Assessing the effectiveness of locally delivered chlorhexidine in the treatment of periodontitis.

Background: Several multicenter random clinical trials have studied a second-generation easy-to-use chlorhexidine local delivery system to assess its effectiveness as an adjunct to scaling and root planing, or SRP.

Methods: The author reviews the pharmacokinetics of the local delivery system and two of the multicenter randomized clinical trials. One study evaluated 118 patients using split-arch design and the other study 447 patients using parallel design. All patients underwent SRP. Test sites, which had pocket depths of 5 millimeters or larger, received a chlorhexidine chip (in both studies) or a placebo chip (the parallel study only). Test sites that remained 5 mm or larger were re-treated with a chip at three months and at six months (parallel study only).

Results: Both studies found greater mean reductions in probing depth when the chlorhexidine chip was used in conjunction with SRP than when SRP was used alone (1.16 mm vs. 0.7 mm, P < or = .0001, in the split-arch-design study and 0.95 mm vs. 0.65 mm, P = .00001, in the parallel-design study). The combined therapy resulted in significantly more sites with probing depth reductions of 2 mm or more compared with SRP alone (49.5 percent vs. 32.1 percent; P < .0001, in the split-arch-design study and 19.1 percent vs. 8 percent, P < .0001, in the parallel-design study).

Conclusions: Use of the chlorhexidine chip has significantly improved the clinical parameters of periodontitis when used as an adjunct to SRP.

Clinical Implications: When used with SRP, the chlorhexidine chip offers the clinician a new method of achieving and maintaining periodontal stability.