Clinical Effects of Adjunctive Periodontal Therapy with 0.12% Chlorhexidine or Water Subgingival Irrigation after Scaling and Root Planing with Ultrasonic Generator

Abstract

Objective: To study the effect of a conventional scaling and root planing with ultrasonic generator P-Max Newtron with or without 0.12% chlorhexidine or water irrigation as an adjunctive therapy for chronic periodontitis patients.

Methods: This was a randomized controlled trial including 349 teeth from 13 chronic periodontitis patients. Total of 2,094 sites were evaluated (6 sites around each tooth). The teeth from each subject were randomly assigned into 4 quadrants to have 4 types of treatment: group 1 (control group), scaling and root planing (SRP) by P-Max Newtron and Gracey curette; group 2, SRP plus 0.12% chlorhexidine subgingival irrigation by P-Max Newtron tip; group 3, SRP and water irrigation at week 1, 2 and 4; and group 4, SRP and 0.12% chlorhexidine by P-Max Newtron tip and 0.12% chlorhexidine irrigation at week 1, 2 and 4. Clinical parameters of gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded before treatment and at 4 weeks and 8 weeks after treatment.

Results: Mean age of 13 subjects was 51.3 ± 7.6 years. Five were males and 8 were females. Out of 2,094 sites, 813 sites were classified as mild periodontal lesion (initial PPD < 4 mm). The remaining 806 and 475 were categorized as moderate (initial PPD 4-6 mm) and severe (initial PPD > 6 mm) lesions, respectively. In comparison to baseline parameters before treatment, all groups showed significant reduction in GI, PPD, and CAL at 4 weeks and 8 weeks after treatment. No significant differences of these parameters were found among the 4 treatment groups. When we analysed the results according to the severity of lesion, no significant difference in pocket depth reduction was found among 4 groups in mild periodontal lesion. In moderate lesion: at 4 week, the mean pocket reduction of group 2 and group 4 were statistical significant more than group 1 (p-value = 0.039 and 0.046, respectively). At 8 week, the reduction in pocket reduction was significantly more in group 4 vs group 3 (p-value = 0.042) or vs group 1 (p-value = 0.035). In severe lesion, at 4 week, mean pocket reduction were significant more in group 2 and group 4 vs group 1 (p-value = 0.036 and 0.008, respectively) or vs group 3 (p-value = 0.047 and 0.014, respectively). At 8 week, the mean pocket reduction were significant more in group 2 and group 4 vs group 1 (p-value = 0.045 and 0.037). Only group 4 showed significant greater pocket reduction than group 3 (p-value = 0.040).

Conclusion: Adjunctive therapy with subgingival irrigation with 0.12% chlorhexidine during scaling and root planing by P-Max Newtron tip can improve periodontal status in moderate and severe periodontal lesions.