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Aplicação tópica da clorohexidina como coadjuvante no tratamento periodontal não cirúrgico : revisão sistemática
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Advisor(s)
Abstract(s)
A doença periodontal (DP) é uma doença inflamatória crónica multifatorial que afeta os tecidos de suporte e sustentação dentários, sendo o biofilme o agente etiológico primário. A remoção do biofilme pela raspagem e alisamento radicular (RAR) é considerada o tratamento padrão, no entanto apresenta algumas limitações. Têm sido propostos diversos tratamentos coadjuvantes para melhorar os resultados clínicos, contudo com eficácia variável. Objectivo: Avaliar o efeito das diversas formas de aplicação tópica de CHX como coadjuvante ao tratamento periodontal não cirúrgico. Metodologia: Foi efectuada uma pesquisa nas bases de dados Medline/PubMed, Cochrane Library e Scielo com as palavras chave MESH: “drug delivery systems”, “chlorhexidine”; e não-MESH: “subgingival antibiotic therapy”, “local drug delivery”, “scaling root and planing”, “chlorhexidine gel”, “chlorhexidine chip, “non-surgical periodontal adjunct treatment” e termos variados destes. Foram incluídos estudos clínicos randomizados realizados em humanos desde 2010 até março de 2020, com follow-up de pelo menos 3 meses, e avaliação dos parâmetros periodontais profundidade de sondagem (PS) e nível clínico de inserção (NCI). Resultados: Foram incluídos 20 artigos para análise qualitativa e 12 para análise quantitativa. Observou-se que existem resultados divergentes na literatura em relação à eficácia do gel e do chip de clorohexidina. A meta-análise mostra que o tratamento chip+RAR apresenta uma eficácia significativamente superior (p<0.001) comparativamente à RAR isolada no tratamento da DP. Apesar de não ser confirmado estatisticamente por esta meta-análise, alguns autores observaram melhorias nos parâmetros periodontais quando o gel à base de xantano foi utilizado como coadjuvante. Conclusão: A utilização do chip de CHX associado à RAR resulta numa melhoria adicional nos parâmetros periodontais (IP, HS, PS, NCI), podendo ajudar a ultrapassar algumas das limitações do tratamento convencional. Relativamente ao gel de clorexidina, devido às evidências analisadas não serem sempre concordantes, são necessários mais estudos para avaliar a sua eficácia no tratamento da DP.
Periodontal disease (PD) is a multifactorial chronic inflammatory disease in tooth-supporting tissues, with biofilm as the primary etiological agent. The removal of biofilm by scaling and root planing (SRP) is considered the standard treatment, however it has some limitations. Several treatments have been proposed in order to improve the clinical results; however, their effectiveness varies. Objective: To evaluate the effect of different methods of topical application of CHX as an adjunct to non-surgical periodontal treatment. Methodology: A search was made in the databases Medline/PubMed, Cochrane Library and Scielo with the MESH keywords: “drug delivery systems”, “chlorhexidine”; and non-MESH keywords: "subgingival antibiotic therapy", "local drug delivery", "scaling root and planing", "chlorhexidine gel", "chlorhexidine chip," non-surgical periodontal adjunct treatment" and different terms of these. Randomized clinical trials carried out in humans from 2010 to March 2020, with follow-up of at least 3 months, and evaluation of the following periodontal: parameters probing depth (PS) and clinical level of insertion (NCI) were included. Results: 20 articles were included for qualitative analysis and 12 for quantitative analysis. It was observed that there are divergent results in the literature regarding the effectiveness of the gel and the chlorhexidine chip. The meta-analysis shows that the chip+RAR treatment is significantly more effective (p <0.001) compared to RAR alone in the treatment of PD. Despite not being statistically confirmed by this meta-analysis, some authors observed improvements in periodontal parameters when the xanthan-based gel was used as an adjuvant. Conclusion: The use of the CHX chip associated with RAR results in a further improvement in periodontal parameters (IP, HS, PS, NCI), which may help to overcome some of the limitations of conventional treatment. Regarding the chlorhexidine gel, further studies are needed to evaluate its effectiveness in the treatment of PD.
Periodontal disease (PD) is a multifactorial chronic inflammatory disease in tooth-supporting tissues, with biofilm as the primary etiological agent. The removal of biofilm by scaling and root planing (SRP) is considered the standard treatment, however it has some limitations. Several treatments have been proposed in order to improve the clinical results; however, their effectiveness varies. Objective: To evaluate the effect of different methods of topical application of CHX as an adjunct to non-surgical periodontal treatment. Methodology: A search was made in the databases Medline/PubMed, Cochrane Library and Scielo with the MESH keywords: “drug delivery systems”, “chlorhexidine”; and non-MESH keywords: "subgingival antibiotic therapy", "local drug delivery", "scaling root and planing", "chlorhexidine gel", "chlorhexidine chip," non-surgical periodontal adjunct treatment" and different terms of these. Randomized clinical trials carried out in humans from 2010 to March 2020, with follow-up of at least 3 months, and evaluation of the following periodontal: parameters probing depth (PS) and clinical level of insertion (NCI) were included. Results: 20 articles were included for qualitative analysis and 12 for quantitative analysis. It was observed that there are divergent results in the literature regarding the effectiveness of the gel and the chlorhexidine chip. The meta-analysis shows that the chip+RAR treatment is significantly more effective (p <0.001) compared to RAR alone in the treatment of PD. Despite not being statistically confirmed by this meta-analysis, some authors observed improvements in periodontal parameters when the xanthan-based gel was used as an adjuvant. Conclusion: The use of the CHX chip associated with RAR results in a further improvement in periodontal parameters (IP, HS, PS, NCI), which may help to overcome some of the limitations of conventional treatment. Regarding the chlorhexidine gel, further studies are needed to evaluate its effectiveness in the treatment of PD.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Clorohexidina Sistema de administração local de medicamentos Doença periodontal Antissépticos