Dental sciences Bhatia Archana et al.

/ JPBMS, 2012, 20 (02)

1 Journal of Pharmaceutical and Biomedical Sciences (JPBMS), Vol. 20, Issue 20
Available online at www.jpbms.info

JPBMS

JOURNAL OF PHARMACEUTICAL AND BIOMEDICAL SCIENCES



To assess the effectiveness of a single subgingival application of chlorhexidine chip in the
treatment of chronic periodontitis: A clinical study

* Bhatia Archana
1
, Bains Sandeep Kumar
2
, Battu Virinder Singh
3


*1
Senior lecturer, Department of Periodontology and Oral implantology Dasmesh Institute of
Research and Dental Sciences, Faridkot(Punjab),India.
2
M.D.S(Senior lecturer) Department of Oral Medicine and Radiology, Swami Devi Dayal Dental College,
Barwala, Haryana, India.
3
Retired Professor, Department of Periodontology & Oral Implantology, National Dental College &
Hospital, Gulabgarh, Derabassi, Distt. SAS nagar, Mohali (Punjab),India.
Abstract:
Background: Controlled local delivery of disinfecting agents has been demonstrated to be efficient in improving the
outcome of periodontal therapy.
Aims: The aim of present study was to evaluate the efficacy of a controlled-release biodegradable chlorhexidine chip
(Periocol CG) when used as an adjunct to scaling and root planing in the treatment of periodontitis.
Study Design: Study was carried out as randomized controlled two group parallel clinical trial.
Material and method: Forty patients in the age group of 30-65 years suffering from chronic periodontitis, having pocket
depth ranging between 5-8mm were selected for the study. At screening visit complete history taking, periodontal
examination and full mouth supragingival scaling was done for each patient. At baseline visit, all clinical parameters were
recorded at selected sites and patients were randomly assigned to either control group (group A) or the treatment group
(group B). All patients in the both groups received complete subgingival scaling and root planing. Then in group B,
chlorhexidine chip (Periocol CG) was inserted at the selected site. Patients were recalled at 1month, 2 months and 3
months from the baseline for recording clinical observations.
Results: There was statistically significant clinical attachment gain, reduction in bleeding index scores and probing pocket
depth reduction in both the groups but group B showed better results than group A and these differences were statistically
significant.
Conclusions: The results of this study show that chlorhexidine chip (PerioCol-CG) is an effective adjunctive therapy to
scaling and root planing in the treatment of chronic periodontitis.
Keywords: Antimicrobial agents, chlorhexidine chip (Periocol-CG), local drug delivery systems, periodontitis.
Introduction:
The periodontal diseases represent a group of localized
microbial-induced infections involving the gingival and
supporting tissues of the teeth. The process of periodontal
pocket formation represents the pathological sequel of
microbial and inflammatory mediated degradation of
collagenous connective tissues and alveolar bone
[1]
.
Recent developments in science and technology have
revolutionized the basic outlook and approach to the
periodontal disease. A thorough understanding of the
etiopathogenesis of periodontal disease has provided the
clinicians and researchers with a number of diagnostic
tools and techniques that has widened the treatment
options
[2]
.

Conventional periodontal treatment consists of mechanical
debridement to eliminate the subgingival microbiota and
infected tissue in the inflamed pocket, usually performed
by scaling and root planning
[3]
. The aim of non-surgical
periodontal therapy is to eliminate both living bacteria in
the microbial biofilm and calcified biofilm microorganisms
i.e. dental calculus, from the root surface and from the
subgingival area without the surgical reflection of the soft
tissues surrounding the teeth
[1]
.
However, deep periodontal pockets, especially with root
surface concavities or furcation involvement prevent the
effectiveness of scaling and root planing. Consequently,
this has led to the adjunctive use of antimicrobials,
assuming that chemical aids would compensate for
technical limitations and prevent early microbial
recolonization to ultimately, ensure the best chance for
clinical improvements
[4]
. Goodson et al. 1979

first
proposed the concept of controlled delivery of drug
therapy in the treatment of periodontitis
[2]
. The advantage
of this form of therapy is that, it reaches the base of the
periodontal pocket and is maintained for an adequate time
for the antimicrobial effect to occur. Local administration
of antimicrobial drugs directly into the periodontal pocket
has been suggested as a means of bypassing systemic
complications and targeting localized areas of periodontal
destruction. The local concentration achieved can be much
higher than is possible by systemic route and there is no
Research article
ISSN NO- 2230 7885
CODEN JPBSCT
NLM Title: J Pharm Biomed Sci.

