Evidence Table 5. Effectiveness of Local Chlorhexidine Combinations as an Adjunct to Scaling and Root Planing to Treat Chronic Periodontitis

Study DescriptionStudy Design CharacteristicsDisease CharacteristicsExaminer CharacteristicsDescription of Scaling and Root PlaningEligible Study Groups and How Defined:Study Group CharacteristicsCompliance MonitoringBaseline MeasuresTime Interval(s)Outcomes AssessedAdverse EffectsStudy Group Attrition and ReasonsType of AnalysisOutcomes Accessed
(N of Pts)Attachment Level mm Image xoverbar.jpg (SD)Probing Depth mm Image xoverbar.jpg (SD)Spirochetes Image xoverbar.jpg% (SD)Comments
Aziz-Gandour and Newman, 198677 Design Type: Severity: Number: SRP performed: Subject/Site allocation:Age:Yes, with irrigationBefore SRP5 times (at baseline and days 7, 28, 56, and 84) Clinical Measurement: NR1 subject excluded from full study because of failure to attend all visits, but it is not clear which treatment group subject was assigned to Type of analysis reported: Baseline:For chlorhexidine and control groups, there were significant differences in pocket depth only at day 56 visit.
Study Period: RCTChronic peridontitisNRSupra and subgingival scaling, root planing and sub-contact area debridement and polishing12 subjectsMean:SBIFull participants onlyT:6 (147 sites)NA4.8 (NR)NAClinically, the differences between groups was relatively small.
12 weeks (84 days) Subject/Site Allocation: Types of Teeth: Trained: Time spent: T: 6 subjects (147 surfaces)T: 43PlIC:6 (118 sites)NA4.6 (NR)NA Quality Score:
Study/Treatment Site: RandomNRNRNRC: 6 subjects (118 surfaces)C: 48PDFinal: 12 weeks (84 days)54; 46
Health Department Clinic Blinding: Widman flap: Assigned to Subjects: Dose, Mode, Schedule:Range:GIT:NRNANRNA
Location: Examiners and patients blindNRNRT: SRP plus 0.2% chlorhexidine irrigation 1×day for 28 daysT: 32 to 53Gingival recessionC:NRNANRNA
UK Placebo: C: SRP plus 0.1% quinine sulphate irrigationC: 43 to 55 Radiographic Techniques: Change:
Patient Population: YesGender:NRT:NANRNA
Patients with approximal surface pockets and ≥ 4 mm bone reabsorption as seen on radiographs Split-mouth: Male: Microbiological Methods: C:NANRNA
NoT: 1NRTest:ChiSquare, Paired t-test
C: 2 Subject Self Report: P value:NS
Female:NR
T: 5
C: 4
Race/Ethnicity:
NR
Azmak et al., 200293 Design Type: Severity: Number: SRP performed: Subject/Site allocation: Age: NABefore SRP4 times (at baseline and months 1, 3, and 6) Clinical Measurement: NRUse of antibiotics (2) Type of analysis reported: Baseline:Outcome data presented graphically.
Study Period: RCTModerate to severe chronic periodontitisNRUnder local anesthesia22 subjects enrolledRange: 36 to 62GCF MMP measured at baseline, days 2 and 10, and months 1, 3, and 6BOP/SBIFull participants onlyT:20 sites8.83 (1.34)7.00 (0.69)NAImprovements were not statistically significant at 1, 3, and 6 months for PD and CAL.
