 GI scale) that was not considered to be clinically relevant. There is high-quality evidence of a large reduction in dental plaque with chlorhexidine mouthrinse used as an adjunct to mechanical oral hygiene procedures for 4 to 6 weeks and 6 months. There is no evidence that one concentration of chlorhexidine rinse is more effective than another. There is insufficient evidence to determine the reduction in gingivitis associated with chlorhexidine mouthrinse use in individuals with mean GI scores of 1.1 to 3 indicating moderate or severe levels of gingival inflammation. Rinsing with chlorhexidine mouthrinse for 4 weeks or longer causes extrinsic tooth staining. In addition, other adverse effects such as calculus build up, transient taste disturbance and effects on the oral mucosa were reported in the included studies.
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Affiliation(s)
- Patrice James
- Oral Health Services Research Centre, Cork University Dental School and Hospital, Wilton, Cork, Ireland
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, JR Moore Building, Oxford Road, Manchester, UK, M13 9PL
| | - Carmel Parnell
- HSE Louth Meath Dental Service, Our Lady's Hospital, Navan, Co Meath, Ireland
| | - Mairead Harding
- Oral Health Services Research Centre, Cork University Dental School and Hospital (UCC), Wilton, Cork, and HSE South (CHO 4), Cork, Ireland
| | - Thomas Lamont
- Dundee Dental School, University of Dundee, Park Place, Dundee, Tayside, UK, DD1 4HN
| | - Andrea Cheung
- Cork University Dental School and Hospital (UCC), Wilton, Cork, Ireland
| | - Helen Whelton
- School of Dentistry, University of Leeds, Worsley Building, Clarendon Way, Leeds, UK, LS2 9JT
| | - Philip Riley
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, JR Moore Building, Oxford Road, Manchester, UK, M13 9PL
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Final Report on the Safety Assessment of Chlorhexidine/Chlorhexidine Diacetate/Chlorhexidine Dihydrochloride/Chlorhexidine Digluconate. ACTA ACUST UNITED AC 2016. [DOI: 10.3109/10915819309140642] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Chlorhexidine and its Diacetate and Digluconate salts are used in cosmetics as preservatives. Chlorhexidine Digluconate was slightly toxic in oral and inhalation studies. At cosmetic use concentrations, Chlorhexidine Digluconate was not irritating to the eyes or skin. Positive sensitization reactions were cited in provocative patch testing at 1.0% concentration in patients with eczema, but not in predictive patch testing of 0.05% in normal subjects. In bacterial assays, Chlorhexidine tested both positive and negative for mutagenesis. In two mammalian systems, Chlorhexidine Digluconate was not genotoxic. p-Chloroaniline is a degradation product of Chlorhexidine salts. A study of the degradation of Chlorhexidine revealed minor amounts of p-chloroaniline after 36 weeks storage. Chlorhexidine Digluconate was not carcinogenic in a 2-year drinking water study. On the basis of the data presented in this report, it is concluded that Chlorhexidine and its salts are safe for use in cosmetic products at concentrations up to 0.14% calculated as Chlorhexidine free base; 0.19% as Chlorhexidine Diacetate; 0.20% as Chlorhexidine Digluconate; and 0.16% as Chlorhexidine Dihydrochloride.
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20
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Laugisch O, Ramseier CA, Salvi GE, Hägi TT, Bürgin W, Eick S, Sculean A. Effects of two different post-surgical protocols including either 0.05 % chlorhexidine herbal extract or 0.1 % chlorhexidine on post-surgical plaque control, early wound healing and patient acceptance following standard periodontal surgery and implant placement. Clin Oral Investig 2016; 20:2175-2183. [PMID: 26795622 DOI: 10.1007/s00784-016-1713-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 01/10/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to compare early wound healing, tooth staining and patient acceptance with two different post-surgical maintenance protocols. MATERIALS AND METHODS Forty patients scheduled for flap surgery to treat periodontal pockets or accommodate dental implants were randomly assigned to receive the following two different post-surgical maintenance protocols: (a) 2 weeks rinsing with a 0.05 % chlorhexidine digluconate (CHX)/herbal extract combination (test) or (b) a 0.1 % CHX solution (control). Early wound healing was evaluated clinically and immunologically. Tooth staining and patient acceptance were assessed by means of visual analogue scale (VAS). RESULTS Both groups presented with comparable wound healing profiles. No statistically significant differences were observed between the two protocols regarding early wound healing and plaque index (p > 0.05). However, in the control group, statistically significantly more patients felt discomfort due to tooth staining (p = 0.0467). Compared with patients from the test group, patients in the control group reported statistically significant more irritation of taste at week 1 (p = 0.0359) and at week 2 (p = 0.0042). CONCLUSIONS The present findings indicate that the two CHX protocols resulted in comparable healing and inhibition of plaque formation. Tooth staining and subjective discomfort related to irritation of taste were more frequent in the control group. CLINICAL RELEVANCE A post-operative protocol including 0.05 % CHX/herbal extract may have the potential to improve patient compliance during post-operative maintenance.
