sodium-hypochlorite and Periodontal-Pocket

The aim of this study is to assess the clinical and microbiological effects of a single subgingival administration of sodium hypochlorite gel (NaOCl) and compare it with 1% chlorhexidine (CHX) gel and a placebo gel following mechanical re-instrumentation during supportive periodontal therapy (SPT).. Sixty-two patients who had been treated for stage III-IV periodontitis and enrolled in SPT were included in the study based on following criteria: (1) active periodontal therapy completed at least 6 months before enrollment in the study, (2) presence of at least 4 non-adjacent sites with probing pocket depths (PPDs) ≥ 4 mm with bleeding on probing (BOP), or presence of 5-8 mm PPDs with or without BOP. All sites presenting PPD ≥ 4 mm and BOP at baseline and 3-, 6-, and 9-month follow-up timepoints were subgingivally re-instrumented with ultrasounds. Selected patients were randomly assigned into three groups and treated additionally with a single subgingival administration of NaOCl gel (group A); 1% CHX gel (group B); and placebo gel (group C). Main outcome variable was pocket closure at 12 months. Secondary outcome variables were changes in mean PPD, BOP, and clinical attachment level (CAL) along with changes in the numbers of the following five keystone bacterial pathogens: Aggregatibacter actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), Prevotella intermedia (P.i.), Tannerella forsythia (T.f.), and Treponema denticola (T.d.).. At 12 months, pocket closure was obtained in 77.5% in the NaOCl treated sites. The reduction in PPD was higher with CHX than with NaOCl, although a statistically significant adjunctive effect for NaOCl (P = 0.028) was only observed in comparison with placebo only. Mean CAL improved in all groups and at all timepoints, compared to the baseline (P < 0.05). However, after 6 months, CAL gain was statistically significantly higher in the NaOCl treated group than following application of CHX (P = 0.0026).. In SPT patients, a single adjunctive use of a NaOCl gel may provide benefits in controlling inflammation and residual pockets.. ISRCTN Registry of Clinical Trials (ISRCTN11387188).. A baseline single application of NaOCl gel in conjunction with mechanical debridement may achieve substantial pocket closure in patients enrolled in SPT; treatment time, cost, and applicability considerations should be taken into account when selecting this therapy.

Topics: Aggregatibacter actinomycetemcomitans; Chlorhexidine; Dental Scaling; Humans; Periodontal Pocket; Periodontitis; Porphyromonas gingivalis; Sodium Hypochlorite

The 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.. To 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.. Forty 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.. At 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%).. Within 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.. In 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.

Topics: Dental Scaling; Gingival Recession; Humans; Periodontal Pocket; Periodontitis; Sodium Hypochlorite; Treatment Outcome

This study evaluated the potential of gingival bleeding on probing to serve as a predictor of future periodontal breakdown. It also assessed the ability of 0.25% sodium hypochlorite twice-a-week oral rinse to convert periodontal pockets showing bleeding on probing to nonbleeding sites.. The study was performed as a randomized, single-blinded, clinical trial in parallel groups. Seven periodontitis patients rinsed twice-weekly for 3 mo with 15 mL of a fresh solution of 0.25% sodium hypochlorite, and five periodontitis patients rinsed with water. The 12 study patients received no subgingival or supragingival scaling. Clorox(®) Regular-Bleach was the source of sodium hypochlorite. At baseline and 3-mo visits, gingival bleeding was assessed within 30 s after probing to full pocket depth using an approximate force of 0.75 N.. A total of 470 (38%) of 1230 periodontal pockets in the bleach-rinse group revealed bleeding on probing at the initial visit but not at the 3-mo visit; only 71 (9%) of 828 pockets in the control group became bleeding-negative during the study (p < 0.001). Bleeding on probing in 4- to 7-mm-deep pockets decreased by 53% in the bleach-rinse group but increased by 6% in the water-rinse group (p < 0.001). Ninety-seven pockets showed depth increases of ≥ 2 mm after 3 mo: 60 (62%) of those pockets exhibited bleeding on probing at both the initial and the 3-mo visits; 24 (25%) bled at only one of the two visits; and 13 (13%) never demonstrated gingival bleeding (p < 0.001).. Persistent gingival bleeding on probing was associated with an increased risk for periodontal breakdown, and the absence of gingival bleeding seemed to be a useful, although not perfect, indicator of disease stability. Twice-weekly oral rinsing with dilute bleach (0.25% sodium hypochlorite) produced a significant reduction in bleeding on probing, even in deep unscaled pockets. Sodium hypochlorite constitutes a valuable antiseptic in periodontal self-care.

