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A randomized clinical trial on the clinical and microbiological efficacy of a xanthan gel with chlorhexidine for subgingival use

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Abstract

Background

The main indication of the adjunctive use of local antimicrobials lies around situations in which the outcome of non-surgical mechanical treatment results in a limited number of residual pockets. The purpose of this investigation was to evaluate the clinical and microbiological effects of the subgingival application of a xanthan-based 1.5% chlorhexidine (CHX) gel (Xan–CHX), adjunctive to scaling and root planing (SRP) in localized periodontitis.

Methods

Periodontitis patients with four to ten residual (after conventional SRP) or relapsing (during supportive periodontal treatment) pockets were recruited and randomized to receive SRP plus the subgingival application of (Xan–CHX) or SRP plus a placebo gel. Supragingival plaque, bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level were evaluated with a computerized probe at baseline, and after 1, 3, and 6 months. Subgingival samples were also collected for the microbiological analysis. Statistical analysis used ANOVA and chi-square tests.

Results

Overall, the clinical results were better in the test group, with significant changes in BOP (between baseline and 3 months) and with a significant increase in the proportion of shallow pockets (1–3 mm) at 6 months. These results did not result in significant intergroup differences. The microbiological impact was limited in both treatment groups.

Conclusion

The adjunctive use of Xan–CHX may improve, although to a limited extent, the clinical outcomes (BOP and PPD), in chronic periodontitis patients with “residual” or “relapsing” pockets, but no significant differences were detected between groups. No side effects, neither clinical nor microbiological, were detected after the use of the test product.

Clinical relevance

Adjunctive use of slow-released chlorhexidine might be considered in the management of periodontal disease and gingival inflammation to reduce the need for periodontal surgery.

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References

  1. Socransky SS, Haffajee AD (1992) The bacterial etiology of destructive periodontal disease: current concepts. J Periodontol 63:322–331

    Article  PubMed  Google Scholar 

  2. Proceedings of the 1996 World Workshop in Periodontics. Lansdowne, Virginia, July 13–17, 1996 (1996) Ann Periodontol 1:1–947

  3. Cosyn J, Wyn I, De Rouck T, Moradi Sabzevar M (2006) Clinical benefits of subgingival chlorhexidine varnish application as an adjunct to same-day full-mouth root planing: a pilot study. J Periodontol 77:1074–1079

    Article  PubMed  Google Scholar 

  4. Badersten A, Nilveus R, Egelberg J (1981) Effect of nonsurgical periodontal therapy. I. Moderately advanced periodontitis. J Clin Periodontol 8:57–72

    Article  PubMed  Google Scholar 

  5. Drisko CH (2000) Nonsurgical periodontal therapy. Periodontol 25:77–88

    Article  Google Scholar 

  6. Haffajee AD, Cugini MA, Dibart S, Smith C, Kent RL Jr, Socransky SS (1997) The effect of SRP on the clinical and microbiological parameters of periodontal diseases. J Clin Periodontol 24:324–334

    Article  PubMed  Google Scholar 

  7. Quirynen M, Teughels W, De Soete M, van Steenberghe D (2000) Topical antiseptics and antibiotics in the initial therapy of chronic adult periodontitis: microbiological aspects. Periodontol 28:72–90

    Article  Google Scholar 

  8. Bonito AJ, Lux L, Lohr KN (2005) Impact of local adjuncts to scaling and root planing in periodontal disease therapy: a systematic review. J Periodontol 76:1227–1236

    Article  PubMed  Google Scholar 

  9. Walker CB, Gordon JM, Magnusson I, Clark WB (1993) A role for antibiotics in the treatment of refractory periodontitis. J Periodontol 64:772–781

    Article  PubMed  Google Scholar 

  10. Killoy WJ (2002) The clinical significance of local chemotherapies. J Clin Periodontol 29(Suppl 2):22–29

    PubMed  Google Scholar 

  11. Hung HC, Douglass CW (2002) Meta-analysis of the effect of scaling and root planing, surgical treatment and antibiotic therapies on periodontal probing depth and attachment loss. J Clin Periodontol 29:975–986

