title: Long-term clinical effects of a chlorhexidine varnish implemented treatment strategy for chronic periodontitis.
abstract: BACKGROUND
  Scaling and root planing in combination with oral hygiene monitoring are still considered the therapeutic standards for periodontitis. Although this treatment concept customarily results in satisfactory clinical improvements, treatment outcome may become less favorable predominantly when full access to periodontal defects is compromised, thereby leaving accretions behind. The purpose of this study was to investigate, over a 9-month period, the clinical benefits of a treatment strategy for chronic periodontitis based on a combination of sequential scaling and root planing and subgingival chlorhexidine varnish administration.
  
  
  METHODS
  This randomized controlled, single blind, parallel trial included 26 volunteers with chronic periodontitis. The control group received oral hygiene instructions and was scaled and root planed in two sessions. The test group received the same instructions and treatment; however, all pockets were additionally disinfected using a highly concentrated chlorhexidine varnish. Clinical response parameters were recorded at baseline and at 1, 3, 6, and 9 months. The impact of the initial strategy on the decision-making process for supplementary therapy at 9 months was investigated based on treatment decisions made by five independent clinicians.
  
  
  RESULTS
  Both treatment strategies showed significant reductions in probing depth and gains in clinical attachment at study termination in comparison with baseline (P<0.001). However, combination therapy resulted in a significant additional pocket reduction of 0.62 mm (P<0.001). Initially deep pockets (>or=7 mm) around multirooted teeth seemed to benefit most from the combination strategy, resulting in an additive pocket reduction of 1.06 mm (P=0.009) and a clinical attachment gain of 0.54 mm (P=0.048) in comparison to scaling and root planing alone. A trend toward a reduction of surgical treatment needs following the varnish-implemented strategy was found (P=0.076).
  
  
  CONCLUSIONS
  These findings suggest that the outcome of initial periodontal therapy may benefit from the adjunctive subgingival administration of a highly concentrated chlorhexidine varnish.
authors.affiliation: Department of Periodontology, School of Dental Medicine, Free University of Brussels, Brussels, Belgium. jan.cosyn@vub.ac.be
authors.forename: Jan
authors.initials: J
authors.lastname: Cosyn
authors.forename: Iris
authors.initials: I
authors.lastname: Wyn
authors.forename: Tim
authors.initials: T
authors.lastname: De Rouck
authors.forename: Mehran Moradi
authors.initials: MM
authors.lastname: Sabzevar
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002710:Chlorhexidine / Q000627:therapeutic use*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003774:Dental Plaque Index; D012534:Dental Scaling; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010512:Periodontal Index; D010518:Periodontitis / Q000188:drug therapy* / Q000628:therapy; D016037:Single-Blind Method
chemical_list: D000891:Anti-Infective Agents, Local; C477721:EC40 dental varnish; D002710:Chlorhexidine