Long-term clinical effects of a chlorhexidine varnish implemented treatment strategy for chronic periodontitis.
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.
Cosyn
Jan
J
Department of Periodontology, School of Dental Medicine, Free University of Brussels, Brussels, Belgium. jan.cosyn@vub.ac.be
Wyn
Iris
I
De Rouck
Tim
T
Sabzevar
Mehran Moradi
MM
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
D000891:Anti-Infective Agents, Local; C477721:EC40 dental varnish; D002710:Chlorhexidine