26 weeks (6 months) Subject/Site Allocation: Types of Teeth: Trained: Time spent: 20 completed Gender: PlIC:20 sites8.72 (0.84)6.83 (0.86)NA Quality Score:
Study/Treatment Site: RandomNRNR5 minutes per tooth2 sites per mouthBothPDFinal: 26 weeks38; 31
Ege University Blinding: Widman flap: Assigned to Subjects: T: 20 sites Race/Ethnicity: CALT:20 sitesNRNRNA
Location: Examiners blindNRSame examiner throughout studyC: 20 sitesNRGCIC:20 sitesNRNRNA
Izmir, Turkey Placebo: Dose, Mode, Schedule: GCF-MMP - 8 levelsChange:
Patient Population: NoT: SRP plus 2.5 mg chlorhexidine chip in isolated pockets Radiographic Techniques: T:20 sitesNRNRNA
Patients with 2 interproximal sites selected from anterior teeth with PD 6 to 8 mm and BOP, ≥ 4 sites with ≥ 4 mm attachment loss, and at least 2 teeth between selected sites Split-mouth: C: SRP onlyNRC:20 sitesNRNRNA
Yes Microbiological Methods: Test:Repeated Measures ANCOVARepeated Measures ANCOVA
NR P value:0.5740.138
Subject Self Report:
NR
Braatz et al., 198530 Design Type: Severity: Number: SRP performed: Subject/Site allocation:Age:Yes, subjects were checked every 2 weeks for their ability to irrigate the experimental sitesBefore SRP3 times (at baseline and weeks 12 and 24) Clinical Measurement: NRNR Type of analysis reported: Baseline:Chlorhexidine group and control group did not differ significantly in any of the studied parameters so treatment did not augment SRP
Study Period: RCTGeneralized chronic periodontitis1Single episode of supra and subgingival instrumentation under local anesthesia14 subjects (2 to 25 sites per subject)Range: 40 to 70BOP/SBIFull participants onlyT:54 sitesNR7.6 (0.9)6.8% (9.0) Quality Score:
24 weeks Subject/Site Allocation: Types of Teeth: Trained: Time spent: T: 54 sitesGender:PDC:52 sitesNR7.5 (0.7)9.2% (11.0)46; 38
Study/Treatment Site: RandomSingle-rootedNANRC: 52 sitesMale: 8CALFinal: 24 weeks
NR Blinding: Widman flap: Assigned to Subjects: Dose, Mode, Schedule:Female: 6 Radiographic Techniques: T:54 sitesNR4.3 (1.4)0.8% (3.0)
Location: NRNRSame examiner throughout studyT: SRP plus irrigation with 0.2% chlorhexidine 1×day for 24 weeks on 1 side of maxillary and/or mandibular jawRace/Ethnicity:NRC:52 sitesNR4.5 (1.5)1.2% (4.1)
USA Placebo: C: SRP onlyNR Microbiological Methods: Change: Gain
Patient Population: NoSpirochete analysis, dark field microscopyT:54 sites1.4 (1.4)3.3* (NR)NR
Patients with at least 2 sites with PD ≥ 7 mm on single-rooted teeth with BOP Split-mouth: Subject Self Report: C:52 sites1.2 (1.1)3.0* (NR)NR
YesNRTest:ANOVAANOVAANOVA
P value:NSNSNS
Author and Year: Design Type: Severity: Number: SRP performed: Subject/Site allocation:Age:NRBefore SRP4 times (at baseline and months 3, 6, and 9) Clinical Measurement: NRAntibiotic use during test period (1) Type of analysis reported: Baseline:SRP produced a significant reduction in microorganisms. The addition of the chlorhexidine chip did not augment the results.
Grisi et al., 200294 RCTChronic periodontitis1Full mouth supragingival scaling under anesthesia with Gracey curets20 subjects invitedMean: 41.8 ± 5.6PlIFull participants onlyT:10 (41 sites)NR5.2 (0.6)NA Quality Score:
Study Period: Subject/Site Allocation: Types of Teeth: Trained: Time spent on SRP: 19 subjects enrolled and completedRange: 35 to 56GRC:9 (39 sites)NR5.2 (0.6)NA46; 38
39 weeks (9 months)RandomNRNANRT: 10 (41 sites)Gender Distribution:PDFinal: 39 weeks (9 months)
Site of Study: Blinding: Widman flap: Assigned to Subjects: C: 9 (43 sites)Male: 11 (T: 5, C: 3)BOPT:10 (41 sites)NR3.0 (0.8)NA
NRExaminer blindNRNRDose, Mode, Schedule:Female: 9 (T: 5, C: 6)SuppurationC:9 (39 sites)NR2.9 (0.6)NA
Location: Placebo: T: SRP plus chlorhexidine chip at baseline and at 3 and 6 months in all pockets ≥ 5 mm; chip position assessed at days 3 and 7 after placementRace/Ethnicity:CALChange: Gain Reduction
BrazilNoC: SRP aloneNRPBST:10 (41 sites)0.6 (0.7)2.2 (0.7)NA
Patients Selected: Split-mouth: Note: Full mouth supragingival prophylaxis 1×month for both treatment and control groups. Radiographic Techniques: C:9 (39 sites)1.0 (0.4)2.4 (0.7)NA
Patients with PD ≥ 5 mm in at least 4 sites and BOPNoNRTest:Mann-WhitneyMann-Whitney
Microbiological Methods: P value:0.07NS
BANA Test; Microbes: B.f., T.d., P.g.