Dental sciences Bhatia Archana et al. / JPBMS, 2012, 20 (02)
2 Journal of Pharmaceutical and Biomedical Sciences (JPBMS), Vol. 20, Issue 20
dependence on patient compliance for success of the
therapy
[5]
.

Different drugs used for local delivery are tetracyclines
including doxycycline
[1,6]
and minocycline
[7]
,
metronidazole
[8,9]
and chlorhexidine
[10-14]
. Of all chemical
plaque control agents, chlorhexidine has proven to be the
most effective, safe, clinically effective in reducing plaque
and gingivitis and is time-tested gold standard for the
treatment of periodontal diseases. The aim of the present
study was to evaluate the efficacy of a controlled-release
biodegradable chlorhexidine chip (Periocol CG)
*
when used
as an adjunct to scaling and root planing in the
management of periodontitis.

Subjects and methods:
Forty patients (28 males and 12 females) in the age group
of 30-65 years suffering from mild to moderate adult
periodontitis were selected amongst the patients visiting
the Department of Periodontology and Oral Implantology,
National Dental College and Hospital, Dera Bassi
(Punjab).The study protocol was approved by the
institutional ethics committee. The patients were duly
informed about the study and their signed consent was
obtained.

Inclusion Criteria
Patients with probing pocket depth ranging between 5 to
8mm in one or both sides of the arches.
Patients with absence of any periapical / pulpal alteration
on qualifying teeth.
Patients without any history of drug allergy to
chlorhexidine.
Patients not using any medicated toothpaste/ antibacterial
mouthwash / antibiotics or any anti-inflammatory drug
before the commencement of study for at least past 3
months.
Exclusion Criteria
Pregnant / Nursing women.
Patients wearing any orthodontic appliance or other
restorative appliance which can impinge on the tissues
being assessed.
Patients on medication that may influence the pattern of
tissue response.
Patients having soft or hard tissue tumors of the oral
cavity.
Patients on any drug/ alcohol abuse.

Material:
A new preparation of sustained release chlorhexidine
(Periocol CG) containing approximately 2.5mg
chlorhexidine gluconate in a biodegradable matrix of type I
collagen of fish origin was used in this study. The chip
measures 4mm in length, 5mm in width and 0.25-0.35mm
thickness (4 50.25-0.35 mm) and a single chip weighs
about 10 mg. It is self retentive and releases chlorhexidine
in vitro, with a release profile of approximately 40-45 %
within first 24 hours and there on, in a linear fashion for 7-
8 days. Collagen based membranes are resorbed after 30
days; however their coronal edge degrades within first 10
days. Its shelf life is 2 years.(Fig 1.).

Study Plan:

*
Periocol CG, Eucare Pharmaceuticals Pvt Ltd, Chennai,
India
A Flow chart indicating chronological order of procedures
done during study period is shown in Figure 2.For each
patient, screening visit was scheduled one week before the
baseline visit.
At screening visit (1 week before baseline visit) after
complete history taking and clinical examination, gingival
index and probing pocket depth were recorded and full
mouth supragingival scaling was done. At baseline,
patients selected at the screening visit returned to the
department and were enrolled in the study if they were
willing to continue the participation and met the
enrolment criteria. Before starting any treatment, all
clinical parameters (probing pocket depth, clinical
attachment level
[15, 16]
, bleeding index
[17]
) were recorded
at selected sites for all the subjects.


Fig 1. sterile collagen periodontal chip with 2.5mg chlorhexidine
gluconate (PerioCol-CG)within the box.


