Keywords
Gel de Clorhexidina; Manejo de dolor postoperatorio; Alargamiento de corona clínica; Periodoncia; Cirugía oral; Sistema de liberación controlada.
How to Cite
Abstract
Pre-prosthetic surgical procedures such as clinical crown lengthening (CLS), can cause pain, discomfort, and postoperative inflammation; causing the need of the prescription of medications such as analgesic, anti-inflammatories and in certain cases systemic antibiotics. However, prolonged and indiscriminate use of these medications often leads to adverse effects on general health. Thus, the ideal to treat locally pain and inflammation, and to prevent local infection is promising. The objective of this preliminary study was to evaluate the controlled use of a local chlorhexidine gel (CHXg) immediately place after pre-prosthetic periodontal surgery to manage postoperative pain using a customized whitening trays. A randomized controlled double-blind parallel-group clinical pilot trial was conducted. A sample of 10 patients aged 18 to 60 years, requiring a crown lengthening procedure was selected. Two groups (Group A: 0.2% CHXg vs Group B: placebo gel). Pain scores were evaluated by using a visual analog scale (VAS), and side effects and poswas 3.32 for Group A and 4.85 for Group B (p=0.05), with results showing no statistically significant difference. Few studies have assessed the effect and influence of 0.2% CHX gel on postoperative pain control. Some reports suggest that intra-alveolar use of CHX gel is more effective than administering 10 mg of ketorolac alone. In this study, there were no statistically significant differences, indicating that the use of 0.2% CHX gel applied after pre-prosthetic surgery may not significantly reduce postoperative pain.
References
Es. C. Atlas of cosmetic and reconstructive periodontal surgery. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 370-380.
Al-Sowygh Z.H. Does surgical crown lengthening procedure produce stable clinical outcomes for restorative treatment? A meta-analysis. J Prosthodont. 2019 Jan; 28 (1): e103-e109.
Lanning S.K., Waldrop T.C., Gunsolley J.C., Maynard J.G. Surgical crown lengthening: evaluation of the biological width. J Periodontol. 2003; 74 (4): 468-74.
Pradeep K., Patil N., Akula U., Gedela R. Full mouth rehabilitation of severe fluorozed teeth with an interdisciplinary approach (6 handed dentistry). J Prosthodont. 2013; 2387-90.
Gargiulo A., Wentz F., Orban B. Dimensions and relations of the dentogingival junction in humans. J Periodontol. 1961; 32 (3): 261-7.
Cunliffe J. Crown lengthening surgery-indications and techniques. Restorative Dent. 2008.
Marzadori M., Stefanini M., Sangiorgi M., Mounssif I., Monaco C., Zucchelli G. Crown lengthening and restorative procedures in the esthetic zone. Periodontol 2000. 2018 jun; 77 (1): 84-92.
Esparza-Villalpando V., Chavarria-Bolaños D., Zapata-Morales J.R. Antinociceptive local effect of the combination of dexketoprofen trometamol and chlorhexidine gluconate in a formalin test: an additive effect. Braz J Pharm Sci. 2018; 54 (2): e17799.
Santos E.C., Huller D., Brigola S., Ferreira M.D., Pochapski M.T., Dos Santos F.A. Pain management in periodontal therapy using local anesthetics and other drugs: an integrative review. J Dent Anesth Pain Med. 2023 Oct; 23 (5): 245-256. doi: 10.17245/jdapm.2023.23.5.245
Varrassi G., Pergolizzi J.V., Dowling P., et al. Ibuprofen safety at the golden anniversary: ¿are all NSAIDs the same? A narrative review. Adv Ther. 2020; 37: 61-82.
Bell B.G., Schellevis F., Stobberingh E., Goossens H., Pringle M. A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance. BMC Infect Dis. 2014; 14:13.
Karpi T.M., Szkaradkiewicz A.K. Chlorhexidine- pharmaco-biological activity and application. Eur Rev Med Pharmacol Sci. 2015; 19: 1321-6.
López-Jornet P., Martinez-Canovas A. Clinical evaluation of polyvinylpyrrolidone sodium hyaluronate gel and 0.2% chlorhexidine gel for pain after oral mucosa biopsy: a preliminary study. Med Oral Patol Oral Cir Bucal. 2010; 15: 2159-63.
Jensen M., Karoly P., Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain. 1986; 27: 117-26.
Chavarría-Bolaños D., Esparza-Villalpando V., Ramírez K. Antibacterial and antifungal capacity of three commercially available mouthwashes with different concentrations of chlorhexidine. ODOVTOS-Int J Dental Sci. 2022; 24 (2): 69-80.
Mohanty R., Jha C. Randomized study on postoperative intra-alveolar Betadine irrigation versus chlorhexidine irrigation on the incidence of occurrence of alveolar osteitis after mandibular third molar surgery. J Maxillofac Oral Surg. 2022 Mar; 21 (1): 163-67.
Ibraheem W.I., Hakami A.A., Shafei A.A., Jerah S.A., Almarghlani A., Makrami A.M., Bhati A.K. Evaluating soft tissue healing after implant placement using two different mouthwashes (myrrh and chlorhexidine gluconate): a randomized control trial. Medicina. 2022; 58: 1351.
