Dental Clinical Articles
Posted: 25 February 2011
Treating Periodontal Pockets
This month, Howard Stean and his team of expert dentists from Aesthetic Dentistry and Professional Testing (ADAPT), discuss the latest clinical findings surrounding certain products. This month, the focus is on Chlosite
Every day, general clinicians have patients attending their practices with a wide range of periodontal pathology, ranging from mild gingivitis through to extensive periodontal breakdown and associated bony pathology.
Those practitioners who employ hygienists, correctly prescribe thorough scaling, with or without root planing, in the hope that some decent improvement will derive from that treatment. Periodontal pathology may be acute or chronic, with or without symptoms, and unless the patient is referred to a specialist periodontist, the practitioner will be responsible for trying their best to achieve a complete resolution or at least an improvement.
For those dentists who possess a dental laser, the wavelength of choice is Erbium Yag, although modern NdYag equipment and even modest diode units claim to treat periodontal disease.
ErbiumYag wavelength has the longest track record and, although not in popular use by periodontists in the UK, holds the power to disinfect pockets surgically and stimulate reattachment of soft tissues to freshly prepared root cementum. These are expensive machines, and Aesthetic Dentistry and Professional Testing (ADAPT), has evaluated a new chemical treatment for disinfecting pockets.
A new treatment
Chlosite, from the established Italian pharmaceutical company Ghimas, is a recent entry to the market, which has already several products designed to medicate the infected pockets. The unique preparation contains two chemical versions of chlorhexidine, a well- known antimicrobial. This is the clever part: the company claims that in addition to the digluconate is also the dihydrochloride chemistry that remains active for a longer period of time. The paste vehicle is a xanthum gum and is sterile in the supplied single use package.
Chlosite is delivered into each pocket via a syringe with a blunt needle, with a side exit for the paste to be applied with very little discomfort. ADAPT members found that patients did not need anaesthesia for this procedure.
Generally, the patient would undergo a routing scaling and then have the Chlosite applied to pockets over 4mm. The patient would be instructed not to eat or drink for one hour, and then resume normal habits and cleaning.
We found an acceptable resolution of swelling and most sites were free of inflammation and bleeding after one week.
A complete cure?
Whether or not Chlosite could be relied upon as a ‘complete cure’ for periodontal disease ADAPT cannot affirm, but we have noted useful improvements in local conditions, and some smaller number of excellent results.
We also found that Chlosite used after certain procedures like uncovering of implant fixtures to be helpful in lowering the soft tissue response to local trauma. Our opinion is that Chlosite is useful as an adjunctive treatment for periodontal pockets, when used with accepted local treatments for soft tissue pathology.
Aesthetic Dentistry and Professional Testing (ADAPT) is the UK’s first specialist society devoted to the study of excellence in aesthetic restorative dentistry, and was founded in 1993 by Dr Howard Stean, its current chairman.
This unique non-profit group works closely with the dental industry both in the UK and abroad, researching to find better techniques and materials dentists need to work with every day, to carry out the best treatment that they possibly can.
ADAPT evaluators are registered dentists who devote their own time, with no financial reward, to testing many types of materials. www.adaptuk.org