Efficacy of chlorhexidine rinses after periodontal or implant surgery: a systematic review.
Chlorhexidine
Dental implant
Mouthwashes
Periodontitis
Journal
Clinical oral investigations
ISSN: 1436-3771
Titre abrégé: Clin Oral Investig
Pays: Germany
ID NLM: 9707115
Informations de publication
Date de publication:
Jan 2019
Jan 2019
Historique:
received:
11
07
2018
accepted:
27
11
2018
pubmed:
12
12
2018
medline:
4
6
2019
entrez:
12
12
2018
Statut:
ppublish
Résumé
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. 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. 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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
OBJECTIVE
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
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
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
CONCLUSIONS
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
CONCLUSIONS
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.
Identifiants
pubmed: 30535817
doi: 10.1007/s00784-018-2761-y
pii: 10.1007/s00784-018-2761-y
doi:
Substances chimiques
Anti-Infective Agents, Local
0
Mouthwashes
0
Chlorhexidine
R4KO0DY52L
Types de publication
Journal Article
Systematic Review
Langues
eng
Pagination
21-32Références
J Clin Periodontol. 1975 Aug;2(3):143-52
pubmed: 1058215
J Clin Periodontol. 2000 Jan;27(1):9-15
pubmed: 10674956
Minerva Stomatol. 2000 May;49(5):221-6
pubmed: 11068420
J Clin Periodontol. 2001 Feb;28(2):168-74
pubmed: 11168742
Chem Senses. 2001 Feb;26(2):105-16
pubmed: 11238242
J Clin Periodontol. 2001 Jun;28(6):558-64
pubmed: 11350523
J Clin Periodontol. 2001 Nov;28(11):1037-44
pubmed: 11686825
Caries Res. 2002 Mar-Apr;36(2):93-100
pubmed: 12037365
J Periodontal Res. 1976 Jun;11(3):135-44
pubmed: 133217
J Periodontal Res. 1976 Jun;11(3):145-52
pubmed: 133218
J Periodontal Res. 1976 Jun;11(3):153-7
pubmed: 133219
J Clin Dent. 1992;3(2):33-8
pubmed: 1524682
Int J Dent Hyg. 2005 May;3(2):59-63
pubmed: 16451383
Int J Dent Hyg. 2004 Aug;2(3):122-6
pubmed: 16451475
J Clin Periodontol. 2006 May;33(5):334-9
pubmed: 16634954
J Clin Periodontol. 2006 Nov;33(11):819-28
pubmed: 16965522
J Clin Periodontol. 2008 Jul;35(7):614-20
pubmed: 18422695
Anaerobe. 2009 Aug;15(4):164-7
pubmed: 19285147
Int J Dent Hyg. 2010 Feb;8(1):35-40
pubmed: 20096080
J Clin Periodontol. 2010 Nov;37(11):988-97
pubmed: 20738456
Swed Dent J. 2012;36(2):91-9
pubmed: 22876396
J Periodontol. 1990 Feb;61(2):112-7
pubmed: 2313527
J Dent Res. 1975 Jun;54 Spec No B:B57-62
pubmed: 237021
J Investig Clin Dent. 2014 Feb;5(1):15-22
pubmed: 23766285
J Investig Clin Dent. 2011 Feb;2(1):29-37
pubmed: 25427325
Int J Dent Hyg. 2017 Feb;15(1):65-72
pubmed: 26084554
Pharmacognosy Res. 2015 Jul-Sep;7(3):277-81
pubmed: 26130940
Clin Prev Dent. 1989 Sep-Oct;11(5):10-4
pubmed: 2638949
Clin Oral Investig. 2016 Nov;20(8):2175-2183
pubmed: 26795622
J Periodontol. 1989 Oct;60(10):570-6
pubmed: 2681675
J Periodontol. 1989 Oct;60(10):577-81
pubmed: 2681676
J Periodontol. 1989 Dec;60(12):704-8
pubmed: 2693684
Am J Dent. 2016 Apr;29(2):75-80
pubmed: 27295864
BMC Oral Health. 2016 Jul 18;17(1):19
pubmed: 27431672
J Clin Diagn Res. 2016 May;10(5):ZC81-3
pubmed: 27437366
J Clin Periodontol. 1989 Jul;16(6):385-7
pubmed: 2760251
J Periodontol. 1989 Sep;60(9):521-5
pubmed: 2795419
J Clin Periodontol. 2017 Mar;44 Suppl 18:S116-S134
pubmed: 28266113
J Am Dent Assoc. 2017 May;148(5):308-318
pubmed: 28284417
Cochrane Database Syst Rev. 2017 Mar 31;3:CD008676
pubmed: 28362061
Clin Oral Investig. 2018 Sep;22(7):2581-2591
pubmed: 29396643
J Indian Soc Periodontol. 2017 Jul-Aug;21(4):270-275
pubmed: 29456300
Northwest Dent. 1985 Nov-Dec;64(6):15-24
pubmed: 3003670
J Clin Periodontol. 1988 Aug;15(7):415-24
pubmed: 3183067
Am J Dent. 1988 Dec;1(6):259-63
pubmed: 3270561
J Clin Periodontol. 1987 Apr;14(4):205-12
pubmed: 3294914
J Periodontal Res Suppl. 1973;12:7-10
pubmed: 4269605
J Pharm Pharmacol. 1966 Sep;18(9):569-78
pubmed: 4381940
Caries Res. 1971;5(1):23
pubmed: 5277138
Scand J Dent Res. 1971;79(2):119-25
pubmed: 5280246
J Clin Periodontol. 1981 Jun;8(3):213-9
pubmed: 6947987
J Periodontol. 1982 May;53(5):315-8
pubmed: 6953229
J Dent Res. 1995 Aug;74(8):1459-67
pubmed: 7560400
Scand J Dent Res. 1976 Jul;84(4):224-8
pubmed: 781795
J Clin Periodontol. 1993 Feb;20(2):130-8
pubmed: 8436632
Control Clin Trials. 1996 Feb;17(1):1-12
pubmed: 8721797
Arch Oral Biol. 1996 Mar;41(3):291-8
pubmed: 8735015
J Clin Periodontol. 1998 Jan;25(1):15-23
pubmed: 9477015
Periodontol 2000. 1997 Oct;15:55-62
pubmed: 9643233