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Affiliation(s)
- Oliver Laugisch
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Christoph A Ramseier
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Tobias T Hägi
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Walter Bürgin
- School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Sigrun Eick
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
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Alshehri M, Alshail F, Aldosary KM, Alamri AA. Comparison of an essential-oil-based oral rinse and chlorhexidine as adjuncts to scaling and root planing in the treatment of periodontal inflammation. Interv Med Appl Sci 2015; 7:78-84. [PMID: 26120480 DOI: 10.1556/1646.7.2015.2.6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 05/01/2015] [Accepted: 05/04/2015] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The aim of the present short-term follow-up study was to compare the effects of an essential oil (EO)-based oral rinse and chlorhexidine as adjuncts to scaling and root planing (SRP) in the treatment of periodontal inflammation. METHODS In Group-1, SRP was performed and participants were instructed to rinse with EO-based oral rinse; in Group-2, SRP was performed and participants were instructed to rinse with chlorhexidine; and in Group-3, SRP was performed and participants were instructed to rinse with water. Periodontal parameters (plaque index [PI], bleeding-on-probing [BOP], and probing pocket depth [PPD] ≥ 4 mm) were assessed at baseline and after 7 and 30 days. RESULTS In all groups, periodontal parameters (PI, BOP, and PPD ≥ 4 mm) were comparable at baseline. In Groups-1 and -2, there was a significant reduction in PI (P < 0.01), BOP (P < 0.01), and PD ≥ 4 mm after 7 days and 30 days of follow-up than baseline. In Group-3, there was a significant reduction in PI (P < 0.01) and BOP (P < 0.01) after 7 days of follow-up compared to baseline. There was no difference in periodontal parameters after 7 days and 30 days of follow-up in Groups-1 and -2. CONCLUSION EO-based oral rinses and chlorhexidine digluconate (CHX) are acceptable adjuncts to SRP in the treatment of periodontal inflammation.
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Effect of topical application of chlorhexidine and metronidazole on the tissue repair of palatal wounds of rats: a clinical and histomorphometric study. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:505-13. [DOI: 10.1016/j.oooo.2014.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/16/2014] [Accepted: 12/23/2014] [Indexed: 11/24/2022]
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Tsourounakis I, Palaiologou-Gallis AA, Stoute D, Maney P, Lallier TE. Effect of essential oil and chlorhexidine mouthwashes on gingival fibroblast survival and migration. J Periodontol 2012; 84:1211-20. [PMID: 23106509 DOI: 10.1902/jop.2012.120312] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Chemical plaque control is the most commonly recommended means of oral hygiene after periodontal surgery. Commercially available mouthwashes contain a variety of active ingredients that have bactericidal properties but may potentially be toxic to the host cells. The goal of this in vitro study is to investigate the effect of commercially available mouthwashes on the survival and migratory capacity of human fibroblasts. METHODS Human gingival and periodontal ligament (PDL) fibroblasts were treated with commercially available mouthwashes that contained either chlorhexidine (CHX) or essential oils (EO) as the active ingredient. Each mouthwash was tested over a range of concentrations for its ability to affect fibroblast survival and migration, as well as long-term effects on cell viability. RESULTS Undiluted mouthwashes induced near-complete cell death 24 hours after only a 60-second treatment. Dilutions of 15% to 20% for both CHX and EO mouthwashes resulted in 50% cell death. When diluted to 10% to 15%, EO did not reduce cell migration, whereas similar dilutions of CHX resulted in reduced cell migration. Concentrations of 10% of both EO and CHX mouthwashes retained most of their antibacterial capacity. Treatment with EO did not result in gingival fibroblast death, whereas 5% CHX resulted in near-complete gingival fibroblast death 7 days after exposure. CONCLUSIONS The results of this in vitro study indicate that diluted EO displayed no detectable detrimental effects on human gingival and PDL fibroblasts, whereas diluted CHX reduced both cell migration and long-term survival. Both solutions retained their antimicrobial activity in lower concentrations.
