Chlorhexidine in extractive, periodontal and implant surgery – A systematic review and meta-analysis

Background

Chlorhexidine digluconate (CHX) is one of the most employed antiseptic agents in extractive, implant and periodontal surgery at different concentrations (0.12–0.2%). Recently, it was demonstrated that the alcoholic component of mouthrinses based on CHX might disturb fibroblast turnover in the early healing stages. It might suggest that the use of CHX during surgical procedures might be detrimental for patient.

Aim/Hypothesis

Aim of the present review is to systematically analyze the literature to test the effect of CHX at different concentrations in procedures of oral surgery procedures (including extractions, periodontal and implant surgery) .

Material and Methods

This systematic review was performed in order to answer the following PICO question- Is the use of CHX formulations able to prevent complications (improves safety) in patients undergoing procedures of either oral surgery, dental implant surgery or periodontal surgery compared to the same treatment procedures without CHX prescription?. After setting inclusion and exclusion criteria, a direct online screening was performed independently by two authors on the following databases- PUBMED MEDLINE, SCOPUS and Web Of Science. Meta-analysis was performed and the power of the meta-analytic findings determined by trial sequential analysis (TSA).

Results

At the end of the selection process only 32 articles fully respect the eligibility criteria and were included in this review. Data extracted for this review allowed authors to perform quantitative synthesis only for primary outcomes related to tooth extraction. Meta-analysis and TSA revealed, with a good statistical power, a significant reduction of alveolar osteitis, after tooth extraction, associated with the use of chlorhexidine compared to a placebo or no use (RR = 0.49 + 95%CI- [0.40, 0.60] P < 0.001 + I2 = 8%). Furthermore, the meta-analysis and TSA revealed that the use of a chlorhexidine formulation (RR = 0.87 + 95%CI- [0.79, 0.96] P = 0.004 + I2 = 4%) reduces the rate of bacteremia after tooth extraction. Clinical data that investigate the effect of CHX of complication rate in periodontal and implant surgery are still missing.

Conclusion and Clinical Implications

This systematic review shows with a good power of evidence that the use of chlorhexidine decreases the risk of osteitis and bacteremia after dental extraction. Although, both gel and mouthwash showed good results no conclusions can be taken on which are the most effective formulations and concentrations. Data are still deficient regarding the use of chlorhexidine in periodontal and implant surgery. This encourage the development of further RCT in these indications.