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

Vincenzo Iorio-Siciliano,Luca Ramaglia,Giovanni E Salvi,Andrea Blasi,Anton Sculean,Gaetano Isola

doi:10.1007/s00784-021-03841-8

Vincenzo Iorio-Siciliano, Luca Ramaglia + Show 4 more

Open Access

https://doi.org/10.1007/s00784-021-03841-8

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Abstract

BackgroundThe 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.ObjectivesTo 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 methodsForty 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.ResultsAt 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%).ConclusionsWithin 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 relevanceIn 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

Highlights

The development and progression of periodontitis depend on the presence of pathogenic microorganisms organized in a supra/subgingival biofilm attached to the dental surface [1, 2]
The present randomized controlled clinical trial has evaluated the outcomes obtained at 6 months by means of minimally invasive nonsurgical therapy (MINST) with and without application of NaOCl in patients with untreated periodontitis exhibiting deep periodontal pockets
Both groups received exactly the same type of mechanical treatment (i.e. MINST), the only difference being the application of NaOCl in the test group prior to mechanical debridement

Summary

Introduction

The development and progression of periodontitis depend on the presence of pathogenic microorganisms organized in a supra/subgingival biofilm attached to the dental surface [1, 2]. It is generally accepted that mechanical disruption and removal of the subgingival biofilm using hand and ultrasonic/sonic instruments represent the most important step in the treatment of periodontitis leading, in the great majority of cases, to successful clinical outcomes [2,3,4]. In certain clinical situations, such as the presence of deep periodontal pockets or deep furcation involvements, mechanical removal of the subgingival biofilm is difficult and frequently incomplete [5]. The mechanical disruption and removal of the subgingival biofilm represent the most important step in the treatment of periodontitis. 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

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