Multi-disciplinary Treatment Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Tian Tan Xi Li Number.4, Beijing, 100050, China.
Department of Periodontology, Witten/Herdecke, University, Alfred-Herrhausen-Str. 45, 58445, Witten, Germany.
BMC Oral Health. 2020 Jan 31;20(1):34. doi: 10.1186/s12903-020-1021-0.
Subgingival applications of chlorhexidine (CHX) gel are commonly used as an adjunct in nonsurgical periodontal treatment (NSPT) for chronic periodontitis (CP). However, there is lack of systematic review and meta-analysis justifying the effects of adjunctive CHX gel on clinical outcomes. The objective of this meta-analysis was to evaluate the efficacy of adjunctive subgingival administration of CHX gel in NSPT compared to NSPT alone for CP.
An electronic search of four databases and a manual search of four journals were conducted up to August 2019. Only randomized controlled trials reporting on the clinical outcomes of subgingival use of CHX gel adjunct to scaling and root planing (SRP), as compared to SRP alone or with placebo, for at least 3 months were included. Primary outcomes were probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain at 3 and 6 months, when data on at least three studies were obtained.
Seventeen studies were included for qualitative analysis and seven studies for quantitative analysis (four studies for the application of CHX gel adjunct to SRP at selected sites with at least pocket depth ≥ 4 mm and three studies for comparison of full-mouth disinfection (FMD) with subgingival use of CHX gel and full-mouth scaling and root planing (FMSRP). For subgroups, the clinical outcomes between adjunctive use of Xanthan-based CHX gel (XAN-CHX gel) and CHX gel were analyzed. Results indicated a significant improvement of PPD reduction following local adjunctive administration of XAN-CHX gel for SRP at selected sites (MD: 0.15 mm). However, no difference was found in CAL gain. Moreover, no significant difference was observed in PPD and CAL at both 3 and 6 months post-treatment between FMD and FMSRP.
Adjunctive subgingival administration of XAN-CHX gel at individual selected sites in NSPT appears to provide slight benefits in PPD reduction compared to NSPT alone for CP. Due to the lack of high-quality studies, further studies with larger sample sizes and strict standards are needed to confirm the conclusions.
龈下应用洗必泰（CHX）凝胶通常作为非手术牙周治疗（NSPT）的辅助手段，用于治疗慢性牙周炎（CP）。然而，目前缺乏系统评价和荟萃分析来证明辅助 CHX 凝胶对临床结果的影响。本荟萃分析的目的是评估 NSPT 中辅助龈下给予 CHX 凝胶与单独 NSPT 相比，对 CP 的疗效。
对四个数据库进行电子检索，并对四本期刊进行手工检索，检索时间截至 2019 年 8 月。仅纳入报告 CHX 凝胶辅助龈下使用与单独龈下刮治和根面平整（SRP）或与安慰剂相比，至少 3 个月后龈下使用 CHX 凝胶的临床结果的随机对照试验。主要结局为 3 个月和 6 个月时探诊袋深度（PPD）减少和临床附着水平（CAL）增加，当获得至少三项研究的数据时。
纳入了 17 项研究进行定性分析，7 项研究进行定量分析（4 项研究为 CHX 凝胶辅助龈下刮治和根面平整（SRP），至少有 4mm 以上的牙周袋深度≥），3 项研究比较了全口消毒（FMD）与龈下应用 CHX 凝胶和全口龈下刮治和根面平整（FMSRP）。对于亚组，分析了基于黄原胶的 CHX 凝胶（XAN-CHX 凝胶）和 CHX 凝胶辅助使用的临床结果。结果表明，在 SRP 中局部辅助使用 XAN-CHX 凝胶在选择性部位治疗时，PPD 减少有显著改善（MD：0.15mm）。然而，CAL 增加无差异。此外，在 FMD 和 FMSRP 治疗后 3 个月和 6 个月时，PPD 和 CAL 均无显著差异。
在 NSPT 中，在个别选定部位辅助龈下给予 XAN-CHX 凝胶，与单独 NSPT 相比，CP 患者的 PPD 减少可能略有获益。由于缺乏高质量的研究，需要进一步进行更大样本量和严格标准的研究，以确认结论。
