Clinical Evaluation of the Use of Locally Delivered Chlorhexidine in Periodontal Maintenance Therapy

Efficacy of Chlorhexidine Chips as Local Drug Delivery in Nonsurgical Management of Chronic Periodontitis: A Systematic Review

This systematic review assesses the efficacy of local chlorhexidine (CHX) chips as an adjunct to nonsurgical scaling and root planing (SRP) in treating chronic periodontitis, compared to SRP alone. A comprehensive search strategy was developed to identify relevant studies, focusing on articles published in English. Searches were conducted in MEDLINE (via PubMed), Web of Science, and periodontology journals up to December 2020, specifically looking for studies on the use of CHX chips alongside SRP for managing chronic periodontitis. This research took place from January to September 2024. The review found that sites treated with SRP plus CHX chips showed improvements in probing pocket depth, clinical attachment level, plaque index, and gingival index. The results revealed that 48.50% of the findings were not statistically significant between the two treatment groups. In contrast, 25.75% of the findings were significant for the CHX chips group compared to the SRP alone group, while 1.5% were significant for the control group. Additionally, 24.25% of the data were unavailable. Combining SRP with CHX chips results in more significant improvements in treating chronic periodontitis.

Chlorhexidine gel topical application ameliorates inflammatory bone loss in experimental periodontitis

OBJECTIVES

This study aimed to evaluate the impact of chlorhexidine (CHX) gel on inflammation-induced periodontal tissue destruction, osteoclastogenesis, subgingival microbiota, and on the modulation of the RANKL/OPG as well as inflammatory mediators during bone remodeling in vivo.

MATERIALS AND METHODS

Ligation- and LPS injection-induced experimental periodontitis were created to investigate the effect of topical application of CHX gel in vivo. Alveolar bone loss, osteoclast number and gingival inflammation was evaluated by micro-CT, histological, immunohistochemistry and biochemical analysis. The composition of the subgingival microbiota was characterized by 16S rRNA gene sequencing.

RESULTS

Data shows significant decreases in the alveolar bone destruction in rats from ligation-plus-CHX gel group compared to ligation group. In addition, significant decreases in the number of osteoclasts on bone surface and the protein level of receptor activator of nuclear factor κB ligand (RANKL) in gingival tissue were observed in rats from ligation-plus-CHX gel group. Moreover, data shows significantly decreased inflammatory cell infiltration and decreased expression of cyclooxygenase (COX-2) and inducible NO synthase (iNOS) in gingival tissue from ligation-plus-CHX gel group versus ligation group. Assessment of the subgingival microbiota revealed changes in rats with CHX gel application treatment.

CONCLUSION

HX gel presents protective effect on gingival tissue inflammation, osteoclastogenesis, RANKL/OPG expression, inflammatory mediators, and alveolar bone loss in vivo, which may have a translational impact on the adjunctive use in the management of inflammation-induced alveolar bone loss.

Clinical and microbiological effects of a single application of sodium hypochlorite gel during subgingival re-instrumentation: a triple-blind randomized placebo-controlled clinical trial

OBJECTIVES

The aim of this study is to assess the clinical and microbiological effects of a single subgingival administration of sodium hypochlorite gel (NaOCl) and compare it with 1% chlorhexidine (CHX) gel and a placebo gel following mechanical re-instrumentation during supportive periodontal therapy (SPT).

MATERIALS AND METHODS

Sixty-two patients who had been treated for stage III-IV periodontitis and enrolled in SPT were included in the study based on following criteria: (1) active periodontal therapy completed at least 6 months before enrollment in the study, (2) presence of at least 4 non-adjacent sites with probing pocket depths (PPDs) ≥ 4 mm with bleeding on probing (BOP), or presence of 5-8 mm PPDs with or without BOP. All sites presenting PPD ≥ 4 mm and BOP at baseline and 3-, 6-, and 9-month follow-up timepoints were subgingivally re-instrumented with ultrasounds. Selected patients were randomly assigned into three groups and treated additionally with a single subgingival administration of NaOCl gel (group A); 1% CHX gel (group B); and placebo gel (group C). Main outcome variable was pocket closure at 12 months. Secondary outcome variables were changes in mean PPD, BOP, and clinical attachment level (CAL) along with changes in the numbers of the following five keystone bacterial pathogens: Aggregatibacter actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), Prevotella intermedia (P.i.), Tannerella forsythia (T.f.), and Treponema denticola (T.d.).

