Efficacy of chlorhexidine rinses after periodontal or implant surgery: a systematic review
Abstract
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
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
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
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
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
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.
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