ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Efficacy Of Periochip In Treating Chronic Periodontitis Is Controversial
Clinical Question In a patient with chronic periodontitis, does adjunctive use of periochip reduce attachment loss better than scaling and root planning alone?
Clinical Bottom Line The conclusions found in the limited amount of current research available on this chip are non-congruent and more research will be necessary on this method of local delivery of chlorhexidine in order to determine efficacy in reducing attachment loss in patients with chronic periodontitis. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 16460252Cosyn/2006Patients with chronic periodontitisSystematic Review
Key results“Considerable heterogeneity in experimental characteristics was found after a preliminary evaluation of the selected articles. Consequently, a quantitative synthesis by means of a meta-analysis was not possible. Therefore, an attempt was made to tabulate the data from a descriptive point of view.” (quoted from the article)
#2) 18251641Paolantonio/2008Patients with moderate to advanced periodontitisRandomized Multicenter Clinical Trial
Key results“The adjunctive use of the CHX chip resulted in a significant PD reduction and a clinical attachment gain compared to SRP alone. These results were concomitant with a significant benefit of SRP + CHX treatment on the subgingival microbiota. When all of the pockets were considered, the PD and RAL were significantly less at 3 and 6 months compared to the baseline scores (P <0.01) for both treatments. The differences in PD reductions between the treatments were 0.30 and 0.55 mm at 3 and 6 months, respectively (P <0.01); for the RAL gain, the differences were 0.28 and 0.64 mm, respectively (P <0.001).” (quoted from the article)
#3) 20593635Sakellari/2010Patients with Chronic PeriodontitisRandomized Controlled Trial
Key results“In this small, six-month, phase 4 trial, no differences in mean probing depth reduction or “red-complex” periodontal pathogens were detected for patients with chronic periodontitis treated with adjunctive chlorhexidine chip (single administration) as compared to patients treated with scaling and root planing alone. Both treatments resulted in improvement of clinical indices and non-statistically significant differences were observed between the two groups at any time point, with the exception of bleeding on probing at three months (ANOVA, p < 0.05). No major differences were observed concerning levels of important periodontal pathogens (Mann-Whitney test, p < or = 0.05).” (quoted from the article)
Evidence Search Limits: Humans, Meta-Analysis, Randomized Controlled Trial, EnglishSearch "Periodontitis"[Mesh]Search "Dental Scaling"[Mesh]Search "Chlorhexidine"[Mesh]
Comments on
The Evidence
The first study was a systematic review of randomized controlled trials. There was a comprehensive detailed search for relevant trials and the individual studies were assessed for validity. No meta-analysis was done due to discrepancies in the studies. The second and third studies represent a more current continuation of the theme of conflicting results found in the studies included in the systematic review.
Applicability The subjects in these studies are representative of patients that could possibly benefit from this treatment. The subjects in these studies are representative of patients that would be seen in a private practice dental or dental specialty office.
Specialty/Discipline (General Dentistry) (Periodontics)
Keywords Periodontitis, Perio chip, Chlorhexidine, Chronic Periodontitis, attachment loss, scaling and root planing, dental scaling
ID# 762
Date of submission: 03/24/2011spacer
E-mail rothsb@livemail.uthscsa.edu
Author Sarah Kinard
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Richard Finlayson, DDS
Faculty mentor/Co-author e-mail finlaysonr@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Richard Finlayson (San Antonio, TX) on 01/13/2014
Although use of a Periochip in conjunction with SRP may produce "statistically significant changes" in the range of .3 to .5mm, the clinical significance of such small changes is negligible in light of the additional cost the patient incurs for this service. Also, the N of this study is small which might also affect the results of the therapy.
by David Flanders, Chris Felicetta, Eulogio Munoz (San Antonio, TX) on 01/13/2014
A PubMed search was conducted in January 2014. A more recent publication was found: Puri 2013, PubMed: 24174754 . This RCT on 15 patients was found to further support the adjunctive use of a Periochip™ with SRP to treat chronic periodontitis. The paper also concluded that healthy microflora could be maintained for a longer period of time and delay in the re-population by periodontopathic microorganisms was observed when the Periochip™ was used.
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