Subject Self Report:
NR
Heasman et al., 200192 Design Type: Severity: Number: SRP performed: Subject/Site allocation:Age:NABefore SRP4 times (at baseline and months 1, 3, and 6) Clinical Measurement: Only 1 subject reported any oral symptoms at any time during trialWithdrew after 3 mos for non-treatment related reasons (2) Type of analysis reported: Baseline:The results suggest that the chlorhexidine chip is beneficial for subjects on maintenance therapy although the benefit is not apparent until 6 months after placement
Study Period: RCTModerate to advanced chronic periodontitis2At baseline, supragingival ultrasonic scaling and prophylaxis of all teeth. All target sites were root planed under local anesthesia26 subjects recruitedMean: 42.6BOP/SBIIntent to treatT:87 sites14.23 (0.19 se)6.64 (0.12 se)NA Quality Score:
26 weeks (6 months) Subject/Site Allocation: Types of Teeth: Trained: Time spent: 24 completedRange: 34 to 59PlIC:165 sites14.14 (0.16 se)6.47 (0.11 se)NA54; 54
Study/Treatment Site: RandomMolarsCalibration (Gold standard)Maximum of 5 minutes per tooth for supragingival scalingT: 87 sitesGender:PDFinal: 26 weeks
Department of Periodontology of Newcastle Dental School and Hospital Blinding: Widman flap: Assigned to Subjects: C: 165 sitesMale: 8CALT:NRNRNRNA
Location: Examiners blindNRSame examiner throughout study. Clinician placed all periochips, always in the absence of examinerDose, Mode, Schedule:Female:18 Radiographic Techniques: C:NRNRNRNA
UK Placebo: T: SRP plus 2.5 mg controlled release chlorhexidine chip inserted in pocketsRace/Ethnicity:NRChange: Gain Reduction
Patient Population: NoC: SRP onlyWhite: 100% Microbiological Methods: T:NR0.43 (0.15 se)0.78 (0.12 se)NA
Adults with ≥ 10 natural uncrowned teeth; ≥ 1 pocket per quadrant with PD ≥ 5 mm and persistent BOP Split-mouth: NRC:NR0.15 (0.09 se)0.45 (0.13 se)NA
Yes (left side, right side) Subject Self Report: Test:t-testt-test
NR P value:0.0480.05
Jeffcoat et al., 199891 Design Type: Severity: Number: SRP performed: Subject/Site allocation:Age:NABefore SRP6 times (at baseline, day 7, week 6, and months 3, 6, and 9) Clinical Measurement: Higher in treatment group:Concurrent medical/ dental treatment; illness; lack of follow-up Type of analysis reported: Baseline: Quality Score:
Study Period: RCTAdult periodontitisAt least one at each centerAll subjects received scaling and root planing447 subjects enteredMean: 46.4BOP/SBIminor and transient toothache (including pain, tenderness, aching, throbbing, soreness, discomfort, or sensitivity)Intent to treat, analysis adjustedT:2255.27 (1.34 se)5.73 (0.59 se)NA85; 93
39 weeks Subject/Site Allocation: Types of Teeth: Trained: Time spent: 419 subjects completedRange: 27 to 79PlIC:2225.14 (1.48 se)5.64 (0.55 se)NA
(9 months)RandomNRCalibration (gold standard)1 hour for all teeth for removal of supragingival calculus and 1 hour for SRPT: 211 sitesGender:PDFinal: 39 weeks (9 months)
Study/Treatment Site: Blinding: Widman flap: Assigned to Subjects: C: 208 sitesMale: 207CALT:NRNRNA
10 centers at 10 different universitiesExaminers and patients blindNRSame examiner throughout studyDose, Mode, Schedule:Female: 240GIC:NRNRNA
Location: Placebo: T: SRP plus 2.5 mg controlled release chlorhexidine chips at baseline, 3 and 6 months if PD ≥ 5 mmRace/Ethnicity:Staining examinationChange: Gain Reduction
USAYesC: SRP with placebo chipNH White: 336 (75.2%) Radiographic Techniques: T:2110.75 (0.06 se)0.95 (0.05 se)NA
Patient Population: Split-mouth: NH Black: 85 (19%)NRC:2080.55 (0.06 se)0.69 (0.05 se)NA
Patients with ≥ 10 natural teeth and ≥ 4 teeth with PD of 5 to 8 mm and BOPYesHispanic: 8 (1.8%) Microbiological Methods: Test:NRNR
Asian/Pacific Islander: 12 (2.7%)NR P value:0.0120.00056
Other: 6 (1.3%) Subject Self Report:
NR