Fig 2. Flow chart indicating chronological order of procedures done
during study period

Grouping
Patients were randomly assigned to one of two groups as
follows:-
Group A-Scaling and root planing alone (twenty patients)
Group B- Scaling and root planing and application of a
degradable drug delivery system contains 2.5 mg
chlorhexidine (twenty patients).
In group A, complete subgingival scaling and root planing
was done with hand instruments. In group B, after
Dental sciences Bhatia Archana et al. / JPBMS, 2012, 20 (02)
3 Journal of Pharmaceutical and Biomedical Sciences (JPBMS), Vol. 20, Issue 20,
complete subgingival scaling and root planing the experimental site was isolated and dried with compressed
air for the placement of chlorhexidine chip as a wet chip
becomes soft and more difficult to insert. Chlorhexidine
chip was carried by using dental forceps, with the round
side of the chip facing away from the forceps. At the
opening of the periodontal pocket, the round edge was
kept along the long axis and chip was inserted into the
pocket until resistance was felt (Fig. 3). The patient was
permitted to perform normal hygiene procedures, but
instructed not to floss for 10 days in the selected sites and
adjacent sites at the same interproximal regions to avoid
the possibility of chlorhexidine chip dislodgement from the
crevice. Patients were also instructed not to use any
chemotherapeutic mouth rinse or oral irrigation devices.
Patients were recalled for follow up at 1, 2 and 3 months
from the baseline for recording clinical parameters.
6.94
6.47
5.89
5.73
5.36
5.26
5.21
4.94
7.36
7.21
7.36
6.89
9.52
9.15
8.47
8.36
0
1
2
3
4
5
6
7
8
9
10
baseline after 1 month after 2 months after 3 months
C
h
a
n
g
e
s

f
r
o
m

b
a
s
e
l
i
n
e
(
m
m
)
Duration
Group B(PD) Group A(PD) group A(CAL) group B(CAL)
p value
BL to 2M(PD)=0.03**
BL to 3 M(PD)=0.44*
BL to 2 M(CAL)=0.02**
1M to 2 M(CAL)=0.38*

Fig 3. Line diagram showing comparison of changes in pocket depth and clinical attachment level in both control group (group A) and experimental group
(group B)

Results:
40 patients were enrolled in the study but 38 patients (26
males and 12 females) completed the study. Data from two
patients who failed to attend an examination during two
consecutive time frames were excluded from the study.
The mean age of the patients was 38.6 years (range 30-54
years) and there were 28 males (70.0%) and 12 females
(30.0%).Male: female ratio was 16:4(M=80.0%,F=20.0%)
and 12:8(M=60.0%,F=40.0%)in group A and group B
respectively. No statistically significant difference was
found between two groups on the basis of cross tabulation
of sex groups by using Chi-square test at baseline.
A) Probing Pocket Depth:
In group A, the mean probing pocket depth of 20
participants at baseline was 5.36+0.59mm and it decreased
to 5.26+0.65mm, 5.21+0.71mm and 4.94+0.97mm at 1, 2
and 3 months interval respectively (Table 1). The
difference between mean score when put to statistical
analysis, was found to be statistically significant only
between observations made at baseline and at 3 months
interval.

Table 1. Mean values of all the clinical parameters taken during the study in both control group (group A) and experimental (group B)

In group B, the mean probing pocket depth of 20 participants at baseline was 6.94+0.84mm and it decreased to
6.47+0.84mm, 5.89+1.41mm and 5.68+1.60mm at 1, 2 and 3 months interval respectively (Table 1). The difference
between mean score when put to statistical analysis was found to be statistically highly significant for the observations
made between baseline and 1 month interval and between baseline and 3 months interval (Table 2, Fig. 3).


PD0

PD1

PD2

PD3

CAL0

CAL1

CAL2

CAL3

BI0

BI1

BI2

BI3

Group
A
Mean 5.36 5.26 5.21 4.94 7.36 7.21 7.36 6.89 1.15 0.94 1.0 0.89
SD 0.59 0.65 0.71 0.97 1.06 1.18 1.11 1.04 0.33 0.55 0.44 0.39


Group
B
Mean 6.94 6.47 5.89 5.68 9.52 9.15 8.47 8.86 1.28 1.05

0.87 0.89
SD 0.84 0.84 1.41 1.60 0.90 1.01 1.34 1.53 0.41 0.52 0.40 0.48
Dental sciences Bhatia Archana et al. / JPBMS, 2012, 20 (02)
4 Journal of Pharmaceutical and Biomedical Sciences (JPBMS), Vol. 20, Issue 20
Table 2.Comparison of pocket depth changes for both control group (group A) and experimental group (group B) at each recall visit.
Paired Samples Test
G
r
o
u
p

