A randomized controlled clinical trial on the effectiveness of three different mouthrinses (chlorhexidine with or without alcohol and C31G), adjunct to periodontal surgery, in early wound healing
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The use of chlorhexidine (CHX) with or without alcohol has been recommended for a number of clinical applications. On the other hand, there is a plethora of widely subscribed antiseptics, such as agent C31G (alkyl dimethyl glycine/alkyl dimethyl amine oxide), which has not yet been evaluated postsurgically. The effectiveness of three different mouthrinses (CHX with and without alcohol, C31G) in plaque control and early wound healing was compared postoperatively.
Materials and methods
In this, randomized, double-blind, controlled clinical trial 42 patients were allocated to three groups assigned to 2 weeks rinsing after non-regenerative periodontal flap surgery with or without osseous surgery with C31G (group A), alcohol-free CHX 0.12% (group B) or alcohol-based CHX 0.12% (group C). At days 7 and 14, plaque and early wound healing indices were recorded. At day 14, total bacterial counts were estimated utilizing real-time quantitative polymerase chain reaction (qPCR). Statistics included linear and generalized linear mixed models.
At day 7, healing response was not significantly different among groups. At day 14, group A revealed the highest while group C demonstrated the lowest plaque index values (B vs A, odds ratio—OR = 0.18, p = 0.012; C vs A, OR = 0.01, p < 0.001; C vs B, OR = 0.06, p < 0.001). Group C demonstrated the lowest bacterial counts levels at day 14 (38.470 × 106, 48.190 × 106, and 3.020 × 106 for groups A, B, and C, respectively). At day 14, healing was significantly better in group C compared to B (p = 0.007). Group A showed no significant differences compared to other groups.
(1) The presence of alcohol may increase the effectiveness of CHX in early wound healing, (2) C31G might be an alternative solution prescribed during early postoperative period after non-regenerative periodontal flap surgery.
The present study found that active agent C31G displayed no significant differences to CHX formulations regarding periodontal wound healing improvement and might be used alternatively after non-regenerative periodontal flap surgery. In addition, an alcohol based 0.12% CHX mouthwash was more effective than an alcohol-free 0.12% CHX and C31G mouthrinse on plaque control in the absence of mechanical oral hygiene.
KeywordsChlorhexidine Alcohol C31G Mouthrinses Early postsurgical wound healing
The laboratory support provided by Dr. Effie C. Tsilibary (Head of Institute of Biosciences and Applications, National Center for Scientific Research “Demokritos”, Athens, Greece) and Christina Gkolfinopoulou is highly appreciated.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in human participants were in accordance with the ethical standards of Research and Ethics Committee of School of Dental Medicine, National and Kapodistrian University of Athens, Greece and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 3.Noguerol B, Sanz M, Follana M, Bascones A (1991) Efficacy of an ultra-soft toothbrush in the postoperative period after periodontal surgery (Spanish). Periodoncia 1:52–63Google Scholar
- 4.Brecx M, Netuschil L, Reichert B, Schreil G (1990) Efficacy of Listerine, Meridol and chlorhexidine mouthrinses on plaque, gingivitis and plaque bacteria vitality. J Clin Periodontol 17(5):292–297. https://doi.org/10.1111/j.1600-051X.1990.tb01092.x CrossRefPubMedGoogle Scholar
- 5.Overholser CD, Meiller TF, DePaola LG, Minah GE, Niehaus C (1990) Comparative effects of 2 chemotherapeutic mouthrinses on the development of supragingival dental plaque and gingivitis. J Clin Periodontol 17(8):575–579. https://doi.org/10.1111/j.1600-051X.1990.tb01108.x CrossRefPubMedGoogle Scholar
- 7.Loe H, Schiott CR (1970) The effect of mouthrinses and topical application of chlorhexidine on the development of dental plaque and gingivitis in man. J Periodontal Res 5(2):79–83. https://doi.org/10.1111/j.1600-0765.1970.tb00696.x CrossRefPubMedGoogle Scholar
