Efficacy of a bioflavonoid-enriched herbal versus 0.12% and 0.2% chlorhexidine mouthwashes in reducing peri-implant inflammation and subgingival Porphyromonas gingivalis carriage in patients with peri-implantitis
DOI:
https://doi.org/10.2340/aos.v84.44870Keywords:
Bioflavonoids, chlorhexidine, Porphyromonas gingivalis, peri-implantitis, probing depthAbstract
Background: This study compared the efficacy of a bioflavonoid-enriched herbal mouthwash versus 0.12% and 0.2% chlorhexidine (CHX) in reducing peri-implant inflammation and subgingival Porphyromonas gingivalis (P. gingivalis) carriage among patients with peri-implantitis.
Methods: In all, 67 individuals diagnosed with peri-implantitis were enrolled. Demographic and implant-related data were retrieved, and subgingival biofilm samples were analysed for P. gingivalis. All patients underwent non-surgical mechanical debridement (MD) and were then randomised into three groups: test group (bioflavonoid mouthwash, n = 22), control group 1 (0.12% CHX, n = 23), and control group 2 (0.2% CHX, n = 22). Participants rinsed with 15 ml of the assigned solution twice daily for 90 days. Clinical parameters, including modified plaque index (mPI), modified bleeding index (mBI), probing depth (PD), and crestal bone loss, were recorded at baseline and after 90 days. Statistical significance was set at P < 0.05.
Results: Significant reductions in mPI, mBI, and PD were observed across all groups compared with baseline (P < 0.05). The follow-up scores for these parameters were significantly lower in the test group compared with both CHX groups (P < 0.05). At baseline, P. gingivalis was detected in 79.1% of participants. After 90 days, P. gingivalis carriage was lower in the test group (13.6%) compared with control group 1 (50.0%) and control group 2 (54.5%).
Conclusion: Prescription of a bioflavonoid-enriched herbal mouthwash following MD is more effective in reducing peri-implant inflammation and subgingival P. gingivalis compared with 0.12% and 0.2% CHX rinses.
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References
Heitz-Mayfield LJA. Peri-implant mucositis and peri-implantitis: key features and differences. Br Dent J. 2024;236:791–4. https://doi.org/10.1038/s41415-024-7402-z DOI: https://doi.org/10.1038/s41415-024-7402-z
Schwarz F, Ramanauskaite A. It is all about peri-implant tissue health. Periodontol 2000. 2022;88:9–12. https://doi.org/10.1111/prd.12407 DOI: https://doi.org/10.1111/prd.12407
Derks J, Tomasi C. Peri-implant health and disease. A systematic review of current epidemiology. J Clin Periodontol. 2015;42 Suppl 16:S158–71. https://doi.org/10.1111/jcpe.12334 DOI: https://doi.org/10.1111/jcpe.12334
Lindhe J, Meyle J. Peri-implant diseases: consensus report of the sixth European Workshop on Periodontology. J Clin Perio-dontol. 2008;35:282–5. https://doi.org/10.1111/j.1600-051X.2008.01283.x DOI: https://doi.org/10.1111/j.1600-051X.2008.01283.x
Schwarz F, Derks J, Monje A, Wang HL. Peri-implantitis. J Periodontol. 2018;89 Suppl 1:S267–90. https://doi.org/10.1002/JPER.16-0350 DOI: https://doi.org/10.1002/JPER.16-0350
Kato A, Imai K, Sato H, Ogata Y. Prevalence of Epstein-Barr virus DNA and Porphyromonas gingivalis in Japanese peri-implantitis patients. BMC Oral Health. 2017;17:148. https://doi.org/10.1186/s12903-017-0438-6 DOI: https://doi.org/10.1186/s12903-017-0438-6
Savčić N, Henjaš D, Jezdić M, Đinić Krasavčević A, Milinković I. Porphyromonas gingivalis in different peri-implant conditions: a pilot cross – sectional study. Acta Stomatol Croat. 2022;56:387–94. https://doi.org/10.15644/asc56/4/5 DOI: https://doi.org/10.15644/asc56/4/5
Galindo-Moreno P, Gutierrez-Garrido L, Duarte J, Robles-Vera I, Martin-Morales N, O’Valle F, et al. Evolution in the peri-implant oral microbiome and their relationship to long-term marginal bone loss: a randomized clinical study. Clin Oral Im-plants Res. 2025;36:802–20. https://doi.org/10.1111/clr.14426 DOI: https://doi.org/10.1111/clr.14426