Paired Differences
Mean Std. deviation Std.
Mean
Error
95% confidence interval of
the difference
T df p - value Result
Lower Upper


A
PD0 PD1 0.10526 0.45883 0.10526 -0.11589 .32641 1.000 18 0.331
NS

PD0 PD2 0.15789 0.60214 0.13814 -0.13233 0.44812 1.143 18 0.268
NS
PD0 PD3 0.42105 0.76853 0.17631 0.05063 0.79147 2.388 18 0.028 S


B
PD0 PD1 0.47368 0.61178 0.14035 0.17882 0.76855 3.375 18 0.003 HS
PD0 PD2 1.05263 0.91127 0.20906 0.61341 1.49185 5.035 18 0.001 HS
PD0 PD3 1.26316 1.19453 0.27404 0.68741 1.83890 4.609 18 0.001 HS
PD0 =Pocket depth at baseline PD1=Pocket depth after 1 month PD2=Pocket depth after 2months PD3=Pocket depth after 3 months
t =paired t test, df =degree of freedom
NS=Non-significant, S=Significant, HS=Highly-significant

B) Clinical Attachment Level:
In group A, the mean clinical attachment level of 20 patients at baseline was 7.36+1.06mm. The mean clinical attachment
level at 1, 2 and 3 months interval was 7.21+1.18mm, 7.36+1.11mm and 6.89+1.04mm respectively (Table 1). The
difference between the mean scores when put to statistical analysis was found to be statistically insignificant between
baseline & 1 month interval, baseline & 2 months interval and baseline & 3 months interval.
In group B, the mean clinical attachment level of 20 patients at baseline was 9.52+0.90mm. The mean clinical attachment
level at 1, 2 and 3 months interval was 9.15+1.01mm, 8.47+1.34mm and 8.86+1.53mm respectively (Table 1). The
difference between mean scores when put to statistical analysis was found to be statistically significant at 1 month interval
and highly significant at 2 and 3 months interval when compared with observations made at the baseline (Table 3 Figure
3).
Table 3. Comparison of change in clinical attachment level for both control group (group A) and experimental group (group B)
Paired Samples Test
G
r
o
u
p
Paired Differences
Mean Std.
deviation
Std. Mean
Error
95% confidence interval of
the difference
t df p-value Result
Lower Upper

A
CAL0 CAL1 0.15789 0.37463 .08595 -0.02267 0.33846 1.837 18 0.083 NS
CAL0 CAL2 0.00000 0.57735 0.13245 -0.27827 0.27827 0.000 18 1.000 NS
CAL0 CAL3 0.47368 1.26352 0.28987 -0.13531 1.08268 1.634 18 0.120 NS

B
CAL0 CAL1 0.36842 0.76089 0.17456 0.00169 0.73516 2.111 18 0.049 S
CAL0 CAL2 1.05263 1.12909 00.25903 0.50843 1.59684 4.064 18 0.001 HS
CAL0 CAL3 1.15789 1.30227 .29876 0.53022 1.78557 3.876 18 0.001 HS

CAL0 =clinical attachment level at baseline, CAL1 =clinical attachment level after 1 month , CAL2 =clinical attachment level after 2 months ,
CAL3 =clinical attachment level after 3 months
t =paired t test
df =degree of freedom.
NS =Non-significant, S =Significant, HS =Highly-significant.

C) Bleeding index scores:
In group A, the mean bleeding index score of 20 patients was 1.15+0.33, 0.94+0.55, 1.0+0.44 and 0.89+0.39 at 0, 1, 2 and 3
months interval respectively (Table 1). The difference between mean scores when put to statistical analysis was found to
be statistically significant only at 3 months interval.
In group B, the mean bleeding index score of 20 patients was 1.28+0.41, 1.05+0.52, 0.87+0.40 and 0.89+0.48 at 0, 1, 2 and
3 months interval respectively (Table 1). The difference between mean scores when put to statistical analysis was found to
be statistically insignificant only at 1 month interval, highly significant at 2 and 3 months interval when compared with
baseline readings (Table 4, Fig. 4).
Table 4. Comparison of bleeding index score in both control group (group A) and experimental group (group B)
Paired Samples Test
G
r
o
u
p