Author and Year: Design Type: Severity: Number: SRP performed: Subject/Site allocation: Age: NABefore SRP4 times (at baseline, and weeks 8, 16, and 24) Clinical Measurement: NRNR Type of analysis reported: Baseline: Quality Score:
MacAlpine 198531 Clinical trialGeneralized chronic periodontitis1Supra and subgingival instrumentation under local anesthesia until operator was confident that the tooth surfaces had been equately debrided11 subjectsRange: 25–67Spirochetes were assessed at baseline and weeks 7, 15, and 23BOPAll who completed treatmentT:16 sitesNR7.7 (0.9)32 (20)38; 38
Study Period: Subject/Site Allocation: Types of Teeth: Trained: Time spent on SRP: 4 or 8 sites per subject Gender Distribution: Plaque scoresC:16 sitesNR7.4 (0.6)39 (21)
24 weeksAssignment method not reportedSingle rootNANRT: 16 sitesMales: 2PDFinal: 24 weeks
Site of Study: Blinding: Widman flap: Assigned to Subjects: C: 16 sitesFemales: 9CALT:16 sitesNR4.2 (1.0)2 (3)
NRNRNoSame investigator throughout study Dose, Mode, Schedule: Race/Ethnicity: Radiographic Techniques: C:16 sitesNR4.9 (1.8)4 (7)
Location: Placebo: T: SRP plus subgingival irrigation with 2% chlorhexidine solution every 2 weeks for 24 weeksNRNRChange: Gain Reduction
NR (Swedish and US authors)YesC: SRP and saline irrigation, every 2 weeks for 24 weeks Microbiological Methods: T:1.7 (1.3)1.7 (1.3)NR
Patients Selected: Split-mouth: Subgingival plaque samples (% spirochetes); dark field microscopyC:0.8 (1.4)0.8 (1.4)NR
Patients with PD ≥ 6 mm demonstrated by attachment loss, BOP, and subgingival calculusYes Subject Self Report: Test:ANOVAANOVA
NR P value:NSNS
Oosterwaal et al., 199189 Design Type: Severity: Number: SRP performed: Subject/Site allocation: Age: NABefore SRP4 times (at baseline and weeks 4, 12, and 36) Clinical Measurement: NRNR Type of analysis reported: Baseline:Data on clinical outcomes presented graphically.
Study Period: RCTAdvanced periodontitis2Selected pockets got both hand and ultrasonic mechanical (Gracey curettes) debridement.10 subjectsMean: 48BOP/SBIFull participants onlyT:10 (10 sites)NA7.6 (0.7)NREffect of SRP and chlorhexidine gel did not differ from SRP and placebo gel.
36 weeks Subject/Site Allocation: Types of Teeth: Trained: Other pockets got SRP 4 weeks laterT: 10 sitesRange: 33 to 62PlIC:10 (10 sites)NANRNRNo differences among groups in PD or % spirochetes after 36 weeks.
Study/Treatment Site: RandomSingle-rootedNR Time spent: C: 10 sites Gender: PDFinal: 36 weeks Quality Score:
Department of Periodontology, University of Nijmegen Blinding: Widman flap: Assigned to Subjects: NR Dose, Mode, Schedule: Male: 4 Radiographic Techniques: T:10 (10 sites)NA4.7 (1.0)NR63; 54
Location: Examiners and patients blindNRNRT: SRP plus 2% chlorhexidine gel, applied 3 times within 10 minutes after SRPFemale: 6NRC:10 (10 sites)NANRNR
Netherlands Placebo: C: SRP with placebo gel applied 3 times with syringe within 10 minutes after SRP Race/Ethnicity: Microbiological Methods: Change:
Patient Population: YesNRSubgingival microflora by microscopic and culture studies of plaque samples (% spirochetes, motile rods, non-motile rods)T:NANRNR
Patients referred with 4 interdental pockets of 7 to 9 mm affecting single rooted teeth, BOP, alveolar bone and attachment loss Split-mouth: Subject Self Report: C:NANRNR
YesNRTest:ANOVAANOVA
P value:NSNS
Author and Year: Design Type: Severity: Number: SRP performed: Subject/Site allocation: Age: Via questionnaireBefore SRP5 times (at baseline, at end of months 1, 2, 4, and 8) Clinical Measurement: Yes, subjects rated subjective outcomes (pain, swelling)NR Type of analysis reported: Single-rootedAt each follow-up visit a statistically significant (P < 0.001) improvement at end of baseline was recorded for PD in both groups. The difference between the Treatment and Control groups were never statistically significant.
