Efficacy of subgingival irrigation with chemical agents as adjuvants to non-surgical periodontal therapy: systematic review and meta-analysis
Clinical Snapshot
PICO Framework
| P — Population | Patients with periodontitis undergoing non-surgical periodontal therapy |
| I — Intervention | Subgingival irrigation with chemical agents (povidone-iodine, essential oils, chlorhexidine, ozonated water, boric acid) as adjunct to NSPT |
| C — Comparator | Non-surgical periodontal therapy alone or with placebo irrigation |
| O — Outcomes | Clinical attachment level (CAL), probing pocket depth (PPD), bleeding on probing (BOP) |
Bottom Line
This systematic review and meta-analysis of 16 randomized trials found no additional clinical benefit from using chemical agents (povidone-iodine, chlorhexidine, essential oils, ozonated water, or boric acid) for subgingival irrigation as adjuncts to non-surgical periodontal therapy. The analysis showed no significant improvements in probing pocket depth, clinical attachment level, or bleeding on probing compared to standard treatment alone. While the evidence quality is low to very low due to bias concerns in most included studies, the findings suggest clinicians can avoid unnecessary adjunctive chemical irrigation during routine periodontal treatment. This evidence supports a more conservative, cost-effective approach to periodontal therapy, focusing resources on proven mechanical debridement techniques rather than unproven chemical adjuncts.
Key Findings
P Value: P > 0.05 for all primary outcomes
Effect Size: Not specified in abstract
Primary Outcome: No additional benefit from chemical agents as adjunct to NSPT for PPD, CAL, or BOP
Nnt Or Sensitivity: Not applicable - no significant benefit demonstrated
Confidence Interval: Not reported in abstract
Clinical Application
High feasibility - relates to commonly used adjunctive treatments that can be avoided based on this evidence Relevant to Australian dental practice; may inform PBS considerations for adjunctive periodontal treatments and support evidence-based RACGP/ADA guidelines Patients with periodontitis receiving non-surgical periodontal therapy in general dental practice
Abstract
OBJECTIVE: This systematic review aims to assess the efficacy of chemical agents (CA) in subgingival irrigation as an adjunct to non-surgical periodontal treatment (NSPT) in the treatment of periodontitis. METHODS: Search strategies were developed for MEDLINE via PubMed, Web of Science, and LILACS databases for publications up to March 2025. Risk of bias was assessed according to the RoB 2.0 tool. Random-effects meta-analyses were conducted for clinical attachment level (CAL), probing pocket depth (PPD), and bleeding on probing (BOP). RESULTS: From 1244 studies initially screened, 16 randomized clinical trials were included for qualitative and quantitative analyses. Studies assessed the effects of the following chemical agents: Povidone-iodine (PVP-I), Essential Oils (EOs); Chlorhexidine (CHX), Ozonated water (OW) and Boric Acid (BA). Overall, the meta-analysis showed that the adjunctive use of CA as subgingival irrigation did not provide additional benefit in PPD reduction, CAL gain, and BOP compared with controls (P > 0.05). Most studies raised some concerns with risk of bias, and 2 showed a high risk of bias. CONCLUSION: Adjunctive use of chemical agents in subgingival irrigation during NSPT for periodontitis patients does not appear to provide additional benefit over NSPT alone, although evidence levels are low to very low. CLINICAL RELEVANCE: CA are frequently used as adjuncts to NSPT, despite uncertainty regarding their real clinical contribution. The findings of this study help clinicians make more evidence-based decisions and avoid unnecessary use of adjunctive subgingival irrigation strategies during periodontal treatment.
References
- 1.da Silveira, M. I., Maciel, C. C. M., Grant, M. M., Chapple, I. L. C., De Marco, A. C., & Rovai, E. S. (2026). Efficacy of subgingival irrigation with chemical agents as adjuvants to non-surgical periodontal therapy: systematic review and meta-analysis. Clinical Oral Investigations. https://doi.org/10.1111/idh.12617
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