Paired Differences
Mean Std.
deviation
Std. Mean
Error
95% confidence interval of
the difference
T df p-value Result
Lower Upper



A
BI0 -BI1

0.21053 0.65226 0.14964 -0.10385 0.52490 1.407 18 0.176
NS
BI0 -BI2

0.15789 0.55409 0.12712 -0.10917 0.42496 1.242 18 0.230
NS
BI0 -BI3

0.26316 0.45241 0.10379 0.04510 0.48121 2.535 18 0.021
S


B
BI0 - BI1 0.23684 0.69459 0.15935 -0.09794 0.57162 1.486 18 0.155 NS
BI0 - BI2

0.42105 0.44917 0.10305 0.20456 0.63755 4.086 18 0.001
HS

BI0 - BI3

0.39474 0.56713 0.13011 0.12139 0.66809 3.034 18 0.007

HS

Dental sciences Bhatia Archana et al. / JPBMS, 2012, 20 (02)
5 Journal of Pharmaceutical and Biomedical Sciences (JPBMS), Vol. 20, Issue 20,
0.76
0.92
0.88
0.84
0.85
0.76
0.74
0.71
1.15
0.94
1
0.89
1.28
1.05
0.87
0.89
0
0.2
0.4
0.6
0.8
1
1.2
1.4
baseline after 1 month after 2 months after 3 months
B
l
e
e
d
i
n
g

a
n
d

p
l
a
q
u
e

i
n
d
e
x

S
c
o
r
e
Duration
group A(PS) group B(PS) group A(BI) group B(BI)
p value
BL to 2 M(PS)=0.25*
BL to 3 M(PS)=0.36*

Fig 4. Line diagram showing comparison of bleeding index (Muhlemann and Sons) in both control group (group A) and experimental group (group B)

PD0 =Pocket depth at baseline, PD1 =Pocket depth after 1 month , PD2 =Pocket depth after 2months, PD3 =Pocket depth after 3 months
CAL0 =clinical attachment level at baseline, CAL1 =clinical attachment level after 1 month, CAL2 =clinical attachment level after 2 months ,
CAL3 =clinical attachment level after 3 months
BI0 =bleeding index baseline, BI1=bleeding index after 1 month, BI2 =bleeding index after 2 months ,BI3 =bleeding index after 3months
SD =Standard Deviation.

D) Adverse effects:
Adverse effects were noted in only 5 subjects of group B
and none of the subjects of group A showed any adverse
effects due to treatment procedure. The difference
between these scores when put to statistical analysis, was
found to be statistically significant (Table 5, Fig. 5).


Fig 5. Bar diagramshowing any adverse effects of treatment outcomes in both
control group (group A) and experimental group (group B)