Quirynen et al., 200095 NRAdvanced chronic adult periodontitis1Under local anesthesia, using periodontal curettes, on all pockets within 24 hours.24 subjects in relevantRange: 37 to 69GIFull participants only Baseline: All pockets showed a statistically significant gain in CAL over the entire experimental period. Differences between groups were small and insignificant
Study Period: Subject/Site Allocation: Types of Teeth: Trained: Time spent on SRP: treatment groups Gender Distribution: PIT:12NR6.2 (2.0)NRFor initial PD ≥ 7 mm, the control group had a 0.3 greater gain in CAL for both single and multi-root teeth
35 weeks (8 months)UnknownSingle and multi-rooted third molars excludedNACompleted during 2 sessions within 24 hours, starting with the lower jaw.T: 12 subjectsMale: 20PDC:12NR6.2 (1.8)NR
Site of Study: Blinding: Widman flap: Assigned to Subjects: C: 12 subjectsFemale: 16Gingival recession or over growth Final: 35 weeks (8 months)
Department of Peridontology of the University Hospital of Catholic University LeuvenNRNRSame examiner throughout study Dose, Mode, Schedule: Race/Ethnicity: CALT:12NR4.0 (1.0)NR
Location: Placebo: T: SRP plus 2× during first 24 hours: brush tongue with 1% chlorhexidine gel for 60 sec; rinse mouth 2× with 0.2% chlorhexidine solution for 1 min; spray tonsils 4×/tonsil with 0.2% chlorhexidine spray; subgingival irrigation of pockets 3× within 10 min with 1% chlorhexidine gel. All repeated a third time at day 8. At home for next 2 months: chlorhexidine rinse 2×day and tonsil sprayWhite: 100%BOPC:12NR3.9 (1.5)NR
BelgiumNoC: SRP alone Radiographic Techniques: Change: GainReduction
Patients Selected: Split-mouth: NRT:NR2.2 (1.8)NR
Patients referred by general dental practitioner with at least 2 multi-rooted teeth and 3 single-rooted teeth in the 1st quadrant and at least 6 sites with PD ≥ 7mmNo Microbiological Methods: C:NR2.3 (1.3)NR
Differential phase-contrast microscopy (coccoid cells, motile rods, spirochetes and others)Test:Mann Whitney U
Subject Self Report: P value: NS
QuestionnaireMulti-rootedStatistically significant differences in reduction of spirochetes at 8 months (data presented graphically)
Baseline: Quality Score:
T:12NR6.4 (1.9)NR54; 54
C:12NR6.6 (1.6)NR
Final: 35 weeks (8 months)
T:12NR4.5 (1.4)NR
C:12NR4.2 (1.3)NR
Change: GainReduction
T:NR1.9 (1.5)NR
C:NR2.4 (1.3)NR
Test:Mann Whitney U
P value:NS
Reynolds et al., 199288 Design Type: Severity: Number: SRP performed: Subject/Site allocation:Age:NABefore SRP3 times (at baseline and weeks 2 and 4) Clinical Measurement: NRNR Type of analysis reported: Baseline:Data in graphic form only.
Study Period: RCTEarly to moderate adult periodontitisNREntire dentition ultrasonically scaled and irrigated until all supra and subgingival calculus was removed60 subjectsRange: 28 to 58PlINRT:NRNANRNRPD changes were nonsignificantly greater in chlorhexidine 7–9 mm and 4–6 mm PD groups only.
4 weeks (28 days) Subject/Site Allocation: Types of Teeth: Trained: Time spent: T: 30 subjectsGender:PDC:NRNANRNRNo significant changes in the % spirochetes.
Study/Treatment Site: RandomNRNR30 to 40 minutes for ultrasonic scaling per subjectC: 30 subjectsMale: 28GIFinal: 4 weeks Quality Score:
Dental School, University of Maryland Blinding: Widman flap: Assigned to Subjects: Dose, Mode, Schedule:Female: 32 Radiographic Techniques: T:NRNANRNR69; 69
Location: Examiners and patients blindNRNRT: SRP plus 200 ml subgingival irrigation with 0.12% chlorhexidine (single episode)Race/Ethnicity:NRC:NRNANRNR
USA Placebo: C: SRP with placebo, subgingival irrigation with sterile water (single episode)NR Microbiological Methods: Change:
Patient Population: YesPlaque microbiota on a subset of 15 subjects (spirochetes and mobile organisms)T:NRNANRNR
New patients Split-mouth: Cell morphologyC:NRNANRNR
NoDark field microscopyTest:
Subject Self Report: P value:
NR
Shiloah and Patters 199454 Design Type: Severity: Number: SRP performed: Subject/Site allocation:Age:NABefore SRP3 times (at baseline, week 1, and month 1) Clinical Measurement: NRNR Type of analysis reported: Baseline:Data shown graphically.
Study Period: RCTModerate to severe periodontitis1Thorough SRP of entire dentition performed with ultrasonic scaler and Gracey curets, under local anesthesia7 subjects, 1 or 2 teeth per subjectMean: 47.8PlIFull participants onlyT:12 sitesNRNRNAAlthough PD decreased significantly (P = 0.0001) no significant difference among the treatment groups was noted (P = 0.67).
4 weeks Subject/Site Allocation: Types of Teeth: Trained: Time spent: T: 12 sitesRange: 33 to 65PDC:12 sitesNRNRNAAttachment loss was reduced by an average 1 mm following therapy. Although CAL decreased significantly (P = 0.0001) no significant difference among treatment groups was noted (P = 0.06).
