Management of Chronic Periodontitis Using Chlorhexidine Chip and Diode Laser-A Clinical Study

Abstract

Introduction: The use of adjuncts like chlorhexidine local delivery and diode laser decontamination have been found to improve the clinical outcomes of scaling and root planing in non-surgical periodontal therapy in patients with chronic periodontitis. Aim:To evaluate the effects of diode laser and chlorhexidine chip as adjuncts to scaling and root planing in the management of chronic periodontitis. The objective is to evaluate the outcome of chlorhexidine chip and diode laser as adjuncts to scaling and root planing on clinical parameters like Plaque Index, Gingival Index, probing pocket depth and clinical attachment level.Study and Design: Department of Periodontics. Randomized clinical trial with split mouth design. Materials and Methods:Fifteen chronic periodontitis patients having a probing pocket depth of 5mm-7mm on at least one interproximal site in each quadrant of the mouth were included in the study. After initial treatment, four sites in each patient were randomly subjected to scaling and root planing (control), chlorhexidine chip application (CHX chip group), diode laser (810 nm) decontamination (Diode laser group) or combination of both (Diode laser and chip group). Plaque Index (PI), Gingival Index (GI), probing pocket depth (PPD) and clinical attachment level (CAL) were assessed at baseline, one month and three months. Statistical analysis:Results were statistically analysed using paired T test, one-way ANOVA, Tukey's HSD test and repeated measure ANOVA.Results: Post-treatment, the test and control sites showed a statistically significant reduction in PI, GI, PPD, and CAL. After three months, a mean PPD reduction of 1.47±0.52 mm in control group, 1.40±0.83 mm in diode laser group, 2.67±0.62 mm in CHX group, and 2.80± 0.77 mm in combination group was seen. The mean gain in CAL were 1.47±0.52 mm in the control group, 1.40±0.83 mm in diode laser group, 2.67± 0.49 mm in CHX group and 2.67± 0.82 mm in combination group respectively. The differences in PPD reduction and CAL gain between control group and CHX chip and combination groups were statistically significant (p<0.05) at three months, whereas, the diode laser group did not show any significant difference from the control group. Conclusion:Chlorhexidine local delivery alone or in combination with diode laser decontamination is effective in reducing probing pocket depth and improving clinical attachment levels when used as adjuncts to scaling and root planing in non-surgical periodontal therapy of patients with chronic periodontitis. adjuncts to mechanical instrumentation in the management of periodontal diseases. Different antibiotics such as tetracycline, nitroimidazoles, fluoroquionolones and macrolides have been used as local drug delivery agents in various studies with promising clinical and microbiological results [5,6].Chlorhexidine, the most widely used topical antiseptic and antiplaque agent in periodontics, has also been used as an agent for local drug delivery. A recent meta analysis [7] on the effect of local drug delivery in chr...

Evaluation of different treatments of chronic and severe periodontitis in adult patients: meta-analysis of clinical trials

“…The evidence supports the adjunctive use of local antimicrobials with subgingival debridement at deep or recurring periodontal sites, mainly with the use of sustained release antimicrobial vehicles 43 . Unlike the other authors, Jose et al 2016 44 compared the effects of a laser diode and a chlorhexidine chip used alone and in combination with scaling and root planing in the management of chronic periodontitis. After treatment, the test and control sites showed a statistically significant reduction in PI, GI and pocket depth (PPD).…”

The Effects of Diode Laser as an Adjunct to Scaling and Root Planing on Treatment of Chronic Periodontitis: A Review of the literature

“…It should be considered that the authors have used the power of 0.5 W for 10 seconds, which may not be adequate. (19) Nguyen et al assessed the effect of 940 nm diode laser and found no significant effect on PD compared to treatment with SRP alone. It should be noted that in this study, laser irradiation and SRP were performed simultaneously, and that power of 0.8 W may be insufficient for therapeutic purposes.…”

“…(15) In a study about gingivitis, Jose et al did not observe a significant difference between laser group irritated with the wavelength of 810 nm and control group in terms of decreasing GI, which can be caused by irradiation settings (power of 0.5 W for 10 seconds). (19) Previous studies have shown that laser radiation can affect the production of cytokines and growth factors, and thereby can accelerate the recovery. (3,6,25) Üstün et al showed that the use of 810 nm diode laser can cause significant decrease in the amount of GCF and IL-1β compared to control group, which could be an explanation for the decrease in GI and PD.…”

“…Seven studies have used the wavelength between 805 and 830 nm: (13)(14)(15)(16)(17)(18)(19) In 1998, Moritz et al performed a study on 50 patients. Bacterial reduction was more significant in test group after 6 months.…”

“…However, laser+SRP group did not show a statistically significant difference with control group. (19) Four studies have used diode laser with the wavelength of 980 nm: (5,(20)(21)(22) In 2008, Caruso et al reviewed the effect of 980 nm diode laser on 13 patients with chronic periodontitis. Changes of 8 pathogens before treatment and one month after treatment were analyzed by PCR techniques.…”