Chlorhexidine and Zinc in Non-Surgical Periodontal Therapy

Periodontitis is a multifactorial chronic inflammatory disease characterized by the destruction of tooth-supporting tissues, including gingiva, periodontal ligament, and alveolar bone. It is initiated by microbial dental plaque and modulated by the host immune response, leading to both local tissue damage and systemic inflammatory effects.

Scaling and root planing (SRP) is the gold standard for non-surgical periodontal therapy and aims to mechanically remove plaque and calculus from root surfaces. However, due to anatomical limitations and microbial persistence in periodontal pockets, SRP alone may not always achieve optimal clinical outcomes. Therefore, adjunctive antimicrobial and anti-inflammatory agents have been proposed to enhance treatment efficacy.

Chlorhexidine (CHX) is considered the gold standard antiseptic in dentistry due to its broad-spectrum antimicrobial activity and substantivity. Zinc, on the other hand, has been shown to possess anti-inflammatory, antioxidant, and immunomodulatory properties. The combination of CHX and zinc may provide a synergistic effect by reducing microbial load while simultaneously modulating the host inflammatory response.

This study is designed as a single-center, randomized, controlled, prospective clinical trial conducted at the Department of Periodontology, Faculty of Dentistry, Ataturk University. A total of 44 systemically healthy individuals aged between 18 and 65 years with stage I and II periodontitis will be included.

Participants will be randomly allocated into two groups using a coin-toss method:

* Test group: SRP with chlorhexidine and zinc
* Control group: SRP with distilled water

All participants will receive standardized oral hygiene instructions prior to treatment. SRP procedures will be performed using ultrasonic instruments. In the test group, chlorhexidine and zinc solution will be used during the procedure, whereas distilled water will be used in the control group.

Clinical periodontal parameters including Plaque Index (PI), Bleeding on Probing (BOP), Probing Pocket Depth (PPD), and Clinical Attachment Level (CAL) will be recorded at baseline, 1 month, and 3 months. In addition, blood and saliva samples will be collected at the same time points to analyze biochemical markers including C-reactive protein (CRP), high-sensitivity CRP (hs-CRP), Oncostatin M (OSM), and Antistreptolysin O (ASO) using ELISA methods.

The primary objective of this study is to evaluate the clinical effectiveness of CHX and zinc as adjuncts to SRP. The secondary objective is to assess their effects on systemic inflammatory biomarkers.

The findings of this study are expected to contribute to the understanding of adjunctive treatment strategies in periodontal therapy and may support the use of CHX and zinc combination as a practical and effective approach in clinical practice.

• Chlorhexidine and zinc application (Procedure): Scaling and root planing is performed using an ultrasonic device with a solution containing chlorhexidine and zinc.
• Scaling and root planing with distilled water (Procedure): Scaling and root planing is performed using an ultrasonic device with distilled water.

Primary outcomes

• Probing Pocket Depth (PPD) [Baseline, 1 month, and 3 months]: Measurement of periodontal pocket depth in millimeters to evaluate clinical periodontal improvement.
• Clinical Attachment Level (CAL) [Baseline, 1 month, and 3 months]: Assessment of clinical attachment level in millimeters as an indicator of periodontal tissue healing.

Secondary outcomes

• Plaque Index (PI) [Baseline, 1 month, and 3 months]: Measurement of dental plaque accumulation.
• Bleeding on Probing (BOP) [Baseline, 1 month, and 3 months]: Assessment of gingival bleeding following periodontal probing.
• C-Reactive Protein (CRP) [Baseline, 1 month, and 3 months]: Measurement of systemic inflammatory response using serum CRP levels.
• High-Sensitivity C-Reactive Protein (hs-CRP) [Baseline, 1 month, and 3 months]: Measurement of low-grade systemic inflammation using high-sensitivity CRP levels.
• Oncostatin M (OSM) [Baseline, 1 month, and 3 months]: Evaluation of inflammatory cytokine levels associated with periodontal disease.
• Antistreptolysin O (ASO) [Baseline, 1 month, and 3 months]: Measurement of systemic immune response related to streptococcal exposure.

Sex: All, ages: 18 Years to 65 Years

Inclusion Criteria:

* Individuals aged between 18 and 65 years
* Systemically healthy individuals
* Diagnosed with Stage I or Stage II periodontitis according to the 2017 classification
* Having probing pocket depth ≤5 mm and clinical attachment loss ≤4 mm
* Having a sufficient number of teeth for periodontal evaluation
* Willing to participate and able to provide informed consent

Exclusion Criteria:

* Presence of systemic diseases affecting periodontal health
* Pregnancy or breastfeeding
* Smoking
* Use of antibiotics or anti-inflammatory drugs within the last 6 months
* History of periodontal treatment within the last 6 months
* Fewer than 15 teeth present
* History of radiotherapy or chemotherapy

• Alparslan Dilsiz, Professor, Principal investigator, Ataturk University