Evaluation of the application of local therapeutic agents in patients with chronic generalized periodontitis

Abstract

Summary. According to WHO epidemiological studies over the last 20 years, the prevalence of generalized periodontitis among patients aged 34–45 years is 80 %, while in individuals over 45 years old, it exceeds 95 %. Subgingival biofilm containing microorganisms of the red complex, such as Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola, is a major etiological factor in the development of periodontitis. Chlorhexidine is considered the gold standard for treating periodontal diseases, effectively targeting microorganisms of the red complex. The global market offers the chlorhexidine product in the form of a gelatin chip called PerioChip, which is inserted into the periodontal pocket after prior scaling and root planing. The chip releases the antiseptic over a span of 7 days. Due to the costliness of PerioChip and its absence of licensure in Ukraine, an alternative approach using a subgingival chip made from cryophilized matrix enriched with chlorhexidine, in the form of official gels (Perio-Aid Gel and Perio-Aid Protect), was proposed to create a domestic counterpart to PerioChip.

The aim of the study – to evaluate the application of local therapeutic agents based on chlorhexidine Perio-Aid Gel and Perio-Aid Protect in patients with chronic generalized periodontitis.

Materials and Methods. The study included 44 patients. The first experimental group comprised 22 patients (11 individuals in subgroup A1, 11 individuals in subgroup A2) diagnosed with chronic generalized periodontitis of grades I–II. The second group consisted of 22 patients (11 individuals in subgroup B1 and 11 individuals in subgroup B2) with chronic generalized periodontitis of grades II–III. After diagnosis, the following treatment was performed: scaling and root planing (SRP), and for subgroups A1 and B1, a gingival insert impregnated with Dentaid Perio-Aid Gel was placed; for subgroups A2 and B2, a gingival insert impregnated with PERIO-AID Protect gel was placed. Patients were given recommendations for individual hygiene. Follow-up examinations were conducted after 2 months, with the assessment of the Plaque Index (simplified O'Leary plaque index), Bleeding on Probing (BOP) index, and probing pocket depth (PPD).

Results and Discussion. Before treatment in subgroup A1 patients, the average Plaque Index (PI) was 57.9±1.0 %, and after treatment, it decreased to 28.31±0.55 %. The average Bleeding on Probing (BOP) index was 50.67±1.45 % before treatment and 18.25±0.79 % after treatment. Among A1 subgroup patients, before treatment, the average gingival sulcus depth of 1–3 mm was 63.76±2.15 %, periodontal pockets with a depth of 4–5 mm were 36.13±2.16 %, and after treatment, they changed to 99.60±0.20 % and 0.43±0.20 %, respectively, p<0.05. Before treatment in subgroup B1 patients, the average Plaque Index (PI) was 70.67±2.26 %, and after treatment, it decreased to 42.7±1.1 %. The average Bleeding on Probing (BOP) index was 66.58±3.20 % before treatment and 29.4±1.32 % after treatment. Among B1 subgroup patients, before treatment, the average gingival sulcus depth of 1–3 mm was 52.87±6.60 %, periodontal pockets with a depth of 4–5 mm were 35.70±4.54 %,  and pockets with a depth of ≥6 mm were 9.61±2.27 %. After treatment, these values changed to 94.03±1.12 %,  5.50±1.10 %, and 0.25±0.16 %, respectively, p<0.05. Before treatment in subgroup A2 patients, the average Plaque Index (PI) was 58.1±1.76 %, and after treatment, it decreased to 29.5±0.79 %. The average Bleeding on Probing (BOP) index was 47.3±2.26 % before treatment and 22.7±0.75 % after treatment. Among A2 subgroup patients, before treatment, the average gingival sulcus depth of 1–3 mm was 68.17±5.0 %, periodontal pockets with a depth of 4–5 mm were 31.84±4.95 %, and after treatment, they changed to 99.5±0.2 % and 0.52±0.23 %, respectively, p<0.05. Before treatment in subgroup B2 patients, the average Plaque Index (PI) was 73.4±2.75 %, and after treatment, it decreased to 43.33±2.17 %. The average Bleeding on Probing (BOP) index was 69.2±2.9 %  before treatment and 25.15±1.49 % after treatment. Among B2 subgroup patients, before treatment, the average gingival sulcus depth of 1–3 mm was 41.80±4.44 %, periodontal pockets with a depth of 4–5 mm were 39.62±2.60 %, and pockets with a depth of ≥6 mm were 18.80±3.40 %. After treatment, these values changed to 90.58±1.72 %, 8.66±1.52 %, and 0.67±0.4 %, respectively, p<0.05.

Conclusions. Treatment involving subgingival application of a cryophilized matrix enriched with chlorhexidine led to improved clinical parameters after 2 months in patients with chronic generalized periodontitis compared to the initial conditions.