Management of residual periodontal pockets using an oscillating chitosan device: A randomized clinical trial.

BACKGROUND

Patients with periodontitis can exhibit persistent periodontal pockets with bleeding representative of inflammation. This clinical study aimed to evaluate the effectiveness of a chitosan brush in improving residual periodontal pockets in patients who had already undergone causative therapy for periodontitis.

METHODS

Thirty-six patients with stage III or IV periodontitis, showing residual pockets that bled on probing, were randomly assigned to 2 groups. The test group received debridement using both an ultrasonic scaler and a chitosan brush, while the control group received only ultrasonic scaling. Clinical parameters-probing pocket depth (PPD), clinical attachment level (CAL), recession (REC), and bleeding on probing (BoP)-were assessed at baseline, 6 weeks, 3 months, and 6 months posttreatment. Gingival crevicular fluid (GCF) was also collected to measure matrix metalloproteinase-8 (MMP-8) levels, a marker of inflammation.

RESULTS

Results showed significant improvements in clinical parameters over time in both groups. Probing depth and clinical attachment loss significantly improved from baseline to 3 months, with slight increases observed from 3 to 6 months. However, no significant differences between groups were found in these parameters. Gingival recession increased in both groups, with no group difference. BoP improved gradually in the test group, while in the control group, it initially decreased but increased again by 6 months, with a significant difference between groups at 6 months (p = 0.007). MMP-8 levels decreased in both groups from baseline to 3 months but increased thereafter, with no significant difference between groups.

CONCLUSION

In conclusion, the chitosan brush, when added to mechanical debridement, led to better improvement in BoP compared to ultrasonic scaling alone, but did not show superior results for other clinical parameters or MMP-8 levels.

CLINICAL TRIAL REGISTRATION: The trial is registered at the US National Library of Medicine ClinicalTrials.gov (NCT06127069).

PLAIN LANGUAGE SUMMARY: After periodontal therapy, patients with periodontitis may still have persistent periodontal pockets with bleeding on probing, indicating ongoing inflammation. However, retreating these pockets can be unpredictable. This study investigated the effectiveness of a new chitosan brush for treating these pockets. Results showed that its use did not improve all clinical parameters, but significantly reduced bleeding-indicating less inflammation-at the treated sites 6 months after therapy. The absence of bleeding is crucial in preventing disease progression. Maintaining clinically healthy sites during the maintenance phase is essential for long-term positive outcomes and helps reduce the risk of further gum disease progression.