RESULTS

At 12 months, pocket closure was obtained in 77.5% in the NaOCl treated sites. The reduction in PPD was higher with CHX than with NaOCl, although a statistically significant adjunctive effect for NaOCl (P = 0.028) was only observed in comparison with placebo only. Mean CAL improved in all groups and at all timepoints, compared to the baseline (P < 0.05). However, after 6 months, CAL gain was statistically significantly higher in the NaOCl treated group than following application of CHX (P = 0.0026).

CONCLUSION

In SPT patients, a single adjunctive use of a NaOCl gel may provide benefits in controlling inflammation and residual pockets.

TRIAL REGISTRATION

ISRCTN Registry of Clinical Trials (ISRCTN11387188).

CLINICAL RELEVANCE

A baseline single application of NaOCl gel in conjunction with mechanical debridement may achieve substantial pocket closure in patients enrolled in SPT; treatment time, cost, and applicability considerations should be taken into account when selecting this therapy.

Local Oral Delivery Agents with Anti-Biofilm Properties for the Treatment of Periodontitis and Peri-Implantitis. A Narrative Review

Despite many discoveries over the past 20 years regarding the etiopathogenesis of periodontal and peri-implant diseases, as well as significant advances in our understanding of microbial biofilms, the incidence of these pathologies continues to rise. For this reason, it was clear that other strategies were needed to eliminate biofilms. In this review, the literature database was searched for studies on locally delivered synthetic agents that exhibit anti-biofilm properties and their potential use in the treatment of two important oral diseases: periodontitis and peri-implantitis.

Design and Evaluation of pH-Dependent Nanosystems Based on Cellulose Acetate Phthalate, Nanoparticles Loaded with Chlorhexidine for Periodontal Treatment

This work aimed to develop and evaluate pH-dependent systems based on nanospheres (NSphs) and nanocapsules (NCs) loaded with chlorhexidine (CHX) base as a novel formulation for the treatment of periodontal disease. Cellulose acetate phthalate (CAP) was employed as a pH-dependent polymeric material. The NSphs and NCs were prepared using the emulsion-diffusion technique and then characterized according to encapsulation efficiency (EE), size, zeta-potential, morphology, thermal properties, release profiles and a preliminary clinical panel test. The formulations showed 77% and 61% EE and 57% and 84% process efficiency (PE), respectively. Both systems were spherical with an average size of 250–300 nm. Differential scanning calorimetry (DSC) studies showed that the drug has the potential to be dispersed molecularly in the NSph matrix or dissolved in the oily center of the NCs. The CHX release test revealed that the release of NSphs-CHX follows Fickian diffusion involving diffusion-erosion processes. The NCs showed a slower release than the NSphs, following non-Fickian diffusion, which is indicative of anomalous transport. These nanosystems may, therefore, be employed as novel formulations for treating periodontal disease, due to (1) their coverage of a large surface area, (2) the controlled release of active substances at different pH, and (3) potential gingival tissue infiltration.

Evaluation of Turmeric Chip Compared with Chlorhexidine Chip as a Local Drug Delivery Agent in the Treatment of Chronic Periodontitis: A Split Mouth Randomized Controlled Clinical Trial

AIMS AND OBJECTIVE

The aim of this study was to evaluate and compare the effect of chlorhexidine (CHX) chip and turmeric chip as a local drug delivery (LDD) agent in the treatment of patients with chronic periodontitis.

MATERIALS AND METHODS

A total of 120 sites with pocket depths 5-8 mm were chosen as a split mouth design at 3 sites in the same patient. Selected sites were randomly divided into three groups to receive CHX chip in addition to scaling and root planing (SRP) in group A, turmeric chip in addition to SRP in group B, and SRP only in group C. Clinical parameters, that is, plaque index (PI), gingival index (GI), probing pocket depth (PPD), and relative attachment level (RAL) were recorded at baseline, 1 month, and 3 months interval.

