Effect of Nonsurgical Mechanical Debridement With or Without Chlorhexidine Formulations in the Treatment of Peri‐Implant Mucositis. A Randomized Placebo‐Controlled Clinical Trial

Abstract

ObjectivesTo evaluate the treatment of peri‐implant mucositis (PM) using a nonsurgical submarginal peri‐implant instrumentation (NSPI) with or without chlorhexidine (CHX) solutions.MethodsFifty‐six patients (28 per group) were randomly assigned to the test (NSPI + 0.12% mouthwash and subgingival CHX irrigation plus tongue brushing with 1% CHX gel) or the control group (NSPI + placebo mouthwash and subgingival placebo irrigation plus tongue brushing with placebo gel). At baseline, 1, 3, 6 months, bleeding on probing (BOP), probing pocket depth (PPD), modified gingival index (mGI), modified plaque index (mPlI), full‐mouth plaque score (FMPS), full‐mouth bleeding score (FMBS), and the proportions of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were recorded. The BOP reduction was set as a primary outcome. Data were analyzed to assess BOP reduction at a 6‐month follow‐up and to identify significant predictors of implant‐site BOP through mixed generalized linear regression.ResultsAfter 6 months in both groups, a significant reduction of BOP, PD, mPlI, mGI, FMBS, and FMPS was noted (p < 0.05). However, at 6 months, the test group was more effective than the controls in reducing median BOP (∆values control/test: 39.3% [95% CI 37.4–42.3] vs. 48.7 [95% CI 46.5–51.2], p = 0.044), as well as mPlI (p = 0.041) and the proportion of Treponema denticola (p = 0.039). Moreover, the implant‐sites BOP reduction was significantly influenced by test treatment (p < 0.001), history of periodontitis (p = 0.003), and a high number of cigarettes/day (p = 0.002), the proportion of Porphyromonas gingivalis (p = 0.021) and Tannerella forsythia (p = 0.032).ConclusionsNSPI + CHX showed better results compared to placebo in implant‐sites BOP reduction. The high number of cigarettes/day and the proportion of Porphyromonas gingivalis and T. forsythia negatively influenced the BOP reduction in PM‐treated patients.