Changes in clinical parameters following adjunctive local sodium hypochlorite gel in minimally invasive nonsurgical therapy (MINST) of periodontal pockets: a 6-month randomized controlled clinical trial

Abstract

Background The mechanical disruption and removal of the subgingival biofilm represent the most important step in the treatment of periodontitis. However, in deep periodontal pockets, mechanical removal of the subgingival biofilm is difficult and frequently incomplete. Preliminary findings indicate that the use of amino acid buffered sodium hypochlorite (NaOCl) gel may chemically destroy the bacterial biofilm and facilitate its mechanical removal. Objectives To clinically evaluate the efficacy of minimally invasive nonsurgical therapy (MINST) of periodontal pockets with or without local application of an amino acid buffered sodium hypochlorite (NaOCl) gel. Materials and methods Forty untreated patients diagnosed with severe/advanced periodontitis (i.e. stage III/IV) with a slow/moderate rate of progression (i.e. grade A/B) were randomly allocated in two treatment groups. In the test group, the periodontal pockets were treated by means of MINST and NaOCl gel application, while in the control group, treatment consisted of MINST alone. Full-mouth plaque scores (FMPS), full-mouth bleeding scores (FMBS), probing depths (PD), clinical attachment levels (CAL) and gingival recessions (GR) were assessed at baseline and at 6 months following therapy. The primary outcome variable was PD reduction at sites with PD ≥ 5 mm at baseline. Results At 6 months, statistically significant differences between the two groups were found (p = 0.001) in terms of PD and CAL change. No statistically significant differences were found in terms of GR (p = 0.81). The number of sites with PD ≥ 5 mm and BOP (+) decreased statistically significantly (p = 0.001), i.e. from 85.3 to 2.2% in the test group and from 81.6 to 7.3% in the control group, respectively. Statistically significant differences between test and control groups were recorded at 6 months (p = 0.001). MINST + NaOCl compared to MINST alone decreased statistically significantly (p = 0.001) the probability of residual PDs ≥ 5 mm with BOP− (14.5% vs 18.3%) and BOP+ (2.2% vs. 7.2%). Conclusions Within their limits, the present results indicate that (a) the use of MINST may represent a clinically valuable approach for nonsurgical therapy and (b) the application of NaOCl gel in conjunction with MINST may additionally improve the clinical outcomes compared to the use of MINST alone. Clinical relevance In patients with untreated periodontitis, treatment of deep pockets by means of MINST in conjunction with a NaOCl gel may represent a valuable approach to additionally improve the clinical outcomes obtained with MINST alone

Adjunctive Application of Hyaluronic Acid in Combination with a Sodium Hypochlorite Gel for Non-Surgical Treatment of Residual Pockets Reduces the Need for Periodontal Surgery—Retrospective Analysis of a Clinical Case Series

“…Nevertheless, its use was associated with significantly reduced recolonization of the sites by T. denticola and T. forsythia [ 22 ]. By contrast, the adjunctive benefit of sodium hypochlorite gel formulation for minimally invasive non-surgical therapy (MINST) was positively evaluated by a recent RCT [ 15 ]. The authors compared the outcome of step-2 therapy after delivering it to untreated stage-3 and -4 periodontitis patients in both study arms.…”

“…By contrast, a novel amino-acid-buffered sodium hypochlorite cleaning gel exhibiting antimicrobial potential was significantly effective in improving the outcome of non-surgical therapy and, thus, significantly reduced counts of Gram-negative pathogens in an artificial biofilm model [ 15 , 16 ].…”

The Emerging Role of microRNA in Periodontitis: Pathophysiology, Clinical Potential and Future Molecular Perspectives

“…A recent study has shown that the formation of miRNA-584 is induced by P. gingivalis lipolysaccharides (LPS). This miRNA, produced by bacterial induction, causes upregulation of IL-8 within gingival epithelial cells by inducing the repression of the lactoferrin receptor, which, if not inhibited, would induce an antimicrobial effect [ 13 , 27 , 28 ].…”

Prevalence of Early Childhood Caries in Southern Italy: An Epidemiological Study

“…is is due to the transmission of the Streptococcus mutans being significantly augmented when inappropriate behaviors [24][25][26] are pursued such as the usage of the baby bottle, the pacifier, or the same cutlery not clean shared with the parent's saliva [3,[27][28][29][30][31][32]. In this respect, the mother can be an important font of transmission in children especially in the first two years of life, when Streptococci mutans are initially transferred, especially using dental materials [3,[33][34][35][36]. us, if the mother does not follow appropriate behaviour of oral hygiene [27][28][29][30][31], the risk of development of cavities in the child increases since the concentration of bacteria is higher and more aggressive [37][38][39][40].…”