RESULT

On applying statistical analysis, results revealed that there was a significant reduction in all the clinical parameters, that is, PI, GI, PPD, and gain in RAL from baseline to 1 month and 3 months in all the three groups. These results were found to be significantly high in the CHX group and turmeric group than in the SRP group. Also, the results in both the test groups were maintained till the end of the study periods, but SRP group showed a significant deterioration after 1 month as was seen by increase in PPD and decrease in RAL scores after 3 months in the SRP group.

CONCLUSION

Both the treatment modalities with the application of LDD as an adjunct to SRP proved to be equally beneficial in the treatment of chronic periodontitis.

Different methods for subgingival application of chlorhexidine in the treatment of patients with chronic periodontitis

OBJECTIVE

The aim of this study was to evaluate clinical efficacy of different chlorhexidine gluconate (CHX) preparations applied subgingivally as an adjunct to scaling and root planing (SRP).

MATERIAL AND METHODS

A total of 120 periodontal pockets was included in this randomized, controlled, split mouth designed study. According to protocols used in treatment, periodontal pockets were assigned to experimental and control groups as follows: CHX solution as an addition to SRP versus control SRP group; CHX gel as an addition to SRP versus control SRP; CHX chip as an addition to SRP versus control SRP group. Following clinical parameters were recorded at baseline, one and three months after the baseline: plaque index (PI), probing pocket depth (PPD), bleeding index (BI) and clinical attachment level (CAL).

RESULTS

The most significant improvements were found concerning PI in CHX solution with SRP and CHX gel with SRP groups over controls at one month recall, as well as concerning BI and PPD in CHX chip with SRP group over SRP alone at three-month recall.

CONCLUSION

Results of this study favour combination therapy using CHX chip as an adjunct to SRP due to greater improvements in BI and PPD compared to those obtained by SRP alone in the treatment of chronic periodontitis.

Influence of application of chlorhexidine gel and curcumin gel as an adjunct to scaling and root planing: A interventional study

Background:

Currently, the most common therapy for periodontal diseases consists of professional scaling and root planing (SRP). However, it was found to be of limited efficacy especially in areas which are inaccessible to periodontal instrumentation. Therefore, treatment strategies using antimicrobials in conjunction with conventional therapy have evolved. Thus, the study was undertaken with an.

Aim:

To evaluate the efficacy of application of chlorhexidine gel and curcumin gel as an adjunct to SRP.

Materials and Methods:

The study was conducted on thirty chronic periodontitis patients who were divided into two groups as control and experimental groups using a split-mouth design. After SRP chlorhexidine gel was applied in control and curcumin gel in experimental groups. The plaque index, gingival index, sulcus bleeding index, probing pocket depth were recorded at baseline and subsequently after 1 month and 45 days.

Results:

The results revealed that both chlorhexidine gel and curcumin gel have an effect on mild to moderate periodontal pockets in chronic periodontitis patients, but greater reduction was observed in the experimental group than the control group.

Conclusion:

It can be concluded that both control and experimental gel can be used as an adjunct to SRP, but the curcumin gel was more effective than the chlorhexidine gel in the treatment of mild to moderate periodontal pockets with a significant reduction in the indice scores when compared to the baseline values.

Adjunctive Effects of A Piscean Collagen-Based Controlled-Release Chlorhexidine Chip in the Treatment of Chronic Periodontitis: A Clinical and Microbiological Study

INTRODUCTION

PerioChip a bovine origin gelatine based CHX chip has shown beneficial effects in the management of Chronic Periodontitis. A new fish collagen based CHX chip similar to PerioChip is currently available; however this product has not been thoroughly researched.

AIM

The aim of the present study was to evaluate the effectiveness of a new Piscean collagen-based controlled-release chlorhexidine chip (CHX chip) as an adjunctive therapy to scaling and root planing (SRP).

SETTINGS AND DESIGN

The study was conducted as a randomised, split-mouth, controlled clinical trial at Krishnadevaraya College of Dental Sciences, Bangalore, India.

MATERIALS AND METHODS

In a split-mouth study involving 20 sites in 10 patients with chronic periodontitis, control sites received scaling and root planing and test sites received scaling and root planing (SRP) and the intrapocket CHX chip placement as an adjunct. Subgingival plaque samples were collected from both control and test sites at baseline, 11 days and 11 weeks and the anaerobic colony count were assessed. Clinical parameters that were recorded at baseline and 11 weeks were gingival index, Plaque index, Probing pocket depth (PPD), and Clinical attachment level (CAL). Plaque index was recorded additionally at 11 days.