Study/Treatment Site: Random sites within subjectsSingle and multi-rootedStandardization Calibration (Gold standard)4 to 7 hours per subject over several visitsC: 12 sitesGender:CALFinal: 4 weeksTreatment resulted in reduction of 3 target species of 67% at month 1
Graduate Program University Clinic Blinding: Widman flap: Assigned to Subjects: Dose, Mode, Schedule:Male: 2GIT:12 sitesNRNRNA Quality Score:
Location: Examiner blindNRSame examiner throughout studyT: SRP plus irrigation with 0.12% chlorhexidine solution, 2cc/site, 1 aplicationFemale: 5Gingival fluid flowC:12 sitesNRNRNA54; 54
USA Placebo: C: SRP plus irrigation of pockets with 0.85%, saline, 2cc/siteRace/Ethnicity: Radiographic Techniques: Change:
Patient Population: YesNRNRT:12 sitesNRNRNA
Volunteer adults with PD ≥ 5 mm in non-adjacent sites with ≥ 5 mm PD, attachment loss and presence of target organism Split-mouth: Microbiological Methods: C:12 sitesNRNRNA
YesDNA/RNA probe for subgingival flora(A.a., P.g., P.i.) Test:ANOVAANOVA
Subject Self Report: P value:NSNS
NR
Soskolne et al., 199790 Design Type: Severity: Number: SRP performed: Subject/Site allocation:Age:NABefore SRP4 times (at baseline, 1, 3, and 6 months) Clinical Measurement: NRAntibiotic or anti-inflammatory drug use; loss to follow-up, or withdrawal of consent (24) Type of analysis reported: Baseline:Results show that the treatment of periodontal pockets with chlorhexidine as an adjunct to SRP provides a significantly greater improvement
Study Period: RCTModerate adult periodontitis3 (1 at each center)Full mouth mechanical supra- and subgingival scaling118 eligible subjects at baselineMean: 47.5BOP/SBIAll with any follow-upT:NR5.99 (0.05 se)NAFor initial PD ≥ 7 mm: Create CAL gain for treatment group of 0.65 mm, P < 0.001.
26 weeks (6 months) Subject/Site Allocation: Types of Teeth: Trained: Time spent: 94 completedRange: 30 to 65PlIC:NR6.01 (0.05 se)NACreate PD reduction in treatment group of 0.22, P ≤ 0.0001
Study/Treatment Site: Random to 2 quadrants of the upper jawNRCalibration (gold standard)≤1 hourT: 94 subjects (401 pockets)Gender:PDFinal: 26 weeks (6 months) Quality Score:
Royal Air Force Base at Halton, UK; Newcastle, UK; Jerusalem, Israel Blinding: Widman flap: Assigned to Subjects: C: 94 subjects (412 pockets)Male: 60CALT:94 (401 pockets)NRNRNA62; 54
Location: Examiners and patients blindNRSame examiner throughout studyDose, Mode, Schedule:Female: 58GIC:94 (412 pockets)NRNRNA
UK and Israel Placebo: T: SRP plus 2.5 mg chlorhexidine chip inserted into each pocket of 5 to 8 mm in designated quadrant at baseline and 3 months if pocket was still 5 to 8mmRace/Ethnicity:Staining indexChange: Gain Reduction
Patient Population: NoC: SRP onlyNR Radiographic Techniques: T:94 (401 pockets)0.47 (0.062 se)1.16 (0.058 se)NA
Patients with ≥ 1 PD 5 to 8 mm and BOP in each of 2 maxillary quadrants Split-mouth: NRC:94 (412 pockets)0.31 (0.06 se)0.70 (0.056 se)NA
Yes Microbiological Methods: Test:MANOVAMANOVA
NR P value:< 0.05≤ 0.0001
Subject Self Report:
NR
Southard et al., 198986 Design Type: Severity: Number: SRP performed: Subject/Site allocation:Age:NABefore SRP5 times (at baseline and weeks 5, 7, 11, and 15) Clinical Measurement: NRNR Type of analysis reported: Baseline:No significant treatment effects
Study Period: RCTModerate periodontitis22 assigned quadrants received SRP. Anesthesized by standard nerve blocks or local infiltration techniques.8 subjectsRange: 35 to 65PlIFull participants onlyT:814.4 (NR)6.6 (NR)NA B.g. was significantly reduced only in treatment group vs control (P < 0.01) but did not extend to the 15th week
15 weeks Subject/Site Allocation: Types of Teeth: Trained: Areas were debrided by hand with a Gracey curette until the root was deemed smooth by tactile sensation with a periodontal probeT: 16 sitesGender:PDC:813.6 (NR)6.3 (NR)NA Quality Score:
Study/Treatment Site: Randomized 4 quadrant designPosteriorNR Time spent: C: 16 sitesMale: 4CALFinal: 15 weeks54; 38
Department of Periodontics, School of Dentistry, University of Missouri Blinding: Widman flap: Assigned to Subjects: NRDose, Mode, Schedule:Female: 4GIT:812.7 (NR)4.2 (NR)NA
Location: Examiners and patients blindNRSame clinician performed all treatments, while a 2nd examiner measured all clinical parametersT: SRP plus irrigation with 2% chlorhexidine at baseline and weeks 1, 2, and 3 on all teeth in quadrantRace/Ethnicity:Bleeding tendencyC:812.0 (NR)3.8 (NR)NA