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Affiliation(s)
- Ioannis Tsourounakis
- Department of Periodontics, School of Dentistry, Louisiana State University Health Science Center, New Orleans, LA 70119, USA
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Amato M, Siciliano VI, Blasi A, Matarasso R, Guida A, Carratù P, Nicolò M. Valutazione clinica di due collutori a base di clorexidina digluconato senza alcol con e senza sistema di antipigmentazione. Studio clinico controllato randomizzato. DENTAL CADMOS 2012. [DOI: 10.1016/j.cadmos.2011.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Duss C, Lang NP, Cosyn J, Persson GR. A randomized, controlled clinical trial on the clinical, microbiological, and staining effects of a novel 0.05% chlorhexidine/herbal extract and a 0.1% chlorhexidine mouthrinse adjunct to periodontal surgery. J Clin Periodontol 2010; 37:988-97. [DOI: 10.1111/j.1600-051x.2010.01609.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cortellini P, Labriola A, Zambelli R, Prato GP, Nieri M, Tonetti MS. Chlorhexidine with an anti discoloration system after periodontal flap surgery: a cross-over, randomized, triple-blind clinical trial. J Clin Periodontol 2008; 35:614-20. [PMID: 18422695 DOI: 10.1111/j.1600-051x.2008.01238.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED The use of chlorhexidine (CHX) has been recommended for a number of clinical applications including plaque control in the post-operative period. However, the use of CHX is burdened by some side effects that could affect the compliance of the patient. The aim of this clinical trial was to evaluate the side effects, the staining in particular, the patient acceptance, and the efficacy of a 0.2% CHX mouthwash containing an anti discoloration system (ADS) compared with a 0.2% CHX alone, after periodontal flap surgery. MATERIAL AND METHODS This single-centre, cross-over, triple-blind randomized clinical trial was carried out on 48 consecutive patients. After periodontal flap surgery, the patients were prescribed to rinse two times per day for 1 min for 1 week with 10 ml of test or control CHX, contained in anonymous bottles coded K or M and assigned randomly. No brushing and interdental cleaning of the surgical area was allowed. At week 1, after suture removal, patients received full-mouth prophylaxis and were given a second anonymous bottle, reversing the products, with the same instructions as at baseline. Patients resumed tooth-brushing but not interdental cleaning. At the end of week 2, prophylaxis was repeated, mouth rinsing was discontinued and patients resumed normal oral hygiene. At weeks 1 and 2, the following variables were recorded: presence of pigmentation, gingival parameters at the surgically treated sites (gingival inflammation, tissue inflammation around the sutures, gingival swelling and presence of granulation tissue), patient perception and acceptance of the 2 mouthwashes. RESULTS Forty-seven patients completed the study. The difference between treatments related to gingival variables was not statistically significant. The test CHX caused consistently less pigmentations than the control CHX in all the evaluated areas of the dental surfaces (odds ratio (OR)=0.083 p<0.0001 in the incisal area, OR=0.036 p<0.0001 in the approximal area and OR=0.065 p<0.0001 in the gingival area). The CHX ADS was found to be more tolerated by patients than the control mouthwash and to cause less food alteration, less alterations to the perception of salt and to be less irritant for the oral tissues. CONCLUSIONS (1) CHX ADS caused less pigmentation, was burdened by less side effects and was more agreeable than the control CHX; (2) CHX ADS was as effective as CHX without ADS in reducing gingival signs of inflammation in the post-surgical early healing phase; (3) the use of CHX ADS could be of value in treatment protocols in which the patient compliance with a CHX mouthwash prescription is relevant.
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Kozlovsky A, Artzi Z, Hirshberg A, Israeli-Tobias C, Reich L. Effect of local antimicrobial agents on excisional palatal wound healing: a clinical and histomorphometric study in rats. J Clin Periodontol 2007; 34:164-71. [PMID: 17309591 DOI: 10.1111/j.1600-051x.2006.01033.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To assess the effect of topically applied antimicrobial agents on palatal excisional wound in rats. MATERIALS AND METHODS Excisional wounds, 5 mm in diameter, were made in the centre of the palate of 125 Wistar male rats. In four experimental groups, chlorhexidine digluconate (CHX) 0.12% solution, 1% CHX gel, phenolic compounds solution (Listerine), amine/stannous fluoride solution (Meridol) and saline solution as a control group were applied daily for 1 min. The wound area was measured photographically and the epithelialization rate was determined histologically at 3, 7, 14 and 21 days post-surgery. RESULTS The mean wound area and mean distance between the epithelial margins decreased significantly with time (p<0.001) in experimental and control groups, with the greatest wound area reduction and rate of epithelialization on day 14. A significantly superior rate of wound epithelialization (p=0.03) was presented following use of 1% CHX gel and Listerine and a comparatively inferior one when the Meridol solution was applied. CONCLUSIONS Each tested antimicrobial agent when applied on an excisional wound with epithelial and connective tissue deficiency did not have a negative effect on the rate of wound closure. The best results were achieved with 1%CHX gel and Listerine.
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Affiliation(s)
- Avital Kozlovsky
- Department of Periodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
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Soldani F, Eastaugh D, Stirrups D, Foley J. Use of a removable healing plate after exposure of an unerupted incisor with an apically repositioned flap. Br J Oral Maxillofac Surg 2005; 44:546-7. [PMID: 16207509 DOI: 10.1016/j.bjoms.2005.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2005] [Accepted: 07/29/2005] [Indexed: 10/25/2022]
Affiliation(s)
- F Soldani
- Unit of Dental and Oral Health, Dundee Dental Hospital, Dundee, DD1 4HN, UK
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Abstract
This article reviews nonsurgical approaches for the management of periodontal diseases. A brief review of the pathogenesis of periodontitis allows the reader to identify the potential points of intervention. Assessment of risk factors for periodontitis and the potential for risk reduction are introduced as the first part of a three-pronged approach to therapy. Antimicrobial approaches, including the use of mechanical therapy, antiseptics, and antibiotics,are described next. Host modulatory therapy is addressed as the fi-nal component of the nonsurgical approach to periodontal therapy. Clinical applications of these nonsurgical options are presented as part of the treatment strategy.