RESULTS

In the test group there was a statistically significant reduction in the total anaerobic colony count, gingival index and plaque scores from baseline as compared to control sites at all time intervals. An additional 0.8mm reduction in mean probing pocket depth was noted in the test group. Gain in Clinical attachment level was comparable in both groups.

CONCLUSION

The adjunctive use of the new collagen-based CHX chip yielded significant antimicrobial benefit accompanied by a reduction in probing depth and a clinical attachment level gain as compared to SRP alone. This suggests that it may be a useful treatment option of nonsurgical periodontal treatment of chronic periodontitis.

Comparison of Periochip (chlorhexidine gluconate 2.5 mg) and Arestin (Minocycline hydrochloride 1 mg) in the management of chronic periodontitis

BACKGROUND

The aim of the study was to compare the efficacy of chlorhexidine gluconate 2.5 mg (Periochip) and Minocycline hydrochloride 1 mg (Arestin) as local drug delivery agents in the management of chronic periodontitis.

MATERIALS AND METHODS

Twenty patients in the age group of 30-50 years suffering from chronic periodontitis (12 males and 8 females), with almost identical probing depth bilaterally (5-8 mm), and exhibiting bleeding on probing were selected and divided into two groups: Group I consisted of periodontal pockets on the left side and received Periochip and group II consisted of periodontal pockets on the right side and received Arestin. Patients were recalled after 6 weeks and 3 months intervals from the baseline visit to record plaque index, gingival index, and probing depth.

RESULTS

There was reduction in all the parameters in both the groups at 6 weeks and 3 months as compared to baseline.

CONCLUSION

From the results of the present study, it was concluded that both the drugs were equally effective in reduction of plaque scores as well as gingival scores. It was further observed that Arestin resulted in better results at 6 weeks while Periochip showed better results at 3 months with respect to probing depth reduction.

Effect of chlorhexidine chip in the treatment of chronic periodontitis

AIMS

The evaluation of clinical and specific microbiological changes associated with chlorhexidine chip in the chronic periodontitis patients.

MATERIALS AND METHODS

A total of 30 chronic periodontitis patients (aged 20-65 years) having pocket depth of ≥5 mm in molar teeth were selected and randomly divided into following treatment groups: Group 1 - Scaling and root planning (SRP), Group 2 - SRP along with chlorhexidine chip and Group 3 - Only chlorhexidine chip. The clinical and microbial parameters were recorded at baseline and 1 and 3 months post-treatment as above. Benzoyl-DL-arginine-naphthylamide (BANA) chair side test was used for estimation of specific microbiota.

RESULTS

Gingival index, probing pocket depth and clinical attachment level scores in selected teeth within the groups at different time intervals was significantly (P < 0.001) different. Although, the comparison between groups for specific microbiota in selected sites at different intervals was not statistically significant at baseline and 1 month, it reached statistical significance at 3(rd) month post-treatment. Although significant reductions in percentage of BANA positive sites were observed in all three groups, the Group 2 had significantly greater percentage of BANA negative sites.

CONCLUSION

Local drug delivery using chlorhexidine chip enhances the benefit of SRP in the treatment of chronic periodontitis.

Chlorhexidine chip in the treatment of chronic periodontitis - a clinical study

AIM

The aim of this study was to clinically evaluate the use of biodegradable chlorhexidine chip when used as an adjunct to scaling and root planing (SRP) in the treatment of moderate to severe periodontitis patients. The study also intended to compare the combined therapy (SRP and Chlorhexidine chip) with chlorhexidine chip alone in individuals with periodontitis.

MATERIALS AND METHODS

Fifteen patients with three sites having a probing depth of 5-8mm were considered for the study. Sites were numbered 1, 2, 3 randomly. The clinical parameters assessed were the Plaque Index (PI), gingival index (GI), Bleeding on probing (BOP), Clinical attachment level (CAL) and Probing pocket depth (PPD). Following baseline evaluation, on two sites scaling and root planing (SRP) was performed, no treatment was carried out in the third site. Chlorhexidine chips were placed on one site with SRP and another without SRP. A periodontal pack was placed on the site to prevent dislodgement of the CHX chip. Clinical parameters were recorded at baseline, one month and three months. Duration of the study was for three months.