    Article  PubMed  Google Scholar 

  12. Etienne D (2003) Locally delivered antimicrobials for the treatment of chronic periodontitis. Oral Dis 9(Suppl 1):45–50

    Article  PubMed  Google Scholar 

  13. Aimetti M, Romano F, Torta I, Cirillo D, Caposio P, Romagnoli R (2004) Debridement and local application of tetracycline-loaded fibres in the management of persistent periodontitis: results after 12 months. J Clin Periodontol 31:166–172

    Article  PubMed  Google Scholar 

  14. Collins JG, Offenbacher S, Arnold RR (1993) Effects of a combination therapy to eliminate Porphyromonas gingivalis in refractory periodontitis. J Periodontol 64:998–1007

    Article  PubMed  Google Scholar 

  15. Heasman PA, Heasman L, Stacey F, McCracken GI (2001) Local delivery of chlorhexidine gluconate (PerioChip) in periodontal maintenance patients. J Clin Periodontol 28:90–95

    Article  PubMed  Google Scholar 

  16. Killoy WJ (1998) The use of locally delivered chlorhexidine in the treatment of periodontitis. Clinical results. J Clin Periodontol 25:953–958, discussion 978–959

    Article  PubMed  Google Scholar 

  17. Lee JM, Song KB, Sohn HY, Jeong SH, Kwon HK (2002) Comparison between patient expectation before and satisfaction after periodontal surgical treatment. J Periodontol 73:1037–1042

    Article  PubMed  Google Scholar 

  18. Matthews DC, McCulloch CA (1993) Evaluating patient perceptions as short-term outcomes of periodontal treatment: a comparison of surgical and non-surgical therapy. J Periodontol 64:990–997

    Article  PubMed  Google Scholar 

  19. Kalkwarf KL, Kaldahl WB, Patil KD (1992) Patient preference regarding 4 types of periodontal therapy following 3 years of maintenance follow-up. J Clin Periodontol 19:788–793

    Article  PubMed  Google Scholar 

  20. Antczak-Bouckoms AA, Weinstein MC (1987) Cost-effectiveness analysis of periodontal disease control. J Dent Res 66:1630–1635

    Article  PubMed  Google Scholar 

  21. Perinetti G, Paolantonio M, Cordella C, D'Ercole S, Serra E, Piccolomini R (2004) Clinical and microbiological effects of subgingival administration of two active gels on persistent pockets of chronic periodontitis patients. J Clin Periodontol 31:273–281

    Article  PubMed  Google Scholar 

  22. Griffiths GS, Smart GJ, Bulman JS, Weiss G, Shrowder J, Newman HN (2000) Comparison of clinical outcomes following treatment of chronic adult periodontitis with subgingival scaling or subgingival scaling plus metronidazole gel. J Clin Periodontol 27:910–917

    Article  PubMed  Google Scholar 

  23. Bosco JM, Lopes BM, Bosco AF, Spolidorio DM, Marcantonio RA (2009) Local application of tetracycline solution with a microbrush: an alternative treatment for persistent periodontitis. Quintessence Int 40:29–40

    PubMed  Google Scholar 

  24. Gupta R, Pandit N, Aggarwal S, Verma A (2008) Comparative evaluation of subgingivally delivered 10% doxycycline hyclate and xanthan-based chlorhexidine gels in the treatment of chronic periodontitis. J Contemp Dent Pract 9:25–32

    PubMed  Google Scholar 

  25. Soskolne WA (1997) Subgingival delivery of therapeutic agents in the treatment of periodontal diseases. Crit Rev Oral Biol Med 8:164–174