Kansas City, MO Placebo: C: SRP onlyNR Radiographic Techniques: Change: Gain Reduction
Patient Population: NoNRT:1.7 (NR)2.4* (NR)NA
Volunteer patients with at least 1 site with PD ≥ 6 mm and BOP in each quadrant Split-mouth: Microbiological Methods: C:1.6 (NR)2.5* (NR)NA
Yes B.g. plaque sample, fluorescent antibody reagent, fluorescent microscopeTest:Newman KeulsNewman Keuls
Subject Self Report: P value:NSNS
NR
Taggart et al., 199087 Design Type: Severity: Number: SRP performed: Subject/Site allocation:Age:NABefore SRP4 times (at baseline and weeks 2, 6, and 10) Clinical Measurement: NRNR Type of analysis reported: Baseline:Chlorhexidine has a slight adjunctive effect in the reduction of pocket depth but not significant
Study Period: NRModerate to advanced chronic periodontitisNRInstrumentation on test and control quadrants with an ultrasonic handpiece scaler, under local anesthesia, until the subgingival root surfaces were considered sufficiently smooth10 subjectsRange: 28 to 51SBIFull participants onlyT:10 (10 sites)NR3.5 (0.6)24.9 (12.4) Quality Score:
10 weeks Subject/Site Allocation: Types of Teeth: Trained: Time spent: 2 sites per subjectGender:PlIC:10 (10 sites)NR3.4 (0.5)23.3 (14)46; 46
Study/Treatment Site: Random assigned to upper quadrantsUpper quadrants, no third molars or central incisorsNRNRT: 10 sitesMale: 3PDFinal: 10 weeks
Health Department Clinic (Department of Periodontology and Preventive Dentistry, United Medical and Dental schools of Guy's and St. Thomas' Hospitals Blinding: Widman flap: Assigned to Subjects: C: 10 sitesFemale: 7CALT:NRNR2.6 (0.3)9.6 (14.7)
Location: NRNRNRDose, Mode, Schedule:Race/Ethnicity: Radiographic Techniques: C:NRNR2.6 (0.7)13.1 (15.3)
London, England Placebo: T: SRP plus irrigation with 0.02% chlorhexidine once during scalingNRNRChange: Gain Reduction
Patient Population: YesC: SRP with placebo (irrigation with water once during scaling) Microbiological Methods: T:NR0.5 (1.1 se)0.9 (NR)15.3* (NR)
Patients with with chronic PD involving both sides of the jaw to a similar extent; at least 1 pair of pockets 4 to 6–7 mm (or above) in contra-lateral quadrants and radiographic evidence of bone loss Split-mouth: Plaque microbiota (cocci, spirochetes, motile rods and other rod forms), dark field microscopyC:NR0.4 (1.0 se)0.8 (NR)16.2* (NR)
Yes Subject Self Report: Test:NRANOVAANOVA
NR P value:NSNSNS
Unsal et al., 199459 Design Type: Severity: Number: SRP performed: Subject/Site allocation: Age: YesNR2 times (at baseline and week 12) Clinical Measurement: NRNR Type of analysis reported: Baseline:No statistically significant differences were found in the reduction of the probing depths or gains in attachment level between the treatment groups
Study Period: RCTModerate to advanced adult periodontitisNRMechanical debridement by hand with Gracey curettes and ultrasonic scaling and root planing in pockets > 4 mm22 subjects invitedMean: 42Bleeding indexIntent to treatT:7 (99 sites)4.03 (1.50)4.90 (1.11)NA Quality Score:
12 weeks Subject/Site Allocation: Types of Teeth: Trained: Time spent: 15 enrolledRange: 30 to 57PlIC:8 (110 sites)3.66 (1.22)5.14 (1.45)NA46; 46
Study/Treatment Site: RandomNRNRNRT: 7 subjects (97 sites) Gender: PDFinal: 12 weeks
Department of Peridontology, Faculty of Dentistry Blinding: Widman flap: Assigned to Subjects: C: 8 subjects (110 sites)Male: 10CALT:73.33 (1.76)3.32 (1.01)NA
Location: NRNRNR Dose, Mode, Schedule: Female: 12GIC:82.62 (1.24)3.32 (0.73)NA
University of Ankara, Turkey Placebo: T: SRP plus 1% chlorhexidine gel applied once Race/Ethnicity: Position of gingival marginChange:
Patient Population: NoC: SRP onlyNR Radiographic Techniques: T:1.04 (0.16)1.58 (0.96)NA
Adult patients with at least 3 teeth in each quadrant having 2 sites with a PD of ≥ 4 mm and radiographic evidence of bone loss Split-mouth: NRC:0.70 (1.09)1.83 (0.54)NA
No Microbiological Methods: Test:ANOVAANOVA
NR P value:NSNS
Subject Self Report:
NR
Watts and Newman, 198684 Design Type: Severity: Number: SRP performed: Subject/Site allocation:Age:NABefore SRP4 times (at baseline and days 28, 56, and 84) Clinical Measurement: No injuries or staining notedNR Type of analysis reported: Baseline:No significant added benefit with 0.02% chlorhexidine was apparent. Data presented graphically.