Discussion:
The present study was undertaken to evaluate the efficacy
of subgingivally placed controlled release degradable
chlorhexidine chip (Periocol CG) as an adjunct to scaling
and root planing in the management of chronic
periodontitis. Three months had been selected as the time
duration of the study because effects of locally delivered
controlled release chlorhexidine have been shown to be
evident up to 11 weeks after administration (Soskolne et
al. 1983
[18]
, Stabolz et al. 1986
[19]
) and 3 months
correspond to the typical recall interval for periodontal
patients (Jeffcoat et al. 1998
[4]
).
Mean reduction in pocket depth from baseline for the
duration of the study at one month, two months and three
months were 0.10+0.45mm, 0.15+0.60mm and 0.42
+0.76mm respectively for the group A (Scaling and root
planing alone group) and 0.47+0.61mm, 1.05+0.91mm and
1.26+1.19mm respectively for the group B (Scaling and
root planing plus chlorhexidine chip group) (Table 2). Our
results are in accordance with Srinivas et al 2000
[20]
and
Rodrigues et al.
[21]
, who found statistically significant
difference in mean pocket depth reduction between scaling
and root planing group and combination group. According
to Soskolne et al 2003
[22]
, if after definitive periodontal
therapy, there are still residual pockets of 5mm
remaining; then combined routine periodontal
maintenance therapy along with the chlorhexidine chip is
advisable.
Clinical attachment gain from the baseline for the duration
of study at 1 month, 2 months and three months interval
were 0.150.37mm, 0.000.57mm and 0.471.26mm
respectively for group A and 0.360.76mm, 1.051.12mm
and 1.151.30mm respectively for group B (Table 3). The
findings of our study are in partial accordance with Azmak
et al. 2002
[3]
, he observed a significant improvement in
clinical attachment level in both scaling and root planing
plus chlorhexidine chip group and scaling and root planing
Dental sciences Bhatia Archana et al. / JPBMS, 2012, 20 (02)
6 Journal of Pharmaceutical and Biomedical Sciences (JPBMS), Vol. 20, Issue 20
alone group at one month, three months and at six months
as compared to baseline.
At the end of the study, the mean change in clinical
attachment level from baseline was 0.47+1.26mm for the
group A and 1.15+1.30mm for group B (Table 3). These
findings are in accordance with Jeffcoat K et al.
2000
[23]
,they observed improved attachment levels over
the 9 month period for the scaling and root planing plus
chlorhexidine chip group and a significant improvement
compared to scaling and root planing alone group at 9
months.
Reduction in bleeding index score at one month, two
months and three months intervals was 0.210.65,
0.150.55 and 0.260.45 respectively for group A and
0.230.69, 0.420.44 and 0.390.56 respectively for group
B as compared to baseline (Table 4). There was statistically
significant difference in bleeding index score observed at
three months interval in group A and statistically highly
significant difference in bleeding index score at two
months and at three months interval in group B compared
to baseline. These findings are in accordance with Azmak
et al. 2002
[3]
,who found a mean reduction in bleeding index
score at one month and three months for both combination
group and scaling and root planing alone group when
compared to baseline. However, at all periods of
observations a statistically non-significant correlation was
observed in bleeding index score in between the group A
and B.
About 5 patients (26 %) observed adverse effects like
gingival pain and tender gums in group B whereas there
was not even a single patient in group A, who observed any
side effect due to treatment procedure. Adverse effects
occurred in the first week of the study, appeared to be
associated with chip placement at baseline after scaling
and root planing. None of the changes discovered on oral
examination were of a serious and irreversible nature
[24].


Conclusion:
In conclusion, the results of this study show that
chlorhexidine chip containing 2.5 mg chlorhexidine
gluconate (Periocol CG) is an effective adjunctive therapy
to scaling and root planing in the treatment of chronic
periodontitis. It provides a safe, easily applied single dose
means of achieving significant better clinical results than
scaling and root planing alone. The adjunctive use of the
chlorhexidine chip with scaling and root planing resulted
in a clinically meaningful improvement in pocket depth
reduction and clinical attachment level gain compared to
scaling and root planing alone.

