Adjunctive Antiseptic Irrigation of Periodontal Pockets: Microbial and Cytokine Profiles

Objectives: Evaluate the effect of adjunctive antiseptic irrigation of periodontal pockets on microbial and cytokine profiles.
Methods: The subjects comprised 59 adults with severe chronic periodontitis, randomly allocated to one of three groups for scaling and root planing with different adjunctive irrigants: Aquin (1% polyhexamethyleneguanidine phosphate (PHMG-P)) (n=19), 0.2% chlorhexidine (CHX) (n=21) or distilled water (n=19). Gingival crevicular fluid and subgingival biofilm were taken at baseline, at 2 weeks, 1 and 4 months. At each follow-up appointment, all treatment procedures were repeated. Levels of interleukin (IL)-1β, IL-8, IL-10 and IL-17A were determined using multiplex immunoassay. Matrix metalloproteinase (MMP)-8 was assessed by time-resolved immunofluorometric assay. Quantity of Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans and Prevotella intermedia were investigated by real-time polymerase chain reaction.
Results: There were no intergroup differences in cytokine concentrations and bacterial counts at any follow-up (p>0.05). However, varying patterns within the treatment groups were observed. In PHMG-P and water groups, IL-1β, IL-8, IL-10 and IL-17A expression peaked at 2 weeks and then gradually declined, almost to baseline level (Fig 1). Changes of IL-1β and IL-17A concentrations were statistically significant within PHMG-P group (p≤0.05). In CHX group, the cytokines production was linear, changing insignificantly over the study (p>0.05). In all three groups, dynamics of MMP-8 concentration were nonlinear, increasing by 2 weeks and then declining to below baseline. P. gingivalis and T. forsythia declined within a month and increased thereafter, without regaining baseline level. Changes of P. gingivalis within PHMG-P group and T. denticola and T. forsythia within CHX group were significant (p≤0.05). Overall changes in A. actinomycetemcomitans, P. intermedia and F. nucleatum counts were statistically insignificant.
Conclusions: Adjunctive antiseptic treatment caused changes in biomarkers and bacterial counts over the course of the study. Overall, in the applied protocol the effects of adjunctive antiseptic irrigation were limited.