    Article  PubMed  Google Scholar 

  26. Hugo WB, Longworth AR (1964) Effect of chlorhexidine diacetate on “Protoplasts” and spheroplasts of Escherichia coli, protoplasts of Bacillus megaterium and the gram staining reaction of Staphylococcus aureus. J Pharm Pharmacol 16:751–758

    Article  PubMed  Google Scholar 

  27. Hugo WB, Longworth AR (1964) Some aspects of the mode of action of chlorhexidine. J Pharm Pharmacol 16:655–662

    Article  PubMed  Google Scholar 

  28. Hugo WB, Longworth AR (1965) Cytological aspects of the mode of action of chlorhexidine diacetate. J Pharm Pharmacol 17:28–32

    Article  PubMed  Google Scholar 

  29. Needleman IG, Smales FC, Martin GP (1997) An investigation of bioadhesion for periodontal and oral mucosal drug delivery. J Clin Periodontol 24:394–400

    Article  PubMed  Google Scholar 

  30. Paolantonio M, D'Ercole S, Pilloni A et al (2009) Clinical, microbiologic, and biochemical effects of subgingival administration of a Xanthan-based chlorhexidine gel in the treatment of periodontitis: a randomized multicenter trial. J Periodontol 80:1479–1492

    Article  PubMed  Google Scholar 

  31. Loe H (1967) The gingival index, the plaque index and the retention index systems. J Periodontol 38(Suppl):610–616

    Article  PubMed  Google Scholar 

  32. Hamp SE, Nyman S, Lindhe J (1975) Periodontal treatment of multirooted teeth. Results after 5 years. J Clin Periodontol 2:126–135

    Article  PubMed  Google Scholar 

  33. Syed SA, Loesche WJ (1972) Survival of human dental plaque flora in various transport media. Appl Microbiol 24:638–644

    PubMed  Google Scholar 

  34. Alsina M, Olle E, Frias J (2001) Improved, low-cost selective culture medium for Actinobacillus actinomycetemcomitans. J Clin Microbiol 39:509–513

    Article  PubMed  Google Scholar 

  35. Walker C, Karpinia K (2002) Rationale for use of antibiotics in periodontics. J Periodontol 73:1188–1196

    Article  PubMed  Google Scholar 

  36. van Winkelhoff AJ, Rams TE, Slots J (1996) Systemic antibiotic therapy in periodontics. Periodontol 10:45–78

    Article  Google Scholar 

  37. Herrera D, Sanz M, Jepsen S, Needleman I, Roldan S (2002) A systematic review on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients. J Clin Periodontol 29:136–159

    Article  PubMed  Google Scholar 

  38. Haffajee AD, Socransky SS, Gunsolley JC (2003) Systemic anti-infective periodontal therapy. A systematic review. Ann Periodontol 8:115–181

    Article  PubMed  Google Scholar 

  39. Rams TE, Slots J (1996) Local delivery of antimicrobial agents in the periodontal pocket. Periodontol 2000 10:139–159

    Article  PubMed  Google Scholar 

  40. Hanes PJ, Purvis JP (2003) Local anti-infective therapy: pharmacological agents. A systematic review. Ann Periodontol 8:79–98

    Article  PubMed  Google Scholar 

  41. Azmak N, Atilla G, Luoto H, Sorsa T (2002) The effect of subgingival controlled-release delivery of chlorhexidine chip on clinical parameters and matrix metalloproteinase-8 levels in gingival crevicular fluid. J Periodontol 73:608–615

    Article  PubMed  Google Scholar 

  42. Dudic VB, Lang NP, Mombelli A (1999) Microbiological and clinical effects of an antiseptic dental varnish after mechanical periodontal therapy. J Clin Periodontol 26:341–346

    Article  PubMed  Google Scholar 

  43. Mizrak T, Guncu GN, Caglayan F, Balci TA, Aktar GS, Ipek F (2006) Effect of a controlled-release chlorhexidine chip on clinical and microbiological parameters and prostaglandin E2 levels in gingival crevicular fluid. J Periodontol 77:437–443