Aabed K, Moubayed N, BinShabaib MS, ALHarthi SS. Is a single session of antimicrobial photodynamic therapy as an adju-vant to non-surgical scaling and root planing effective in reducing periodontal inflammation and subgingival presence of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans in patients with periodontitis? Photodiagnosis Pho-todyn Ther. 2022;38:102847. https://doi.org/10.1016/j.pdpdt.2022.102847 DOI: https://doi.org/10.1016/j.pdpdt.2022.102847
Carvalho É BS, Romandini M, Sadilina S, Sant’Ana ACP, Sanz M. Microbiota associated with peri-implantitis-A systematic review with meta-analyses. Clin Oral Implants Res. 2023;34:1176–87. https://doi.org/10.1111/clr.14153 DOI: https://doi.org/10.1111/clr.14153
Cui Z, Wang P, Gao W. Microbial dysbiosis in periodontitis and peri-implantitis: pathogenesis, immune responses, and thera-peutic. Front Cell Infect Microbiol. 2025;15:1517154. https://doi.org/10.3389/fcimb.2025.1517154 DOI: https://doi.org/10.3389/fcimb.2025.1517154
Abduljabbar T, Javed F, Kellesarian SV, Vohra F, Romanos GE. Effect of Nd:YAG laser-assisted non-surgical mechanical deb-ridement on clinical and radiographic peri-implant inflammatory parameters in patients with peri-implant disease. J Photo-chem Photobiol B. 2017;168:16–9. https://doi.org/10.1016/j.jphotobiol.2017.01.015 DOI: https://doi.org/10.1016/j.jphotobiol.2017.01.015
Al Amri MD, Kellesarian SV, Ahmed A, Al-Kheraif AA, Romanos GE, Javed F. Efficacy of periimplant mechanical debridement with and without adjunct antimicrobial photodynamic therapy in patients with type 2 diabetes mellitus. Photodiagnosis Pho-todyn Ther. 2016;14:166–9. https://doi.org/10.1016/j.pdpdt.2016.04.015 DOI: https://doi.org/10.1016/j.pdpdt.2016.04.015
Alqahtani F, Alqhtani N, Alkhtani F, Divakar DD, Al-Kheraif AA, Javed F. Efficacy of mechanical debridement with and with-out adjunct antimicrobial photodynamic therapy in the treatment of peri-implantitis among moderate cigarette-smokers and waterpipe-users. Photodiagnosis Photodyn Ther. 2019;28:153–8. https://doi.org/10.1016/j.pdpdt.2019.09.003 DOI: https://doi.org/10.1016/j.pdpdt.2019.09.003
Kotsailidi EA, Michelogiannakis D, Al-Zawawi AS, Javed F. Surgical or non-surgical treatment of peri-implantitis—what is the verdict? Surg Pract Sci. 2020;1:100010. https://doi.org/10.1016/j.sipas.2020.100010 DOI: https://doi.org/10.1016/j.sipas.2020.100010
Schwarz F, Jepsen S, Obreja K, Galarraga-Vinueza ME, Ramanauskaite A. Surgical therapy of peri-implantitis. Periodontol 2000. 2022;88:145–81. https://doi.org/10.1111/prd.12417 DOI: https://doi.org/10.1111/prd.12417
Al-Zawawi AS, Shaheen MY, Divakar DD, Aldulaijan HA, Basudan AM. Postoperative anti-inflammatory efficacy of 2% saline rinses and a herbal- mouthwash after non-surgical periodontal therapy for the management of periodontal inflammation in young adults with chlorhexidine allergy: a randomized controlled trial. Int J Dent Hyg. 2022;20:408–14. DOI: https://doi.org/10.1111/idh.12583
Shaheen MY, Al-Zawawi AS, Divakar DD, Aldulaijan HA, Basudan AM. Role of chlorhexidine and herbal oral rinses in managing periodon-titis. Int Dent J. 2023;73:235–42. https://doi.org/10.1016/j.identj.2022.06.027 DOI: https://doi.org/10.1016/j.identj.2022.06.027
Alqutub MN, Alhumaidan AA, Alali Y, Al-Aali KA, Javed F, Vohra F, et al. Comparison of the postoperative anti-inflammatory efficacy of chlorhexidine, saline rinses and herbal mouthwashes after mechanical debridement in patients with peri-implant mucositis: a randomized controlled trial. Int J Dent Hyg. 2023;21:203–10. https://doi.org/10.1111/idh.12582 DOI: https://doi.org/10.1111/idh.12582
Alzoman H, Alojaym TG, Chalikkandy SN, Mehmood A, Rashed F, Divakar DD. Comparison of an herbal- and a 0.12% chlorhex-idine-based oral rinse as adjuncts to nonsurgical mechanical debridement in the management of peri-implant mucositis: a randomised controlled trial. Oral Health Prev Dent. 2020;18:645–51.