- 11.Schiott CR, Loe H, Jensen SB, Kilian M, Davies RM, Glavind K (1970) The effect of chlorhexidine mouthrinses on the human oral flora. J Periodontal Res 5(2):84–89. https://doi.org/10.1111/j.1600-0765.1970.tb00697.x CrossRefPubMedGoogle Scholar
- 15.Van Strydonck DA, Slot DE, Van der Velden U, Van der Weijden F (2012) Effect of a chlorhexidine mouthrinse on plaque, gingival inflammation and staining in gingivitis patients: a systematic review. J Clin Periodontol 39(11):1042–1055. https://doi.org/10.1111/j.1600-051X.2012.01883.x CrossRefPubMedGoogle Scholar
- 20.Lamster IB, Alfano MC, Seiguer MC, Gordon JM (1983) The effect of Listerine antiseptic on reduction of existing plaque and gingivitis. Clin Prev Dent 5:12–16Google Scholar
- 22.Bolanowski SJ, Gescheider GA, Sutton SV (1995) Relationship between oral pain and ethanol concentration in mouthrinses. J Periodontal Res 30(3):192–197. https://doi.org/10.1111/j.1600-0765.1995.tb01273.x CrossRefPubMedGoogle Scholar
- 27.La Vecchia C (2009) Mouthwash and oral cancer risk: an update. Oral Oncol 45(3):198–200. https://doi.org/10.1016/j.oraloncology.2008.08.012 CrossRefPubMedGoogle Scholar
- 29.Lorenz K, Bruhn G, Heumann C, Netuschil L, Brecx M, Hoffmann T (2006) Effect of two new chlorhexidine mouthrinses on the development of dental plaque, gingivitis, and discolouration. A randomized, investigator-blind, placebo-controlled, 3-week experimental gingivitis study. J Clin Periodontol 33(8):561–567. https://doi.org/10.1111/j.1600-051X.2006.00946.x CrossRefPubMedGoogle Scholar
- 31.Papaioannou W, Vassilopoulos S, Vrotsos I, Margaritis V, Panis VA (2016) Comparison of a new alcohol-free 0.2% chlorhexidine oral rinse to an established 0.2% chlorhexidine rinse with alcohol for the control of dental plaque accumulation. Int J Dent Hyg 14(4):272–277. https://doi.org/10.1111/idh.12182 CrossRefPubMedGoogle Scholar
- 32.Cortellini P, Labriola A, Zambelli R, Prato GP, Nieri M, Tonetti MS (2008) Chlorhexidine with an anti discoloration system after periodontal flap surgery: a cross-over, randomized, triple-blind clinical trial. J Clin Periodontol 35(7):614–620. https://doi.org/10.1111/j.1600-051X.2008.01238.x CrossRefPubMedGoogle Scholar
- 38.Miller SC (1950) Textbook of Periodontia, 3rd edn. The Blakeston Co., Philadelphia, p 125Google Scholar
- 45.Wachtel H, Schenk G, Bohm S, Weng D, Zuhr O, Hurzeler MB (2003) Microsurgical access flap and enamel matrix derivative for the treatment of periodontal intrabony defects: a controlled clinical study. J Clin Periodontol 30(6):496–504. https://doi.org/10.1034/j.1600-051X.2003.00013.x CrossRefPubMedGoogle Scholar
- 48.Laugisch O, Ramseier CA, Salvi GE, Hägi TT, Bürgin W, Eick S, Sculean A (2016) Effects of two different post-surgical protocols including either 0.05% chlorhexidine herbal extract or 0.1% chlorhexidine on post-surgical plaque control, early wound healing and patient acceptance following standard periodontal surgery and implant placement. Clin Oral Investig 20(8):2175–2183. https://doi.org/10.1007/s00784-016-1713-7 CrossRefPubMedGoogle Scholar
- 50.Dastoor SF, Travan S, Neiva RF, Rayburn LA, Giannobile WV, Wang HL (2007) Effect of adjunctive systemic azithromycin with periodontal surgery in the treatment of chronic periodontitis in smokers: a pilot study. J Periodontol 78(10):1887–1896. https://doi.org/10.1902/jop.2007.070072 CrossRefPubMedPubMedCentralGoogle Scholar
- 53.Furuichi Y, Lindhe J, Ramberg P, Volpe AR (1992) Patterns of de novo plaque formation in the human dentition. J Clin Periodontol 19(6):423–433. https://doi.org/10.1111/j.1600-051X.1992.tb00673.x CrossRefPubMedGoogle Scholar
- 54.Caton JG, Blieden TM, Eowenguth RA, Erantz BJ, Wagener CJ, Dohlin JM, Stein SH, Proskin HM (1993) Comparison between mechanical cleaning and an antimicrobial rinse for the treatment and prevention of interdental gingivitis. J Clin Periodontol 20(3):172–178. https://doi.org/10.1111/j.1600-051X.1993.tb00340.x CrossRefPubMedGoogle Scholar
- 58.Diaz PI, Chalmers NI, Rickard AH, Kong C, Milburn CL, Palmer RJ, Kolenbrander PE (2006) Molecular characterization of subject-specific oral microflora during initial colonization of enamel. Appl Environ Microbiol 72(4):2837–2848. https://doi.org/10.1128/AEM.72.4.2837-2848.2006 CrossRefPubMedPubMedCentralGoogle Scholar