    Article  PubMed  Google Scholar 

  44. Badersten A, Nilveus R, Egelberg J (1984) Effect of nonsurgical periodontal therapy. II. Severely advanced periodontitis. J Clin Periodontol 11:63–76

    Article  PubMed  Google Scholar 

  45. Colombo AP, Haffajee AD, Dewhirst FE et al (1998) Clinical and microbiological features of refractory periodontitis subjects. J Clin Periodontol 25:169–180

    Article  PubMed  Google Scholar 

  46. Badersten A, Nilveus R, Egelberg J (1984) Effect of nonsurgical periodontal therapy. III. Single versus repeated instrumentation. J Clin Periodontol 11:114–124

    Article  PubMed  Google Scholar 

  47. Brecx M, Netuschil L, Hoffmann T (2003) How to select the right mouthrinses in periodontal prevention and therapy. Part II. Clinical use and recommendations. Int J Dent Hygiene 1:188–194

    Article  Google Scholar 

  48. Waerhaug J (1978) Healing of the dento-epithelial junction following subgingival plaque control. II: As observed on extracted teeth. J Periodontol 49:119–134

    Article  PubMed  Google Scholar 

  49. Waerhaug J (1978) Healing of the dento-epithelial junction following subgingival plaque control. I. As observed in human biopsy material. J Periodontol 49:1–8

    Article  PubMed  Google Scholar 

  50. Buchanan SA, Robertson PB (1987) Calculus removal by scaling/root planing with and without surgical access. J Periodontol 58:159–163

    Article  PubMed  Google Scholar 

  51. Brayer WK, Mellonig JT, Dunlap RM, Marinak KW, Carson RE (1989) Scaling and root planing effectiveness: the effect of root surface access and operator experience. J Periodontol 60:67–72

    Article  PubMed  Google Scholar 

  52. Mombelli A, Gmur R, Gobbi C, Lang NP (1994) Actinobacillus actinomycetemcomitans in adult periodontitis. I. Topographic distribution before and after treatment. J Periodontol 65:820–826

    Article  PubMed  Google Scholar 

  53. Mombelli A, Schmid B, Rutar A, Lang NP (2000) Persistence patterns of Porphyromonas gingivalis, Prevotella intermedia/nigrescens, and Actinobacillus actinomyetemcomitans after mechanical therapy of periodontal disease. J Periodontol 71:14–21

    Article  PubMed  Google Scholar 

  54. Kaner D, Bernimoulin JP, Hopfenmuller W, Kleber BM, Friedmann A (2007) Controlled-delivery chlorhexidine chip versus amoxicillin/metronidazole as adjunctive antimicrobial therapy for generalized aggressive periodontitis: a randomized controlled clinical trial. J Clin Periodontol 34:880–891

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was supported by GHIMAS S.P.A. (Bolonia, Italy) by means of a research contract with the University Complutense, Madrid, Spain.

Conflict of interest

They authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Section of Graduate Periodontology, Faculty of Dentistry, Complutense University, Plaza Ramón y Cajal S/N, 28040, Madrid, Spain

    Paula Matesanz, David Herrera, Ana Echeverría & Mariano Sanz

  2. Research Laboratory, Complutense University, Madrid, Spain

    Ana O’Connor & Itziar González

  3. ETEP Research Group, Faculty of Dentistry, Complutense University, Madrid, Spain

    David Herrera & Mariano Sanz

Authors
  1. Paula Matesanz
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  2. David Herrera
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  6. Mariano Sanz
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Correspondence to David Herrera.

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Matesanz, P., Herrera, D., Echeverría, A. et al. A randomized clinical trial on the clinical and microbiological efficacy of a xanthan gel with chlorhexidine for subgingival use. Clin Oral Invest 17, 55–66 (2013). https://doi.org/10.1007/s00784-012-0685-5

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  • DOI: https://doi.org/10.1007/s00784-012-0685-5

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