Solderer A., Kaufmann M., Hofer D., Wiedemeier D., Attin T., Schmidlin P.R. Efficacy of chlorhexidine rinses after periodontal or implant surgery: a systematic review. Clin Oral Investig. 2019 Jan; 23 (1): 21-32. doi: 10.1007/s00784-018-2761-y. Epub 2018 Dec 7. PMID: 30535817.
Canakçi C.F., Canakçi V. Pain experienced by patients undergoing different periodontal therapies. J Am Dent Assoc. 2007; 138: 1563-73.
Powell C., Mealey B., Deas D., McDonnell H., Moritz A. Post-surgical infections: prevalence. J Periodontal Res. 2005; 76 (3): 3 29-33.
Liu Y., Duan D., Xin Y., Bai L., Li T., Li C., et al. A review of the literature: antibiotic usage and its relevance to the infection in periodontal flaps. Acta Odontol Scand. 2017; 75 (4): 288-93.
Oswal S., Ravindra S., Sinha A., Manjunath S. Antibiotics in periodontal surgeries: a prospective randomized crossover clinical trial. J Indian Soc Periodontol. 2014; 18 (5): 570-4.
Chugh A,. P.G G., Kumar P., Kaur A. Localized 0.2% chlorhexidine irrigation delivery system versus oral antibiotics in reducing postoperative complications in the surgical extraction of impacted mandibular third molar: a randomized controlled trial. Med Oral Patol Oral Cir Bucal. 2024 Sep 1; 29 (5): e690-e697.
Suárez-Rodríguez B., Regueira-Iglesias A., Blanco-Pintos T., et al. Randomized-crossover clinical trial on the substantivity of a single application of a gel containing chlorhexidine and o-cymen-5-ol on the oral biofilm and saliva. BMC Oral Health. 2024; 24: 1247.
Teshome A. The efficacy of chlorhexidine gel in the prevention of alveolar osteitis after mandibular third molar extraction: a systematic review and meta-analysis. BMC Oral Health. 2017 May 19; 17 (1): 82.
Medina J., Rodriguez A., Nevarez M., Rios V., Nervárez A. Clorhexidina empleada en cirugía de los terceros molares y sus efectos sobre el dolor y la inflamación. Rev Iberoam Ciencias. 2014; 1 (3): 168-74.
Barajas L., Hernández M., Aguilar S., Guerrero M., Castañeda A. Control de dolor post-extracción con clorhexidina en gel. Rev Odontol Latinoam. 2011; 3 (2): 39-43.
Haraji A., Rakhshan V., Khamverdi N., Alishahi H.K. Effects of intra-alveolar placement of 0.2% chlorhexidine bioadhesive gel on dry socket incidence and postsurgical pain: a double-blind split-mouth randomized controlled clinical trial. J Orofac Pain. 2013; 27 (3): 256-62.
Haraji A., Rakhshan V. Chlorhexidine gel and less difficult surgeries might reduce postoperative pain, controlling for dry socket, infection and analgesic consumption: a split-mouth controlled randomized clinical trial. J Oral Rehabil. 2014; 41 (3): 10-2.
Esparza-Villalpando V., Chavarria-Bolaños D., Zapata-Morales J.R., Vértiz-Hernández A., Pozos-Guillén A. Antinociceptive local effect of the combination of dexketoprofen trometamol and chlorhexidine gluconate in a formalin test: an additive effect. Braz J Pharm Sci. 2018; 54 (2): e17799.
Esparza-Villalpando V., Pozos-Guillén A., Zapata-Morales J.R., Vértiz-Hernández A., Martinez-Aguilar V.M., Chavarria-Bolaños D. Evaluation of the local synergistic effect of a dexketoprofen and chlorhexidine combination in the formalin test. P R Health Sci J. 2023 Mar; 42 (1): 35-42.
Shaihutdinova A.R., Nikolsky E.E., Vyskocil F., Skorinkin A.I. Mechanisms of the inhibition of endplate acetylcholine receptors by antiseptic chlorhexidine (experiments and models). Naunyn Schmiedebergs Arch Pharmacol. 2009; 380 (6): 551-60.
Tan W.C., Krishnaswamy G., Ong M.M.A., Lang N.P. Patient-reported outcome measures after routine periodontal and implant surgical procedures. J Clin Periodontol. 2014; 41 (6): 618-24.
Curtis J.W., McLain J.B., Hutchinson R.A. The incidence and severity of complications and pain following periodontal surgery. J Periodontol. 1985; 56 (10): 597-601.
Seymour R.A., Blair G.S., Wyatt F.A.R. Post-operative dental pain and analgesic efficacy. Part I. Br J Oral Surg. 1983; 21 (4): 290-7.
Kashefimehr A., Babaloo A., Ghanizadeh M., Ghasemi S., Mollazadeh H. Effect of prophylactic administration of Novafen for periodontal surgery on postoperative pain relief. J Med Life. 2017; 10 (2): 127-30.
López J., Roselló X., Jané E. Valoración de un gel de clorhexidina en el control del dolor postextracción dental. Rev Eur Odontoestomatol. 1998;10 (5): 1998.
Xu J., Zanvit P., Hu L., Tseng P.Y., Liu N., Wang F., et al. The cytokine TGF-β induces interleukin-31 expression from dermal dendritic cells to activate sensory neurons and stimulate wound itching. Immunity. 2020; 53 (2): 371-83. e5.
Flötra L., Gjermo P., Gunna R., Waerhaug J. Side effects of chlorhexidine mouth washes. Scand J Dent Res. 1971; 79: 119-25.