STATISTICAL ANALYSIS

T-test and Analysis of variance (ANOVA) has been carried out in the present study.

RESULTS

All three groups presented with an improvement in the clinical parameters compared to baseline. There was no statistically significant difference between the SRP and SRP + CHIP group in all parameters. There was a significant difference when these two groups were compared to the chip alone group. The mean reductions in PPD were 2.8mm (SRP group), 2.6 (SRP+CHIP group), 0.8 (chip alone group) The mean gain in CAL were 2.8mm (SRP group), 2.5 (SRP+CHIP group), 0.7 (chip alone group). Reduction in bleeding on probing were significant for the SRP and SRP +CHIP group but not for the chip alone group.

CONCLUSION

The CHX chip did not provide any clinical benefit beyond that achieved with conventional scaling and rootplaning after a three month period.

Therapeutic effects of local drug delivery systems - PerioChip® in the treatment of periodontal disease

The primary goal of periodontal treatment is to stop periodontal disease progression and reduce future risks in disease recurrence. In order to overcome the limitations of the conventional treatment, controlled drug delivery systems for application in periodontal pockets have been developed. Their use offers several advantages: the therapeutic agent is targeted directly to the disease site and concentrations are 10-100 folds higher than the concentrations achieved by systemic administration, with low incidence of side effects. The PerioChip® is as local controlled-release biodegradable delivery system containing chlorhexidine digluconate. Several multicenter clinical trials have shown that the application of the PerioChip® in periodontal pockets as adjunct to the conventional periodontal treatment significantly improved the clinical parameters. In this article, the results from controlled clinical studies aimed to evaluate the clinical and microbiological efficacy of the PerioChip®, are discussed.

Comparison of the efficacy of chlorhexidine varnish and chip in the treatment of chronic periodontitis

BACKGROUND

The purpose of this study was to clinically evaluate the benefits of sub gingival chlorhexidine (CHX) varnish and biodegradable CHX chip application used as an adjunct to scaling and root planning (SRP) as combined therapy and also to compare the effect of combined therapy with SRP alone.

MATERIALS AND METHODS

Fifteen patients with at least three sites with a probing pocket depth (PPD) of 5-8 mm were considered. Following baseline evaluation, all three sites were subjected for SRP. After completing SRP, each site was randomly subjected for CHX varnish, CHX chip application and the 3(rd) site was left without any medication as a control. Clinical parameters such as sulcus bleeding index, plaque index, bleeding on probing (BOP), PPD, and clinical attachment level (CAL) were recorded at baseline, 1 month and 3 months post-operatively.

RESULTS

All three groups presented with an improvement in clinical parameters compared to baseline. The mean reduction in PPD was 2.4 mm in SRP sites, 2.5 mm in SRP + CHX varnish sites and 2.8 mm in SRP + CHX chip sites. The mean gain in CAL was 2.4 mm in SRP sites, 2.3 mm in SRP + CHX varnish sites and 2.8 mm SRP + CHX chip sites.

INTERPRETATION AND CONCLUSION

The present study indicated that application of CHX varnish and placement of CHX chip as an adjunct to SRP produced a clinically significant reduction in the PPD, BOP and a gain in CAL at 30(th) day and 90(th) day from baseline when compared to SRP alone. The results though were not statistically significant.

Evaluation of metronidazole nanofibers in patients with chronic periodontitis: A clinical study

AIM

Prevention of periodontal disease progression is the primary goal of periodontal therapy. When conventional therapy is found to be inadequate in achieving periodontal health in chronic periodontitis, local antimicrobial agents are used as an adjunct to scaling and root planing (SRP), which produces encouraging results. In the present study, an attempt was made to develop a low-dose controlled-release delivery system for the treatment of periodontal infections. A new sustained release drug system of poly e-caprolactone (PCL) nanofibers containing metronidazole (MET) was successfully electrospun and evaluated clinically for periodontal diseases. The retentive nanofibres were shown to provide a controlled delivery of the drugs.