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Affiliation(s)
- Maria Emanuel Ryan
- Department of Oral Biology and Pathology, School of Dental Medicine, Stony Brook University, State University of New York, South Campus, Stony Brook, NY 11794-8702, USA.
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Yukna RA, Krauser JT, Callan DP, Evans GH, Cruz R, Martin M. Thirty-six month follow-up of 25 patients treated with combination anorganic bovine-derived hydroxyapatite matrix (ABM)/cell-binding peptide (P-15) bone replacement grafts in human infrabony defects. I. Clinical findings. J Periodontol 2002; 73:123-8. [PMID: 11846193 DOI: 10.1902/jop.2002.73.1.123] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Long-term evaluation of periodontal therapy is important for clinical decision making. METHODS A synthetic cell-binding peptide (P-15) combined with anorganic bovine-derived hydroxyapatite bone matrix (ABM) was evaluated as a bone replacement graft in human periodontal osseous defects. Following initial preparation and reevaluation, flap surgery was performed. A variety of 1-, 2-, 3-wall bony defects were curetted and root surfaces subjected to mechanical debridement only. The bone defects were grafted with ABM/P-15, and the host flaps replaced or slightly coronally positioned. Weekly, then monthly deplaquing was performed until surgical reentry at 6 to 7 months. Patients were then followed on approximate 3-month recalls for 3 years. Twenty-five of the original 31 patients qualified for long-term evaluation in that their ABM/P-15 treated sites did not receive any additional therapy at the time of reentry. RESULTS Significant clinical changes for the overall group of bony defects included improvement in mean clinical attachment level from 5.4 mm at surgery to 4.5 mm at the 6-month reentry to 3.8 mm at 3 years. There was also a decrease in mean probing depth from 5.3 mm at surgery to 3.1 mm at the 6-month reentry to 2.9 mm at 3 years. The mean gingival recession changed from +0.1 mm at surgery to 1.4 mm at the 6-month reentry to 0.9 mm at 3 years. All of these differences were at least P <0.05 from surgery to the 6-month reentry, and surgery to 3 years, but were not significant from reentry to 3 years via repeated measures analysis of variance. CONCLUSIONS These favorable 3-year results with ABM/P-15 suggest that it may have a beneficial effect in the long-term clinical management of infrabony defects. Further long-term randomized controlled studies are needed to better assess the role of ABM/P-15 in long-term healing of periodontal osseous defects.
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Affiliation(s)
- Raymond A Yukna
- Department of Periodontics, Louisiana State University School of Dentistry, New Orleans 70119-2799, USA.
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Yukna RA, Krauser JT, Callan DP, Evans GH, Cruz R, Martin M. Multi-center clinical comparison of combination anorganic bovine-derived hydroxyapatite matrix (ABM)/cell binding peptide (P-15) and ABM in human periodontal osseous defects. 6-month results. J Periodontol 2000; 71:1671-9. [PMID: 11128913 DOI: 10.1902/jop.2000.71.11.1671] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Intraosseous periodontal defects present a particular treatment problem. New bone replacement grafts offer promise for improved results. METHODS The role of a synthetic cell-binding peptide (P-15), combined with anorganic [corrected] bovine-derived hydroxyapatite bone matrix (ABM), was compared to ABM alone in human periodontal osseous defects in a controlled, monitored, multi-center trial. Following appropriate initial preparation procedures, flap surgery with defect and root debridement was performed. Two osseous defects per patient were treated randomly with each procedure after surgical preparation. Appropriate periodontal maintenance schedules were followed, and at 6 to 7 months, re-entry flap surgery was performed for documentation and finalization of treatment. RESULTS T test and Mann-Whitney U analyses of patient mean values from 33 patients revealed that the combination ABM/P-15 grafts demonstrated significantly better mean defect fill of 2.9 +/- 1.2 mm (72.9%) versus a mean defect fill of 2.2 +/- 1.4 mm (50.67%) for defects treated with ABM (P<0.05). Other hard tissue findings showed similar clinically superior results with the use of ABM/P-15. Relative defect fill results showed 81% positive (50% to 100% defect fill) responses with ABM/P-15 and 67% positive responses with ABM. There were 3.5 times as many optimal results (> or = 90% defect fill) with ABM/P-15 and twice as many failures (minimal response) with ABM. Soft tissue findings showed no significant differences between treatments. CONCLUSIONS These results suggest that the use of the P-15 synthetic cell-binding peptide combined with ABM yields better clinical results than the ABM alone in intrabony periodontal defects.