Topics: Adult; Anti-Infective Agents, Local; Disease Progression; Follow-Up Studies; Gingival Hemorrhage; Humans; Mouthwashes; Periodontal Index; Periodontal Pocket; Periodontitis; Single-Blind Method; Sodium Hypochlorite; Treatment Outcome

Post-obturation pain is frustrating to both patients and dentists. Its incidence may change with the use of contemporary endodontic techniques. This randomised clinical trial aims to compare the incidence of post-obturation pain at one and seven days after single-visit and multiple-visit non-surgical endodontic treatments.. Patients who required primary endodontic treatment in the two clinical trial centres in Hong Kong (HK) and in Beijing (PK) were recruited. Three HK dentists and three PK dentists performed endodontic treatments on 567 teeth using the same procedures and materials, either in a single visit or over multiple visits, using either core carrier or cold lateral condensation for obturation.. The attrition rate was 5.1%, and a total of 538 teeth were evaluated. Among these teeth, 232 (43%) were operated in HK, 275 (51%) were treated in a single visit, and 234 (43%) were treated using core carrier obturation. Logistic regression analysis showed that teeth with apical periodontitis (OR = 0.35, 95% CI = 0.21-0.57, p < 0.01) and less pre-operative pain (OR = 1.10, 95% CI = 1.03-1.18, p < 0.01) had lower incidences of post-obturation pain after one day. The incidences of post-obturation pain after one day for single-visit and multiple-visit treatments were 24.7% (68 of 275) and 33.5% (88 of 263), respectively (p = 0.50). The incidences of post-obturation pain after seven days for single-visit and multiple-visit treatments were 4.0% (11 of 275) and 5.3% (14 of 263), respectively (p = 0.47).. There was no significant difference in the incidences of post-obturation pain after one day and seven days with single-visit or multiple-visit endodontic treatments.. ChiCTR-IOR-15005989.

Topics: Adult; Appointments and Schedules; Calcium Hydroxide; Dental Fistula; Epoxy Resins; Female; Follow-Up Studies; Gutta-Percha; Humans; Male; Middle Aged; Pain; Pain Measurement; Periapical Abscess; Periapical Periodontitis; Periodontal Pocket; Root Canal Filling Materials; Root Canal Irrigants; Root Canal Obturation; Root Canal Preparation; Root Canal Therapy; Sodium Hypochlorite; Tooth Mobility

The study aimed to evaluate the effect of 0.25% sodium hypochlorite twice-weekly oral rinse on plaque and gingivitis in patients with minimally treated periodontitis.. The study included 30 patients with periodontitis, it lasted 3 mo, and it was performed as a randomized, controlled, single-blinded, clinical trial in parallel groups. Fifteen patients rinsed for 30 s with 15 mL of a fresh solution of 0.25% sodium hypochlorite (test) and 15 patients rinsed with 15 mL of water (control). Clorox(®) regular bleach was the source of the sodium hypochlorite. At baseline and at 2 wk, the study patients received professional subgingival irrigation for 5 min with either 0.25% sodium hypochlorite or water, but no subgingival or supragingival scaling. The presence or absence of supragingival plaque on facial and lingual surfaces was determined by visual inspection; each tooth was dried with air and mouth mirror rotation was used to provide light reflection to identify plaque on smooth surfaces and at the tooth line angles. Gingival bleeding within 30 s after probing to full pocket depth was assessed in six sites of each tooth. Adverse events were evaluated by questionnaire and visual examination.. All 30 patients in the study completed the baseline and the 2 wk parts of the study and a subset of 12 participants completed the 3 mo part of the study. The sodium hypochlorite rinse group and the water rinse group, respectively, showed increases from baseline to 3 mo of 94% and 29% (3.2-fold difference) in plaque-free facial surfaces, of 195% and 30% (6.5-fold difference) in plaque-free lingual surfaces, and of 421% and 29% (14.5-fold difference) in number of teeth with no bleeding on probing. The differences in clinical improvement between the sodium hypochlorite rinse group and the water rinse group were statistically significant. No adverse events were identified in any of the study patients, except for minor complaints about the taste of bleach.. A twice-weekly oral rinse with 0.25% sodium hypochlorite produced marked decreases in dental plaque level and bleeding on probing and may constitute a promising new approach to the management of periodontal disease. Long-term controlled studies on the effectiveness of sodium hypochlorite oral rinse are needed and encouraged.

Topics: Adult; Anti-Infective Agents, Local; Bacterial Load; Dental Plaque; Female; Follow-Up Studies; Fusobacterium; Gingival Hemorrhage; Gingivitis; Gram-Negative Bacteria; Humans; Male; Mouthwashes; Patient Satisfaction; Periodontal Pocket; Periodontitis; Pilot Projects; Single-Blind Method; Sodium Hypochlorite; Therapeutic Irrigation

This study investigated the hypothesis that antiformin-citric acid chemical curettage combined with scaling and root planing (SRP/AF) would significantly reduce pathogenic bacteria of the periodontal pocket when compared to scaling and root planing alone (SRP). Ten patients with moderate periodontitis participated. Four pockets per patient, one in each posterior sextant, were chosen. Pocket depths, attachment levels, and gingival index (GI) were measured. Bacterial samples were examined under dark-field microscope for: (1) spirochetes, (2) motile rods, and (3) all others. A randomized four-sextant treatment design was used. One sextant received no treatment, a second received SRP, and the two remaining sextants received identical treatments of SRP/AF. Of these two sextants, one was sampled at baseline and 12 weeks only in order to serve as an additional control. The remaining sextants were sampled at 1, 4, 8, and 12 weeks. Both SRP and SRP/AF significantly reduced the percentage of spirochetes and motile rods. A significant reduction in GI and pocket depths was also noted. Attachment level showed no significant change. Results of both treatment groups showed no significant differences among any of the parameters. A comparison of the two SRP/AF groups indicated no significant difference among clinical or bacterial parameters due to sampling.