References:
1. Drisko CL, Cobb CM, Killoy WJ, Michalowicz BS,
Pihlstrom BL, Lowenguth RA et al. Evaluation of
periodontal treatments using controlled release
tetracycline fiber: clinical response. J Periodontol
1995;66:692-9.
2. Divya PV and Nandakumar K. Local drug delivery-
Periocol in Periodontics.Trends iomater. Artif.Organs
2006;19:74-80.
3. Azmak N, Atilla G, Luoto H and Sorsa T. The effect of
subgingival controlled release delivery of chlorhexidine
chip on clinical parameters and matrix
metalloproteinase-8 levels in gingival crevicular fluid. J
Periodontol 2002;73:608-15.
4. Jeffcoat M , Kimberly BS, Sebastian G, Ciancio G, Dentino
AR, Fine DH et al. Adjunctive use of a subgingival
release chlorhexidine chip reduces probing depth and
improves attachment level compared with scaling and
root planing alone. J Periodontol 1998;69:989-97.
5. Killoy WJ, Polson AJ. Controlled local delivery of
antimicrobials in the treatment of periodontitis. Dent
Clin North Am 1998;42:263-83
6. Sivaram G and Jayakumar ND. Clinical and
microbiological evaluation of local drug delivery using
tetracycline fibers, a comparative study. JISP
2004;7:162-7.
7. Jog A and Silva I. Clinical effects of minocycline loaded
microcapsules in chronic periodontitis. JISP 2002-
03;3:5-16.
8. Desai R and Bhavsar NV. A new intrapocket drug
delivery system containing 25% metronidazole gel (a
clinical and darkground micro-biological study). JISP
2002-03;4:36-40.
9. Hitzig C, Fosse T, Charbit Y, Bitton C and Hannoun L.
Effects of combined topical metronidazole and
mechanical treatment on the subgingival flora in deep
periodontal pockets in cupids and bicuspids. J
Periodontol 1997;68:613-17.
10. Carvalho J, Novak JM and Mota FL. Evaluation of the
effect of subgingival placement of chlorhexidine chips
as an adjunct to scaling and root planing. J Periodontol
2007;78:997-1001.
11. Cosyn J, Wyn I. A systematic review on the effects of the
chlorhexidine chip when used as an adjunct to scaling
and root planing in the treatment of chronic
periodontitis. J Periodontol 2006;77:257-64.
12. Friedman M, Golamb G. New sustained release dosage
form of chlorhexidine for dental use. J Periodontol Res
1982;17:323-28.
13. Harnack L, Gonzales J, Meyle J. Local periodontal
therapy with subgingival controlled release of
chlorhexidine-A case report. Perio 2000 2005;2:107-16.
14. Mythili R, Ramakrishnan T, Mammen B. Effect of
controlled release device containing chlorhexidine
gluconate in the treatment of adult periodontitis-A
clinical and microbiological study. JISP 2006;10:321-4
15. Humagain M, Nayak DG, Uppoor AS. A clinical
evaluation of bioactive glass particulate in the
treatment of mandibular class II furcation defects.
Brazilian journal of oral sciences 2007;6:1450-56
16. Vandana KL, Gupta I. The location of cemento enamel
junction for CAL measurement: A clinical crisis. JISP
2009;13:12-15
17. Benamghar L, Penaud J, Kaminsky P, Abt F, Martin J.
Comparison of gingival index and sulcus bleeding index
as indicators of periodontal status. Bulletin of World
Health Organization 1982;60:147-51.
18. Soskolne A, Golomb G, Friedman Micheal, Sela N M.
New sustained dosage form of chlorhexidine for dental
use. J Periodontol Res 1983;18:330-36.
19. Stabholz A, Sela M N, Friedman M, Golomb G, Soskolne
A. Clinical and microbiological effects of sustained
release chlorhexidine in periodontal pockets. J Clin
Periodontol 1986;13:783-8.
20. Reddy NS, Prakash S, Mehta SD. Comparative evaluation
of sustained local delivery of chlorhexidine (periochip)
Dental sciences Bhatia Archana et al. / JPBMS, 2012, 20 (02)
7 Journal of Pharmaceutical and Biomedical Sciences (JPBMS), Vol. 20, Issue 20,
and phase I therapy in the treatment of chronic adult
periodontitis-a clinical study. JICD 2000;47:15-19.
21. Rodrigues GF, Machion L, Casati MZ, Humberto F,
Toledo S, Sallum AW et al. Clinical evaluation of the use
of locally delivered chlorhexidine in periodontal
maintenance therapy. J Periodontol 2007;78:624-8.
22. Soskolne AW, Proskin HM, Stabholz A. Probing depth
changes following 2 years of periodontal maintenance
therapy including adjunctive controlled release of
chlorhexidine. J Periodontol 2003;74:420-27.
23. Jeffcoat MK, Palcanis KG, Weatherford TW, Reese M,
Geurs NC, Flashner M. Use of a biodegradable
chlorhexidine chip in the treatment of adult
periodontitis:clinical and radiographic findings. J
Periodontol 2000;71:256-62.
24. Steinberg D, Friedman M, Soskolne A, Sela MN. A new
degradable controlled release device for treatment of
periodontal disease:In vitro release study J Periodontol
1990;61:393-8.



Source of funding:- None
Conflict of interest:-Not declared.


Corresponding Author:-
Dr. Bhatia Archana.,
Senior lecturer,
Department of Periodontology and Oral implantology, Dasmesh Institute of Research and Dental Sciences
Faridkot (Punjab), India.
Contact no.+91-9888370446















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