Abstract
Chlorhexidine (CHX) mouthwashes are frequently used as an adjunctive measure for the treatment of periodontitis and peri-implantitis, as well as in patients on maintenance therapy. However, their prolonged use is associated with several side effects. This study aimed at evaluating if a mouthwash with a reduced concentration of CHX combined with cetylpyridnium chloride (CPC) was as effective as a conventional CHX mouthwash in the reduction in living cells in oral biofilms attached to hydroxyapatite (HA) and micro-rough titanium (Ti) surfaces. Four healthy volunteers wore a customized acrylic appliance containing HA and Ti discs for in situ plaque accumulation. Biofilms were grown on the discs for 24 or 48 h and then randomly exposed for 60 s to: 0.05% CHX + 0.05% CPC, 0.1% CHX (positive control) or sterile saline (negative control). Viability assay and live-dead staining were performed to quantify bacterial viability and to distinguish live and dead cells, respectively. At both time points, contrary to saline, CHX, both alone and in combination with CPC, exhibited high antibacterial properties and induced a significant reduction in biofilm viability. This study demonstrates the potential of mouthwashes containing a low concentration of CHX combined with CPC as effective antibacterial agents for long-term applications with reduced undesired side effects.
Highlights
Periodontal and peri-implant diseases are highly prevalent biofilm-associated inflammatory diseases affecting the supportive structure of teeth or dental implants [1,2,3,4,5,6]
After 24 h, the highest cell counts per second were recorded for the discs rinsed with NaCl (Figure 1), whereas titanium (Ti) and hydroxyapatite (HA) discs treated with 0.05% CHX + 0.05% cetylpyridnium chloride (CPC) (CHX + CPC) and 0.1% CHX (CHX) rinses showed very low counts per second (Figure 1)
Significant differences were detected between the NaCl Antibiotics 2021, 10, x FOR PEER REV(nIEeWgative control) and the two other groups (CHX + CPC, CHX), whereas 3siogfn1i0ficance failed between the latter for both surfaces (Table 1)
Summary
Periodontal and peri-implant diseases are highly prevalent biofilm-associated inflammatory diseases affecting the supportive structure of teeth or dental implants [1,2,3,4,5,6]. Without treatment, they can evolve into the more severe and irreversible periodontitis or peri-implantitis, respectively, characterized by connective tissue inflammation and progressive loss of the supporting bone [7,8]. Maintenance becomes important when moderately rough implant surfaces are exposed to the oral cavity. They are widely used owing to the favorable bone response [19]; they facilitate microbial adhesion, leading to an increased risk of recurrence [20,21,22,23]
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