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Affiliation(s)
- R A Yukna
- Department of Periodontics, Louisiana State University School of Dentistry, New Orleans 70119-2799, USA
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Horwitz J, Machtei EE, Peled M, Laufer D. Amine fluoride/stannous fluoride and chlorhexidine mouthwashes as adjuncts to surgical periodontal therapy: a comparative study. J Periodontol 2000; 71:1601-6. [PMID: 11063393 DOI: 10.1902/jop.2000.71.10.1601] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Postsurgical mouthwashes are routinely used in clinical studies and also in daily clinical practice. Chlorhexidine gluconate (CHX) has long been the gold standard for supra-gingival chemical plaque control regimens. Amine fluoride/stannous fluoride (AmF/SnF2) formulations have also been extensively studied and shown to have an antibacterial effect and be useful as antiplaque agents. The antibacterial effect of AmF/SnF2 and its minimal extrinsic tooth staining make it a possible alternative to CHX as an adjunct to periodontal surgical therapy. The aim of this double-blind, controlled clinical trial was to evaluate and compare the combined effect of an AmF/SnF2 or a CHX mouthwash and surgical periodontal therapy on periodontal parameters. METHODS Thirty-two patients with at least 3 pockets > or =5 mm in the same quadrant were selected for this study, following a hygienic phase of therapy. They were randomized into 2 treatment groups: surgical flap debridement and a postsurgical CHX mouthwash or surgical flap debridement and an AmF/SnF2 postsurgical mouthwash, performed twice daily for 3 weeks. Clinical measurements were taken at baseline and 3 and 12 weeks postsurgery. RESULTS Both treatment modalities resulted in significant improvements in probing depth and clinical attachment level. There was no significant difference between groups in any of the recorded parameters. Staining index at week 3 in the CHX group was significantly higher than in the AmF/SnF2 group (P<0.05). However these differences leveled down at 12 weeks. CONCLUSIONS Our results support the alternative use of an AmF/SnF2 mouthwash in plaque control management of patients following flap debridement surgery.
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Affiliation(s)
- J Horwitz
- Department of Oral and Maxillofacial Surgery, Rambam Medical Center, Haifa, Israel.
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Yukna RA, Callan DP, Krauser JT, Evans GH, Aichelmann-Reidy ME, Moore K, Cruz R, Scott JB. Multi-center clinical evaluation of combination anorganic bovine-derived hydroxyapatite matrix (ABM)/cell binding peptide (P-15) as a bone replacement graft material in human periodontal osseous defects. 6-month results. J Periodontol 1998; 69:655-63. [PMID: 9660334 DOI: 10.1902/jop.1998.69.6.655] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A synthetic cell-binding peptide (P-15) combined with anorganic bovine-derived hydroxyapatite bone matrix (ABM) was compared to demineralized freeze-dried bone allograft (DFDBA) and open flap debridement (DEBR) in human periodontal osseous defects in a controlled, monitored, multi-center trial. Following appropriate initial preparation procedures, flap surgery with defect and root debridement was performed. Three osseous defects per patient were treated randomly with one of three procedures after surgical preparation. Appropriate periodontal maintenance schedules were followed, and at 6 to 7 months re-entry flap surgery was performed for documentation and finalization of treatment. Analysis of variation (ANOVA) and t test analyses of patient mean values from 31 patients revealed that the combination ABM/P-15 grafts demonstrated significantly better mean defect fill of 2.8 +/- 1.2 mm (72.3%) versus a mean defect fill of 2.0 +/- 1.4 mm (51.4%) for defects treated with DFDBA (P <0.05) and a mean defect fill of 1.5 +/- 1.3 mm (40.3%) (P <0.05) for defects treated with DEBR. Other hard tissue findings showed similar clinically superior results with the use of ABM/P-15. Relative defect fill results showed 87% positive (50% to 100% defect fill) responses with ABM/P-15, 58% positive responses with DFDBA, and 41% positive responses with DEBR. There were 8 to 9 times more failures (minimal response) with DFDBA and DEBR (26% to 29% frequency) than with ABM/P-15. Soft tissue findings showed no significant differences among treatments except for greater clinical attachment level gain with ABM/P-15 compared to DEBR. These results suggest that the use of the P-15 synthetic cell-binding peptide combined with ABM yields better clinical results than either DFDBA or DEBR. Further studies are needed to determine the relative roles of the ABM and/or the P-15 in these improved results.