Topics: Adult; Bacteria; Bacterial Physiological Phenomena; Citrates; Citric Acid; Dental Plaque; Dental Prophylaxis; Dental Scaling; Female; Humans; Male; Middle Aged; Periodontal Index; Periodontal Pocket; Periodontitis; Sodium Hypochlorite; Subgingival Curettage; Tooth Root

The purpose of the present study was to compare cementum surfaces after etching at neutral or low pH in both healthy monkey teeth and periodontitis-affected human teeth. 16 monkey teeth and 16 human periodontitis-affected teeth were used. Etching with phosphoric and citric acids as well as EDTA was performed on the following surfaces: healthy monkey cementum, human cementum surfaces coronal and apical to the level of periodontal breakdown as well as exposed human dentin surfaces. Results indicate a profoundly higher capacity of EDTA to selectively expose collagen fibers in both healthy cementum surfaces and periodontitis-affected dentin surfaces compared to agents operating at low pH which seemed to erode the surfaces to varying degrees. Variable results were seen on cementum surfaces which had been exposed to the environment of the periodontal pocket or the oral cavity. In view of this, it would seem preferable to mechanically remove the superficial layer of "diseased" cementum prior to the etching procedure. In conventional periodontal surgery, etching may be of limited value. However, in regenerative procedures, exposure of an intact collagenous matrix provides a matrix for retention of implants of biologically active substances such as growth factors, in addition to serving as a biocompatible surface for periodontal ligament cell colonization.

Topics: Acid Etching, Dental; Animals; Biocompatible Materials; Chelating Agents; Citrates; Citric Acid; Collagen; Dental Cementum; Dental Scaling; Dentin; Edetic Acid; Growth Substances; Humans; Hydrogen-Ion Concentration; Macaca fascicularis; Oxidants; Periodontal Ligament; Periodontal Pocket; Periodontitis; Phosphoric Acids; Regeneration; Sodium Hypochlorite; Tooth Root

Root surfaces, exposed by periodontal disease, were studied after treatment with sodium hypochlorite. Observations of the anorganic specimens demonstrated that substantial changes occur in root surfaces incident to periodontal disease. A mineralized surface coating was seen in all areas of the involved root surface, although local regions occurred where the coating was apparently unmineralized. These findings generally confirmed the results of a previous study where the same specimens were studied without hypochlorite treatment. It is concluded that the coating is probably identical to the dental cuticle, and stems from adsorption of components of the gingival inflammatory exudate to the root surface. The coating may also be the carrier matrix for exogenous cytotoxic substances, previously thought to be located in the cementum. The findings may have implications for the way of treating periodontitis-involved root surfaces.

Topics: Calcinosis; Dental Cementum; Dental Enamel; Humans; Microscopy, Electron, Scanning; Periodontal Diseases; Periodontal Pocket; Sodium Hypochlorite; Surface Properties; Tooth Root

Gingival curettage has long been used as a modality in periodontal therapy. Recent longitudinal studies have shown that diligent curettage of periodontal pockets may aid in maintaining the attachment levels around periodontally involved teeth. This study was designed to histologically evaluate the controlled use of concentrated sodium hypochlorite solution to facilitate gingival curettage therapy. The results indicate that the action of sodium hypochlorite solution may be adequately controlled to provide predictable chemolysis of the soft tissue wall of a periodontal pocket with minimal effect upon the adjacent tissues. The action of the solution appears to have no detrimental effect upon healing. Reduction of inflammation prior to the procedure and careful technique are important to assure predictability. The use of gingival curettage augmented by sodium hypochlorite solution may aid in the management of patients undergoing periodontal maintenance.

Topics: Gingiva; Humans; Periodontal Pocket; Periodontitis; Sodium Hypochlorite; Subgingival Curettage; Wound Healing

Topics: Animals; Citrates; Citric Acid; Dental Scaling; Dogs; Male; Periodontal Pocket; Periodontitis; Sodium Hypochlorite; Subgingival Curettage; Time Factors; Tooth Root

Topics: Anti-Bacterial Agents; Humans; Periodontal Diseases; Periodontal Pocket; Sodium Hypochlorite

Topics: Caustics; Connective Tissue; Disease; Humans; Periodontal Diseases; Periodontal Pocket; Periodontium; Sodium Hypochlorite