Study Period: RCTChronic periodontitisNRSupra and subgingival scaling and root planing of the test sites, reduction of any overhanging restorations that were present and full mouth polishing using a rubber cup11 subjectsMean: 39SBIFull participants only.T:5 (128 sites)NA6.1 (NR)NAChi Square of PD reduction = 4.9
12 weeks (84 days) Subject/Site Allocation: Types of Teeth: Trained: Time spent: 262 sitesRange:PlISites less than 5 mm PD were eliminated prior to the next visit.C:6 (134 sites)NA5.9 (NR)NA Quality Score:
Study/Treatment Site: RandomNRNRNRT: 5 pockets (128 sites)T: 26 to 49PDFinal: 12 weeks46; 46
Eastman Dental Hospital Blinding: Widman flap: Assigned to Subjects: C: 6 pockets (134 sites)C: 34 to 48 Radiographic Techniques: T:NRNANRNA
Location: Examiners and patients blindNRNRDose, Mode, Schedule:Gender:NRC:NRNANRNA
UK Placebo: T: SRP plus irrigation with 0.02% chlorhexidine 1×day for 28 daysMale: Microbiological Methods: Change:
Patient Population: YesC: SRP with 0.01% quinine sulphate (placebo) irrigation 1×day for 28 daysT: 3NRT:NANRNA
Adult patients referred for periodontal treatment with PD ≥ 5 mm and radiographic evidence of bone loss Split-mouth: C: 1 Subject Self Report: C:NANRNA
NoFemale:Found the procedure pleasantTest:Chi Square
T: 2 P value:NS
C: 5
Race/Ethnicity:
NR
Wennström et al., 198785 Design Type: Severity: Number: SRP performed: Subject/Site allocation:Age:NABefore SRP3 times (at baseline and weeks 40 and 52) Clinical Measurement: NRNR Type of analysis reported: Baseline:Results are presented in terms of percentage of sites
Study Period: RCTModerate to severe periodontal disease1Subgingival mechanical debridement of entire dentition at week 32 of study10 subjectsMean: 43.152 week study, SRP and treatment at week 32BOP/SBIFull participants onlyT:NR6.7 (NR)NA Quality Score:
52 weeks Subject/Site Allocation: Types of Teeth: Trained: Time spent: T: 28 sitesRange: 22 to 61PlIC:NR6.9 (NR)NA46; 46
Study/Treatment Site: Random assignment of quadrantsNRNA6 visits during 6 weeksC: 24 sitesGender:PDFinal: 52 weeks
Graduate Program, Department of Periodontology, University Clinic Blinding: Widman flap: Assigned to Subjects: Dose, Mode, Schedule:NRCALT:NR4.8 (NR)NA
Location: Examiners blindNRSame examiner throughout studyAll subjects received professional tooth cleaning every 4 weeksRace/Ethnicity:GIC:NR5.1 (NR)NA
Sweden Placebo: T: SRP plus irrigation with 0.2% chlorhexidine 3×weekNR Radiographic Techniques: Change: Gain Reduction
Patient Population: YesC: SRP plus irrigation with saline 3×weekBone Loss/RegenerationT:28 sites0.6 (0.4)1.9* (NR)NA
Patients with PD ≥ 6 mm and BOP selected from the waiting list Split-mouth: Microbiological Methods: C:24 sites0.7 (0.5)1.8* (NR)NA
YesCrevicular fluid microbiotaTest:Paired t-testNR
Subject Self Report: P value:NSNR
NR

From: Evidence Tables

Cover of Effectiveness of Antimicrobial Adjuncts to Scaling and Root Planing Therapy for Periodontitis
Effectiveness of Antimicrobial Adjuncts to Scaling and Root Planing Therapy for Periodontitis.
Evidence Reports/Technology Assessments, No. 88.
Bonito AJ, Lohr KN, Lux L, et al.

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