James P, Worthington HV, Parnell C, Harding M, Lamont T, Cheung A, et al. Chlorhexidine mouthrinse as an adjunctive treat-ment for gingival health. Cochrane Database Syst Rev. 2017;3:Cd008676. https://doi.org/10.1002/14651858.CD008676.pub2 DOI: https://doi.org/10.1002/14651858.CD008676.pub2
Esposito M, Grusovin MG, Coulthard P, Worthington HV. The efficacy of interventions to treat peri-implantitis: a Cochrane systematic review of randomised controlled clinical trials. Eur J Oral Implantol. 2008;9 Suppl 1:111–25.
Hooper SJ, Lewis MA, Wilson MJ, Williams DW. Antimicrobial activity of Citrox bioflavonoid preparations against oral microor-ganisms. Br Dent J. 2011;210:E22. https://doi.org/10.1038/sj.bdj.2010.1224 DOI: https://doi.org/10.1038/sj.bdj.2010.1224
Farhadi F, Khameneh B, Iranshahi M, Iranshahy M. Antibacterial activity of flavonoids and their structure-activity relation-ship: an update review. Phytother Res. 2019;33:13–40. DOI: https://doi.org/10.1002/ptr.6208
Baykulova SB. [Assessment of antimicrobial activity of bioflavonoid CITROX and chlorhexidine combination against P. gingi-valis (in vitro)]. Stomatologiia (Mosk). 2022;101:14–18. https://doi.org/10.17116/stomat202210102114 DOI: https://doi.org/10.17116/stomat202210102114
Collaert B, Edwardsson S, Attström R, Hase JC, Aström M, Movert R. Rinsing with delmopinol 0.2% and chlorhexidine 0.2%: short-term effect on salivary microbiology, plaque, and gingivitis. J Periodontol. 1992;63:618–25. https://doi.org/10.1902/jop.1992.63.7.618 DOI: https://doi.org/10.1902/jop.1992.63.7.618
Yaghooti Khorasani MM, Mohammadi Kamalabadi Y, Salari Sedigh S, Jafari M, Sadeghi M, Assar S. Comparative evaluation of a commercial herbal extract and 0.2% chlorhexidine mouthwash on three periodontal facultative anaerobes: an in vitro study. Int J Dent. 2022;2022:6359841. https://doi.org/10.1155/2022/6359841 DOI: https://doi.org/10.1155/2022/6359841
Lee SY, Nam EJ. Clinical efficacy of 1% CHX gluconate gel and 0.12% CHX solution: a randomized controlled trial. Int J Environ Res Public Health. 2022;19. DOI: https://doi.org/10.3390/ijerph19159358
Newman MG, Sanz M, Nachnani S, Saltini C, Anderson L. Effect of 0.12% chlorhexidine on bacterial recolonization following periodontal surgery. J Periodontol. 1989;60:577–81. https://doi.org/10.1902/jop.1989.60.10.577 DOI: https://doi.org/10.1902/jop.1989.60.10.577
Berglundh T, Armitage G, Araujo MG, Avila-Ortiz G, Blanco J, Camargo PM, et al. Peri-implant diseases and conditions: con-sensus report of workgroup 4 of the 2017 world workshop on the classification of periodontal and peri-implant diseases and conditions. J Clin Periodontol. 2018;45 Suppl 20:S286–91. DOI: https://doi.org/10.1111/jcpe.12957
World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310:2191–4. https://doi.org/10.1001/jama.2013.281053 DOI: https://doi.org/10.1001/jama.2013.281053
Ingalagi P, Bhat KG, Kulkarni RD, Kotrashetti VS, Kumbar V, Kugaji M. Detection and comparison of prevalence of Porphy-romonas gingivalis through culture and Real Time-polymerase chain reaction in subgingival plaque samples of chronic perio-dontitis and healthy individuals. J Oral Maxillofac Pathol. 2022;26:288. https://doi.org/10.4103/jomfp.jomfp_163_21 DOI: https://doi.org/10.4103/jomfp.jomfp_163_21
Tran SD, Rudney JD. Improved multiplex PCR using conserved and species-specific 16S rRNA gene primers for simultaneous detection of Actinobacillus actinomycetemcomitans, Bacteroides forsythus, and Porphyromonas gingivalis. J Clin Microbiol. 1999;37:3504–8. DOI: https://doi.org/10.1128/JCM.37.11.3504-3508.1999
Mombelli A, van Oosten MA, Schurch E, Jr, Land NP. The microbiota associated with successful or failing osseointegrated titanium implants. Oral Microbiol Immunol. 1987;2:145–51. https://doi.org/10.1111/j.1399-302X.1987.tb00298.x DOI: https://doi.org/10.1111/j.1399-302X.1987.tb00298.x
Abduljabbar T, Vohra F, Ullah A, Alhamoudi N, Khan J, Javed F. Relationship between self-rated pain and peri-implant clini-cal, radiographic and whole salivary inflammatory markers among patients with and without peri-implantitis. Clin Implant Dent Relat Res. 2019;21:1218–24. DOI: https://doi.org/10.1111/cid.12866