MATERIALS AND METHODS

Nanofibers were prepared with MET in PCL by electrospinning technique. The drug-coated nanofibers provided sustained effect up to a period of 11 days (264 h) and followed first-order release. Forty sites in seven patients (four females and three males) with chronic periodontitis (5-8 mm probing depth) were allocated in two experimental treatment groups: Group A treated with SRP + MET nanofibers and Group B treated with SRP alone (control group). All these patients were evaluated clinically for probing depth (PD), plaque index (PI), and gingival index (GI).

RESULTS

Both the treatment groups were found to be efficacious in the treatment of periodontal disease as demonstrated by improvement in PD, PI, and GI.

CONCLUSION

Combination of SRP + MET nanofibers (Group A) resulted in added benefits, compared to the control group.

To assess the effectiveness of a chlorhexidine chip in the treatment of chronic periodontitis: A clinical and radiographic study

CONTEXT

Controlled local delivery of disinfecting agents has been demonstrated to be efficient in improving the outcome of periodontal therapy.

AIMS

The aim of the present study was to evaluate the efficacy of a controlled-release biodegradable chlorhexidine chip (Periocol CG) when used as an adjunct to scaling and root planing in the treatment of periodontitis.

SETTINGS AND DESIGN

The study was carried out as randomized controlled two-group parallel clinical trial.

MATERIALS AND METHODS

Forty patients in the age group of 30-65 years suffering from mild to moderate chronic periodontitis, having pocket depth ranging between 5 and 8 mm, were selected for the study. At the screening visit, complete history taking, periodontal examination and full-mouth supragingival scaling was carried out for each patient. At the baseline visit (on the 7(th) day), all clinical parameters and radiographic parameters were recorded at selected sites and patients were randomly assigned to either the control group (group A) or the treatment group (group B). All patients in both the groups received complete subgingival scaling and root planing. Then, in group B, chlorhexidine chip (Periocol CG) was inserted at the selected site. Patients were recalled at 1 month, 2 months and 3 months from the baseline for recording clinical observations, and radiographic parameters were recorded at the end of the study.

STATISTICAL ANALYSIS

Mean, standard deviation, Chi-square test, "t" test for equality of means and paired samples correlations were used.

RESULTS

There was a statistically significant clinical attachment gain, reduction in bleeding index scores, probing pocket depth reduction and bone gain in both the groups, but group B showed better results than group A, and these differences were statistically significant.

CONCLUSIONS

The results of this study show that chlorhexidine chip (PerioCol-CG) is an effective adjunctive therapy to scaling and root planing in the treatment of chronic periodontitis.

A novel approach to the use of subgingival controlled-release chlorhexidine delivery in chronic periodontitis: a randomized clinical trial

BACKGROUND

We aimed to analyze clinical, microbiologic, and serologic effects of chlorhexidine (CHX) chips used as a subgingival controlled-release delivery device before and immediately after scaling and root planing (SRP).

METHODS

Twenty-four patients presenting with ≥12 teeth with probing depth (PD) ≥5 mm and bleeding on probing were assigned in test or control groups. After prophylaxis, CHX chips (test) or placebo chips (control) were placed in pockets with PD ≥5 mm. Ten days later, SRP was performed in all teeth with PD ≥4 mm in a single appointment. Immediately after SRP, new chips were inserted in all pockets with PD ≥5 mm. Parameters were assessed at baseline; beginning of SRP; and 1, 3, and 6 months after treatment. Subgingival samples were obtained at baseline; beginning of SRP; and at 1 month after treatment. Periodontal pathogens Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, and Treponema denticola were analyzed. Serum levels of high sensitive C-reactive and lipopolysaccharide-binding proteins were measured. The changes of the parameters between and within the groups were tested by Mann-Whitney U test (P <0.05).

RESULTS

All clinical and serologic parameters improved in both groups over time. There was a significant difference in clinical attachment level (CAL) gain from baseline to 6 months between groups (1.17 mm in the test group versus 0.79 mm in the placebo group) (P <0.05). The treatment with CHX chips showed a greater reduction of the microorganisms of the "red complex" after 1 month (P = 0.02).

CONCLUSION

The use of CHX chips before and immediately after SRP improved CAL and reduced the subgingival microorganisms of the red complex in the treatment of chronic periodontitis.