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Affiliation(s)
- R A Yukna
- Department of Periodontics, Louisiana State University School of Dentistry, New Orleans 70119-2799, USA
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Yukna RA, Yukna CN. Six-year clinical evaluation of HTR synthetic bone grafts in human grade II molar furcations. J Periodontal Res 1997; 32:627-33. [PMID: 9409457 DOI: 10.1111/j.1600-0765.1997.tb00572.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A biocompatible microporous composite of PMMA (poly-methyl-methacrylate), PHEMA (poly-hydroxy-ethyl-methacrylate) and calcium hydroxide bone replacement graft material (Bioplant HTR Synthetic Bone) was evaluated in 16 maxillary molar and 10 mandibular molar Grade II furcations in 13 patients. Following initial preparation, full thickness flaps were raised to gain access to the furcations; mechanical hand and ultrasonic root and defect debridement and chemical tetracycline root preparation were performed; furcation and adjacent osseous defects in each patient were grafted with HTR Synthetic Bone; and the host flaps replaced or slightly coronally positioned. Weekly, then monthly deplaquing was performed until surgical re-entry at 6-12 months. Patients were then followed on approximate 3-month recalls for > or = 6 yr. Evaluation of the primary clinical outcome of furcation grade change showed that in the maxilla 5/16 furcations were clinically closed, 9/16 were Grade I, and 2/16 remained Grade II; while in the mandible 3/10 were clinically closed, 5/10 were Grade I, and 2/10 remained Grade II. Other significant clinical changes included decrease in mean horizontal furcation probing attachment level from 4.4 mm at surgery to 2.2 mm at re-entry to 2.0 mm at 6 yr, decrease in probing pocket depth from 5.4 mm at surgery to 3.0 mm at re-entry to 3.2 mm at 6 yr, and improvement in vertical clinical probing attachment level from 5.4 mm at surgery to 4.2 mm at re-entry to 4.1 mm at 6 yr (all p < 0.05 from surgery to re-entry and surgery to 6 yr, n.s. from re-entry to 6 yr via ANOVA). These favorable results with HTR polymer are similar to several reports with other graft materials and with GTR barriers, and suggest that HTR polymer may have a beneficial effect in the clinical management of Grade II molar furcations.
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Affiliation(s)
- R A Yukna
- Louisiana State University School of Dentistry, New Orleans, USA
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Abstract
The aim of the present study was to determine the effects of a 0.2% hexetidine spray, used as a supplement to regular oral hygiene measures, on dental plaque and gingival condition following periodontal surgery. This study was carried out on 38 patients who required 2 episodes of periodontal surgery. Examinations regarding dental plaque were performed at 0, 7, 14, 21 and 28 days, while the condition of the gingiva were examined at 0 and 28 days. Dental plaque was assessed by the Turesky modification of Quigley-Hein index; the gingival condition was evaluated using the gingival index of Löe-Silness and the papilla bleeding index. In a double-blind cross-over study of 28 days duration, significant reduction in plaque accumulation and an improvement in wound healing were demonstrated for the test spray compared to the placebo.
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Affiliation(s)
- M Bokor
- Department of Periodontology and Oral Medicine, Dental School, Faculty of Medicine, University of Novi Sad, Yugoslavia
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Affiliation(s)
- K G Palcanis
- Department of Periodontics, School of Dentistry, University of Alabama, Birmingham, USA
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Simion M, Trisi P, Maglione M, Piattelli A. Bacterial penetration in vitro through GTAM membrane with and without topical chlorhexidine application. A light and scanning electron microscopic study. J Clin Periodontol 1995; 22:321-31. [PMID: 7622640 DOI: 10.1111/j.1600-051x.1995.tb00155.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Premature exposure of membrane in the oral cavity is considered the most common complication as well as a reason for failure or incomplete success of guided tissue regeneration, as the exposed membrane undergoes plaque accumulation. A method to control, or at least to reduce the bacterial invasion of the membrane allowing a delay in the membrane removal, could be of clinical interest. The purpose of the present study was to evaluate the possibility of treating, with topical chlorhexidine application, the bacterial colonization of exposed membranes. A special device was developed in order to evaluate, under an experimental environment, the bacterial colonization. This device was made from a removable acrylic denture base to which 5 gold cups were attached. The cups consisted of an internal compartment, isolated from the oral cavity by a GTAM membrane, and an external compartment exposed to the oral environment. 3 healthy subjects had this device fitted, bilaterally, in the molar-premolar region of the upper jaw. The cups of one side of each subject had 0.2% chlorhexidine gluconate gel applied 2x a day for 1 min, whereas those of the other side served as controls. 12 cups were removed after 2 weeks and the remainder removed after 1 month. The non-treated control specimens were characterized by greater amounts of plaque accumulation. In all the test sites, plaque deposits increased in thickness and quantity during the 4 weeks of the experiment. Complete invasion of the membrane and initial colonization of its internal surface were observed only in 4-week specimens. A relatively simple flora consisting mainly of cocci and short rods, was found in bacterial deposits forming under the influence of chlorhexidine, whereas in non-treated specimens, it was possible to observe a more mature and complex plaque, composed mostly of filamentous bacteria. In conclusion, topical application of chlorhexidine gel is an effective method of reducing plaque and calculus formation on the surface of GTAM membranes exposed to the oral cavity for up to 4 weeks. This study has, however, failed to demonstrate the capacity of chlorhexidine to prevent or to retard bacterial penetration through the thickness of the inner portion of the membranes.
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Affiliation(s)
- M Simion
- University of Milan, Dental School, Italy
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Abstract
The purpose of this paper is to review the mechanism of the action, safety, and side-effects of chlorhexidine, and to provide guidelines for its use in special populations. Chlorhexidine has been used orally since 1959, primarily for the control of dental plaque. Chlorhexidine is a safe material, with low toxicity potential when used correctly. The most conspicuous side-effects are the development of yellow-brown stains on the teeth, tongue, and at the margins of anterior restorations, and an alteration in taste sensation. The use of chlorhexidine is indicated in developmentally disabled, medically compromised patients, and in dependent elderly populations, since these groups are often physically unable to remove plaque by mechanical means. Clinicians should not prescribe chlorhexidine indiscriminately for all patients, however, until analyzing its efficacy, safety, and side-effects.