Alqahtani F, Alqhtani N, Alkhtani F, Devang Divakar D, Al-Kheraif AA, Javed F. Clinicoradiographic markers of peri-implantitis in cigarette-smokers and never-smokers with type 2 diabetes mellitus at 7-years follow-up. J Periodontol. 2020;91:1132–8. https://doi.org/10.1002/JPER.19-0501 DOI: https://doi.org/10.1002/JPER.19-0501
Gatti C, Gatti F, Silvestri M, Mintrone F, Rossi R, Tridondani G, et al. A prospective multicenter study on radiographic crestal bone changes around dental implants placed at crestal or subcrestal level: one-year findings. Int J Oral Maxillofac Implants. 2018;33:913–8. DOI: https://doi.org/10.11607/jomi.6509
Kariu T, Hamada N, Lakshmyya K. Luteolin inhibits Porphyromonas gingivalis growth and alleviates alveolar bone destruction in experimental murine periodontitis. Biosci Biotechnol Biochem. 2023;88:37–43. DOI: https://doi.org/10.1093/bbb/zbad137
Ohira C, Kaneki M, Shirao D, Kurauchi N, Fukuyama T. Oral treatment with catechin isolated from Japanese green tea signifi-cantly inhibits the growth of periodontal pathogen Porphyromonas gulae and ameliorates the gingivitis and halitosis caused by periodontal disease in cats and dogs. Int Immunopharmacol. 2025;146:113805. https://doi.org/10.1016/j.intimp.2024.113805 DOI: https://doi.org/10.1016/j.intimp.2024.113805
Wang W, Sun DF, Dong Z, Zhang WL. Icariin suppresses osteogenic differentiation and promotes bone regeneration in Por-phyromonas gingivalis-infected conditions through EphA2-RhoA signaling pathway. Int Immunopharmacol. 2024;143:113302. https://doi.org/10.1016/j.intimp.2024.113302 DOI: https://doi.org/10.1016/j.intimp.2024.113302
Donadio G, Mensitieri F, Santoro V, Parisi V, Bellone ML, De Tommasi N, et al. Interactions with microbial proteins driving the antibacterial activity of flavonoids. Pharmaceutics. 2021;13. https://doi.org/10.3390/pharmaceutics13050660 DOI: https://doi.org/10.3390/pharmaceutics13050660
Deryabin D, Galadzhieva A, Kosyan D, Duskaev G. Plant-derived inhibitors of AHL-mediated quorum sensing in bacteria: modes of action. Int J Mol Sci. 2019;20. https://doi.org/10.3390/ijms20225588 DOI: https://doi.org/10.3390/ijms20225588
Chiewchalermsri C, Sompornrattanaphan M, Wongsa C, Thongngarm T. Chlorhexidine allergy: current challenges and future prospects. J Asthma Allergy. 2020;13:127–33. https://doi.org/10.2147/JAA.S207980 DOI: https://doi.org/10.2147/JAA.S207980
Keni NN, Aras MA, Chitre V. Chlorhexidine allergy due to topical application. Indian J Dent Res. 2012;23:674–6. https://doi.org/10.4103/0970-9290.107393 DOI: https://doi.org/10.4103/0970-9290.107393
Kotsailidi EA, Kalogirou EM, Michelogiannakis D, Vlachodimitropoulos D, Tosios KI. Hypersensitivity reaction of the gingiva to chlorhexidine: case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2020;130:156–60.e1. https://doi.org/10.1016/j.oooo.2020.04.814 DOI: https://doi.org/10.1016/j.oooo.2020.04.814
Shahbazi S, Esmaeili S, Moscowchi A, Amid R, Romanos G, Kadkhodazadeh M. Adjunctive photochemical therapy for man-agement of inflammatory peri-implant diseases: a systematic review and meta-analysis. Photochem Photobiol. 2025. https://doi.org/10.1111/php.14098 DOI: https://doi.org/10.1111/php.14098
Sánchez-Martos R, Kronkah NA, Arias-Herrera S. Comparison of photothermal and photodynamic diode laser therapy in patients with peri-implant mucositis: a systematic review. J Clin Exp Dent. 2023;15:e760–72. https://doi.org/10.4317/jced.60711 DOI: https://doi.org/10.4317/jced.60711
Javed F, Näsström K, Benchimol D, Altamash M, Klinge B, Engström PE. Comparison of periodontal and socioeconomic status between subjects with type 2 diabetes mellitus and non-diabetic controls. J Periodontol. 2007;78:2112–9. https://doi.org/10.1902/jop.2007.070186 DOI: https://doi.org/10.1902/jop.2007.070186
Javed F, Rahman I, Romanos GE. Tobacco-product usage as a risk factor for dental implants. Periodontol 2000. 2019;81:48–56. https://doi.org/10.1111/prd.12282 DOI: https://doi.org/10.1111/prd.12282
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