[Subgingival application of chlorhexidine in the treatment of periodontitis]

The clinician is frequently faced with poor treatment outcome of scaling and root planing predominantly in deep pockets and furcations. In an attempt to optimize clinical effects at these weakly responding sites chemo-mechanical treatment strategies have been developed and studied, among those using chlorhexidine as an antimicrobial agent. In this overview the clinical effects of subgingival chlorhexidine irrigation, gel, chip and varnish administration as an adjunct to scaling and root planing in the treatment of periodontitis are discussed. There is little to no evidence indicating treatment outcome will benefit from subgingival irrigation using chlorhexidine solutions. Furthermore, the use of a chlorhexidine solution as a coolant during (ultra)sonic scaling does not result in a clinically superior response when compared to water cooling. Despite the high viscosity of a gel, its use cannot be justified in the treatment of periodontitis as clinical effects are also negligible. Multi-center studies have indicated significantly higher pocket reductions and clinical attachment gains following a combination of scaling and root planing and the administration of a chlorhexidine chip. As some studies failed to confirm this finding, more research is needed to elucidate the additional value of the chip. The subgingival administration of a supersaturated chlorhexidine varnish seems promising as additive clinical effects have been reported. Large-scale studies are however lacking on this treatment concept. The clinician should continue treating periodontitis primarily by mechanical means. Supplemental chemical therapy based on subgingival chlorhexidine administration can be considered; yet, solutions and gels are not suitable as compensatory aids when scaling and root planing becomes less effective.