The Effect of an Antioxidant Gel Compared to Chlorhexidine Gel During the Soft Tissue Healing Process Follow Scaling and Root Planing: A Randomized Controlled Clinical Trial

Background

Periodontitis is characterised by inflammation that results in the loss of periodontal attachment. Scaling and root planing (SRP) is a fundamental non-surgical treatment for periodontitis, which aims to remove the primary causative agents - dental plaque and calculus, from the tooth surfaces. Postoperative care is critical to ensure optimal healing and to manage potential inflammation and microbial load. Traditionally, chlorhexidine, an antimicrobial agent, has been utilized as an adjunctive treatment to prevent infection and manage inflammation following SRP. Chlorhexidine's broad-spectrum antimicrobial properties have been well-documented, and its application has been associated with reduced clinical symptoms and enhanced periodontal healing.

However, recent research has suggested potential benefits of antioxidant gels in promoting tissue repair and reducing oxidative stress, which could be beneficial in the postoperative period. Antioxidant gels, containing compounds such as vitamin C, vitamin E, or polyphenols, are proposed to mitigate oxidative damage and inflammation, potentially offering a different mechanism of action compared to traditional antimicrobial approaches.

Given these advances, there is a need to evaluate and compare the efficacy of chlorhexidine and antioxidant gels in managing postoperative outcomes following SRP. Specifically, assessing their impact on postoperative biomarkers, such as inflammatory cytokines, oxidative stress markers, and periodontal tissue regeneration indicators, could provide valuable insights into their relative effectiveness. In an animal model, found that animals treated with antioxidant gels healed faster and also led to an upregulation of TNFalpha and the antioxidant enzyme superoxide dismutase. However, to the best of our knowledge there are no human clinical studies that have established this relationship. Therefore, this study aims to compare the efficacy adjunctive treatment with chlorhexidine and antioxidant gels along with SRP in the management of patients with periodontitis.

Objectives The objectives of this study are to evaluate and compare the effects of chlorhexidine and antioxidant gel on inflammatory biomarkers (e.g.: Tumor Necrosis Factor-alpha (TNF-alpha); and antioxidant related markers (e.g.: Myeloperoxidase (MPO), among patients undergoing scaling and root planing (SRP). Additionally, the study aims to determine the clinical efficacy of these postoperative treatments in modulating the tissue response.