title: A novel approach to the use of subgingival controlled-release chlorhexidine delivery in chronic periodontitis: a randomized clinical trial.
abstract: BACKGROUND
  We aimed to analyze clinical, microbiologic, and serologic effects of chlorhexidine (CHX) chips used as a subgingival controlled-release delivery device before and immediately after scaling and root planing (SRP).
  
  
  METHODS
  Twenty-four patients presenting with ≥12 teeth with probing depth (PD) ≥5 mm and bleeding on probing were assigned in test or control groups. After prophylaxis, CHX chips (test) or placebo chips (control) were placed in pockets with PD ≥5 mm. Ten days later, SRP was performed in all teeth with PD ≥4 mm in a single appointment. Immediately after SRP, new chips were inserted in all pockets with PD ≥5 mm. Parameters were assessed at baseline; beginning of SRP; and 1, 3, and 6 months after treatment. Subgingival samples were obtained at baseline; beginning of SRP; and at 1 month after treatment. Periodontal pathogens Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, and Treponema denticola were analyzed. Serum levels of high sensitive C-reactive and lipopolysaccharide-binding proteins were measured. The changes of the parameters between and within the groups were tested by Mann-Whitney U test (P <0.05).
  
  
  RESULTS
  All clinical and serologic parameters improved in both groups over time. There was a significant difference in clinical attachment level (CAL) gain from baseline to 6 months between groups (1.17 mm in the test group versus 0.79 mm in the placebo group) (P <0.05). The treatment with CHX chips showed a greater reduction of the microorganisms of the "red complex" after 1 month (P = 0.02).
  
  
  CONCLUSIONS
  The use of CHX chips before and immediately after SRP improved CAL and reduced the subgingival microorganisms of the red complex in the treatment of chronic periodontitis.
authors.affiliation: Department of Periodontology, Dental School, Justus Liebig University, Giessen, Germany.
authors.forename: Jose R
authors.initials: JR
authors.lastname: Gonzales
authors.forename: Lutz
authors.initials: L
authors.lastname: Harnack
authors.forename: Gabriella
authors.initials: G
authors.lastname: Schmitt-Corsitto
authors.forename: Rolf H
authors.initials: RH
authors.lastname: Boedeker
authors.forename: Trinad
authors.initials: T
authors.lastname: Chakraborty
authors.forename: Eugen
authors.initials: E
authors.lastname: Domann
authors.forename: Joerg
authors.initials: J
authors.lastname: Meyle
mesh_terms: D000209:Acute-Phase Proteins; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002097:C-Reactive Protein / Q000032:analysis; D002352:Carrier Proteins / Q000097:blood; D002710:Chlorhexidine / Q000627:therapeutic use*; D055113:Chronic Periodontitis / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D003131:Combined Modality Therapy; D003692:Delayed-Action Preparations; D003773:Dental Plaque / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control; D012534:Dental Scaling; D004311:Double-Blind Method; D006801:Humans; D008137:Longitudinal Studies; D008562:Membrane Glycoproteins / Q000097:blood; D017622:Periodontal Attachment Loss / Q000150:complications / Q000188:drug therapy*; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome; D000099231:Lipopolysaccharide-Binding Protein
chemical_list: D000209:Acute-Phase Proteins; D000891:Anti-Infective Agents, Local; D002097:C-Reactive Protein; D002352:Carrier Proteins; D002710:Chlorhexidine; D003692:Delayed-Action Preparations; D008562:Membrane Glycoproteins; D000099231:Lipopolysaccharide-Binding Protein