Efficacy of chlorhexidine rinses after periodontal or implant surgery: a systematic review
- 7 Downloads
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.
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.
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.
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.
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.
KeywordsChlorhexidine Periodontitis Dental implant Mouthwashes
The work was supported by the Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
For this type of study, formal consent is not required.
- 3.Lang NP, Lindhe J (2015) Clinical periodontology and implant dentistry. Blackwell Munksgaard, OxfordGoogle Scholar
- 5.Fine DH (1988) Mouthrinses as adjuncts for plaque and gingivitis management. A status report for the American Journal of Dentistry. Am J Dent 1:259–263Google Scholar
- 11.Wolff LF (1985) Chemotherapeutic agents in the prevention and treatment of periodontal disease. Northwest Dent 64:15–24Google Scholar
- 15.Rölla G, Loe H, Schiott CR (1971) Affinity of chlorhexidine gluconate to hydroxylapatite and to salivary mucins. Caries Res 5:23Google Scholar
- 19.Schiott CR (1973) Effect of chlorhexidine on the microflora of the oral cavity. J Periodontal Res Suppl 12:7–10Google Scholar
- 23.Marinone MG, Savoldi E (2000) Chlorhexidine and taste. Influence of mouthwashes concentration and of rinsing time. Minerva Stomatol 49:221–226Google Scholar
- 24.Flötra L, Gjermo P, Rölla G, Waerhaug J (1971) Side effects of chlorhexidine mouth washes. Scand J Dent Res 79:119–125Google Scholar
- 26.Addy M, Wade WG, Jenkins S, Goodfield S (1989) Comparison of two commercially available chlorhexidine mouthrinses: I. staining and antimicrobial effects in vitro. Clin Prev Dent 11:10–14Google Scholar
- 29.Duss C, Lang NP, Cosyn J, Persson GR (2010) A randomized, controlled clinical trial on the clinical, microbiological, and staining effects of a novel 0.05% chlorhexidine/herbal extract and a 0.1% chlorhexidine mouthrinse adjunct to periodontal surgery. J Clin Periodontol 37:988–997CrossRefGoogle Scholar
- 30.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 20:2175–2183CrossRefGoogle Scholar
- 47.Langebaek J, Bay L (1976) The effect of chlorhexidine mouthrinse on healing after gingivectomy. Scand J Dent Res 84:224–228Google Scholar
- 50.Bevilacqua L, Liani G, Castronovo G, Costantinides F (2016) Clinical and spectrophotometric evaluation after chlorhexidine use in periodontal flap surgery: a prospective randomized clinical trial. Am J Dent 29:75–80Google Scholar
- 51.Olsson H, Asklow B, Johansson E, Slotte C (2012) Rinsing with alcohol-free or alcohol-based chlorhexidine solutions after periodontal surgery. A double-blind, randomized, cross-over, pilot study. Swed Dent J 36:91–99Google Scholar
- 52.Gkatzonis AM, Vassilopoulos S, Karoussis IK, Kaminari A, Madianos PN (2018) Vrostos, I.a. 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. Clin Oral Investig 22:2581–2591CrossRefGoogle Scholar
- 56.Beiswanger BB, Mallat ME, Jackson RD, Mau MS, Farah CF, Bosma ML, Bollmer BW, Hancock EB (1992) Clinical effects of a 0.12% chlorhexidine rinse as an adjunct to scaling and root planing. J Clin Dent 3:33–38Google Scholar
- 57.James P et al (2017) Chlorhexidine mouthrinse as an adjunctive treatment for gingival health. Cochrane Database Syst Rev 3:CD008676Google Scholar
- 58.Pathan MM, Bhat KG, Joshi VM (2017) Comparative evaluation of the efficacy of a herbal mouthwash and chlorhexidine mouthwash on select periodontal pathogens. J Indian Soc Periodontol 21:270–275Google Scholar
- 59.Gupta D et al (2015) Are herbal mouthwash efficacious over chlorhexidine on the dental plaque. Pharm Res 7:277–281Google Scholar
- 60.Manipal S, Hussain S, Wadgave U, Duraiswamy P, Ravi K (2016) The mouthwash war—chlorhexidine vs. Herbal Mouth Rinses: A Meta-Analysis. J Clin Diagn Res 10:ZC81–ZC83Google Scholar