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Affiliation(s)
- M A al-Tannir
- Department of Veterans Affairs, Perry Point, Maryland
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Yukna RA. Clinical evaluation of HTR polymer bone replacement grafts in human mandibular Class II molar furcations. J Periodontol 1994; 65:342-9. [PMID: 8195979 DOI: 10.1902/jop.1994.65.4.342] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A biocompatible microporous composite of PMMA (poly-methyl-methacrylate), PHEMA (poly-hydroxyl-ethyl-methacrylate), and calcium hydroxide (HTR) or autogenous osseous coagulum (AOC) bone replacement grafts were evaluated in 15 pairs of mandibular molar Class II furcations in 9 patients. Following initial preparation, full thickness flaps were raised to gain access to the furcations; mechanical hand and ultrasonic root and defect debridement and chemical (tetracycline) root preparation were performed; paired furcations in each patient were randomly grafted with either HTR or AOC; and the host flaps replaced or slightly coronally positioned. Weekly, then monthly, deplaquing was performed until surgical re-entry at 6 to 12 months. Both treatments improved the clinical status of the treated furcations. Direct clinical measurements demonstrated essentially equivalent clinical results with both bone replacement graft materials related to most hard and soft tissue changes in the furcations. Differences in favor of HTR were found for horizontal residual furcation depth (2.4 mm vs. 3.9 mm), horizontal furcation fill (1.9 mm vs. 0.8 mm), and percent horizontal furcation fill (44.4% vs. 17.1%) (all P < or = 0.05 paired t test). These favorable results with HTR polymer are similar to several reports with other graft materials and with GTR barriers, and suggest that HTR polymer may be a useful therapeutic adjunct in the clinical management of grade II mandibular molar furcations.
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Affiliation(s)
- R A Yukna
- Department of Periodontics, Louisiana State University School of Dentistry, New Orleans
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Yukna RA. Clinical human comparison of expanded polytetrafluoroethylene barrier membrane and freeze-dried dura mater allografts for guided tissue regeneration of lost periodontal support. I. Mandibular molar Class II furcations. J Periodontol 1992; 63:431-42. [PMID: 1527687 DOI: 10.1902/jop.1992.63.5.431] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The response of mandibular Class II facial furcations to guided tissue regeneration treatment with expanded polytetrafluoroethylene barrier membrane (e-PTFE) or freeze-dried dura mater allograft (FDDMA) barriers was evaluated in 11 pairs of molars in 11 patients. Following initial preparation, full thickness flaps were raised in the area being treated, the bone and furcation defects debrided of granulomatous tissue, and the involved root surfaces mechanically and chemically prepared. By random allocation, e-PTFE or FDDMA barriers were fitted over the furcations, secured in place, and the host flap repositioned or coronally positioned. Postsurgical deplaquing was performed every 10 days leading up to e-PTFE removal at about 6 weeks (the resorbable FDDMA did not require removal). Continuing supportive periodontal therapy was provided until surgical re-entry at one year for documentation and any further necessary treatment. Direct clinical measurements demonstrated essentially similar clinical results with both barrier materials for bone and soft tissue changes (few statistically or clinically significant differences). Exceptions were the amount of horizontal furcation fill and the change in the width of the keratinized gingiva, both of which were better with FDDMA (P less than 0.05). Improvements in open probing attachment levels observed at the time of e-PTFE removal were lost over the intervening months, more so for the vertical than the horizontal component of the furcation lesion. Intrapatient comparisons suggested better horizontal furcation responses with FDDMA. The findings of this study suggest equal clinical results with e-PTFE and FDDMA barriers utilizing the GTR technique. These results in Class II mandibular furcations are less favorable than those reported by others. Barrier techniques to handicap the race between different tissues of the periodontal complex appear to be of some clinical benefit and deserve further evaluation.
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Affiliation(s)
- R A Yukna
- Department of Surgical Dentistry, University of Colorado School of Dentistry, Denver
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Veksler AE, Kayrouz GA, Newman MG. Reduction of salivary bacteria by pre-procedural rinses with chlorhexidine 0.12%. J Periodontol 1991; 62:649-51. [PMID: 1753316 DOI: 10.1902/jop.1991.62.11.649] [Citation(s) in RCA: 63] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The purpose of this study was to assess the effect of pre-procedural rinsing (2 consecutive rinses) with 0.12% chlorhexidine gluconate (CHX) on salivary bacteria during scaling and root planing procedures (S&RP). Because blood and debris arising from S&RP could inactivate CHX and decrease its antimicrobial effect, patients were evaluated throughout their appointment. Forty subjects rinsed with either 15 ml of CHX rinse or control (sterile water) for 30 seconds, expectorated and immediately rinsed again for 30 seconds. Unstimulated saliva samples were obtained at baseline (immediately before rinsing), and at 1 minute, 30 minutes, and 60 minutes after baseline. All 30 and 60 minute samples contained visible blood and debris. Samples were immediately diluted in transport fluid containing a CHX-neutralizer and then plated on trypticase soy agar for enumeration of the total aerobic and facultative bacterial load. The dual rinses with 0.12% CHX immediately reduced the salivary bacterial load 97% and this reduction persisted for 60 minutes during S&RP. At 30 minutes and at 60 minutes aerobic bacteria were reduced 77% compared to control, and 96% compared to baseline. CHX was not inactivated by the high organic load (blood and debris) present during the procedure. Pre-procedural rinsing with CHX has a profound and sustained effect on the aerobic and facultative flora of the oral cavity, which may contribute to a variety of clinical benefits. Pre-procedural rinsing may also be of value in protecting patients and dental professionals during dental manipulations.
