Effectiveness of Adjunctive Irrigation in Early Periodontitis: Multi‐Center Evaluation

Abstract

The purpose of this study was to determine the effect of daily water irrigation versus regular oral hygiene alone on gingival and periodontal health in periodontitis patients receiving supportive periodontal treatment. The study also sought to determine if there are enhanced benefits from using an antiplaque zinc sulfate rinse as an irrigant. One hundred fifty‐five patients who have had periodontitis and had been treated either surgically or non‐surgically completed the 6‐month multi‐center multi‐national study. Patients with at least two 5 mm sites demonstrating bleeding on probing were assigned to 3 equal groups by balanced randomization. In all centers Group A (n = 57) performed regular oral hygiene only, and Group B (n = 58) irrigated with 500 ml water once daily after regular oral hygiene. Group C (n = 40) patients irrigated with a total of 500 ml once daily; following irrigation with 300 ml water, the patients then irrigated with an additional 200 ml with a zinc sulfate solution. The irrigants were diluted to provide the manufacturer's recommended daily dosage. The supragingival irrigation was performed with a commercially available oral irrigator. Bacterial measurements at baseline, 3 months, and 6 months were taken to determine the effect of irrigation on the target organisms and will be reported elsewhere. Gingival index: irrigation with water (Group B) was significantly better than normal oral hygiene (Group A) and irrigation with zinc sulfate (Group C) (P < 0.05) in reducing gingival inflammation. Bleeding on probing: significant reductions in bleeding on probing occurred for water (Group B) compared to normal oral hygiene (Group A) (P < 0.01). Among the patients with greater baseline bleeding (> 30% sites), irrigation with water (Group B) was significantly better than normal oral hygiene (Group A) in reducing bleeding on probing and gingival inflammation (P < 0.01); and water irrigation was significantly better than zinc sulfate irrigation (P < 0.05) for reducing gingival inflammation. Probing depth: irrigation with water (Group B) demonstrated clinically small, but statistically significant, reduction (P < 0.05) in probing depth compared to Group A and Group C. Plaque index: there were no significant differences observed. This study demonstrates that adjunctive supragingival irrigation with water can provide meaningful clinical outcomes for patients with periodontitis who are being treated in the maintenance phase of periodontal therapy. J Periodontol 1994; 65:224–229.

Oral hygiene in the prevention of periodontal diseases: the evidence

“…Since its introduction, the oral irrigator has at times been a popular device (95). However, there has been considerable controversy regarding the appropriate use and efficacy of this instrument (8, 95).…”

“…Since its introduction, the oral irrigator has at times been a popular device (95). However, there has been considerable controversy regarding the appropriate use and efficacy of this instrument (8, 95). Studies using an oral irrigator have reported both positive (43, 62, 81, 130) and negative results (10, 138) in terms of periodontal inflammation and plaque.…”

Treatment modalities and evaluation models for periodontitis

“…[19] A positive correlation was found between supragingival irrigation, which could be either by acetyl salicylic acid (ASA) or water and the reduction in disease severity. Thus, regular supragingival irrigation with either 0.3% ASA or water besides usual oral hygiene seems to be a valuable extra periodontal supportive remedy in patients showing the signs of moderate to severe periodontitis.…”

Locally delivered antimicrobials for the treatment of chronic periodontitis

“…Pulsated home irrigation with a regular tip has been used in a multicenter study on maintenance patients and at 6 months, water irrigation showed a small additional significant reduction in pocket depth (Newman et al , 1994a). Drisko (1996) points out that significant results from patient home therapy are highly dependent on patient compliance (time consuming) and dexterity.…”

“…The use of tetracycline‐loaded ethylene vinyl acetate fibers (TNC) in combination with thorough scaling and root planing has shown statistically a significant reduction in pocket depth when compared to scaling and root planing alone (Goodson et al , 1991; Newman et al , 1994a; Kinane and Radvar, 1999). The fiber must completely fill the pocket and be maintained with a cyanoacrylate adhesive for 7–10 days.…”