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Sorensen JA, Doherty FM, Newman MG, Flemmig TF. Gingival enhancement in fixed prosthodontics. Part I: Clinical findings. J Prosthet Dent 1991; 65:100-7. [PMID: 2033528 DOI: 10.1016/0022-3913(91)90059-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study assessed the efficacy of a 0.12% chlorhexidine gluconate (CHX) rinse on the enhancement and maintenance of gingival health in patients receiving fixed prosthodontic treatment. Thirty patient participants in this examiner blind study were randomly assigned into two groups, one control and another group using CHX 15 ml b.i.d. in addition to normal oral hygiene. The medication was used for 2 weeks prior to crown preparation, 3 weeks during provisional crown placement, and 2 weeks after definitive crown cementation. Plaque and gingivitis indices were measured initially and at the three aforementioned points during the 7-week period. The plaque index for the control group decreased by 0.26 units; CHX decreased by 0.63 units at 7 weeks. The gingival index of the control group decreased by 0.37 units; CHX decreased by 0.87 units. Adjunctive use of chlorhexidine with fixed prosthodontic procedures significantly reduced plaque levels and significantly improved gingival health compared with the control patients. Fixed prosthodontic procedures alone decreased plaque levels and increased gingival health.
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Affiliation(s)
- J A Sorensen
- University of California, School of Dentistry, Los Angeles
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Phillips RW, Jendresen MD, Klooster J, McNeil C, Preston JD, Schallhorn RG. Report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 1990; 64:74-110. [PMID: 2200881 DOI: 10.1016/0022-3913(90)90155-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The growth in the dental literature continues to escalate, as evidenced by the publication of at least 326 new books in 1988 and 1989 and more than 20 new journals in 1989. There still appears to be undue emphasis on quantity instead of quality of research. This proliferation in the literature poses ever increasing difficulties to this Committee in filtering out the articles that are of particular interest to the members of the Academy and identifying those that are most likely to have a major impact on dental practice and service. The subjects covered include periodontics, caries and preventive dentistry, craniomandibular disorders, occlusion, pulp biology, ceramics, and restorative dental materials.
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Newman MG, Sanz M, Nachnani S, Saltini C, Anderson L. Effect of 0.12% chlorhexidine on bacterial recolonization following periodontal surgery. J Periodontol 1989; 60:577-81. [PMID: 2681676 DOI: 10.1902/jop.1989.60.10.577] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Bacterial plaque accumulation following periodontal surgery has been directly associated with delayed and altered surgical wound healing. Successful antimicrobial treatment following periodontal surgery depends upon the elimination and suppression of wound associated microorganisms. Highly effective antimicrobials should also prevent recolonization of periodontopathogens. In this investigation, the antimicrobial effect of a 0.12% chlorhexidine gluconate mouthrinse (Peridex) on bacterial recolonization after periodontal surgery was determined. A double-blind, randomized, placebo-controlled study was carried out on 40 patients for 6 weeks. Patients with moderate periodontitis (AAP Class III) underwent osseous periodontal flap surgery in one quadrant. Subgingival and marginal plaque samples from the surgery area were taken prior to surgery and 2 and 6 weeks postoperatively. General descriptive bacteriological cultural analysis and assays for specific microbial populations were carried out. During the 6 weeks of mouthrinse use, patients using chlorhexidine had significant reductions over placebo (P less than 0.05) in the number of total Gram-positive facultative cocci, streptococci (85.8%); Gram-positive facultative rods, primarily Actinomyces (91.7%); Capnocytophaga (97.6%) and Gram-negative anaerobic rods (94.5%). Few black pigmented Bacteroides or Actinobacillus actinomycetemcomitans were found prior to surgery or any time postoperatively. In the chlorhexidine group, 6 weeks post surgery, streptococci were the predominant bacterial group in the sampled plaque. Quantitatively, the distribution of bacteria, after 2 and 6 weeks of mouthrinse use, was consistent with a young, less mature plaque. A previous study demonstrated that this plaque was associated with clinical health.
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Affiliation(s)
- M G Newman
- UCLA School of Dentistry, Section of Periodontics
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