Case Series Report of 66 Refractory Maintenance Patients Evaluating the Effectiveness of Topical Oxidizing Agents
Periodontal disease can often be difficult to keep stable, even with the best efforts of the clinician and patient. Though traditional periodontal therapy is successful in some cases, this treatment protocol is not universally successful over time for everyone. Therefore, the use of an adjunctive treatment may be warranted. In a case report published in The Journal of Clinical Dentistry (2015) the authors aimed to evaluate the “clinical effects of prescription tray application of hydrogen peroxide gel as an adjunct to frequent maintenance appointments for refractory periodontal patients.”1
Previous studies have assessed the efficacy of hydrogen peroxide gel in custom trays; however, this case report differs as it focused on patients that were not responding well to traditional periodontal therapy. This case study also followed subjects for an extended period of time ranging from 2.5-5 years to assess long-term maintenance outcome with continued use of hydrogen peroxide gel in trays.
This study includes 37 females and 29 males, 16 of whom were smokers. All participants were evaluated to determine the baseline by charting the bleeding index and periodontal probing depths. All participants were on a regular periodontal maintenance schedule and proper OHI was demonstrated with proper technique multiple times before the first prescription tray was delivered.
The results showed a significant reduction in BOP at six months with the use of prescription trays with hydrogen peroxide gel. Additionally, the reduction in bleeding lasted throughout the duration of the study. Reduced bleeding was significant in both smokers and non-smokers. This is interesting as smoking has long been an indicator of periodontal health.
The authors reported a surprising finding when they observed the frequency of use between once a day and twice a day did not show a significant difference. They state, “tray delivery for ten minutes once a day was statistically as significant as twice a day.” The authors do call for further studies to evaluate the frequency of use and compare results to ensure they are reproducible.
The authors also noted that deeper periodontal probing depths and bleeding index after tray use was varied and was seemed to be directly associated with periodontal probing depths. Deeper periodontal probing depths were more likely to continue to bleed.
The authors conclude by stating, “The use of prescription tray delivery of 1.7% hydrogen peroxide gel demonstrated a clinical and significant decrease in BOP at six months of treatment and at all following assessments for 66 refractory periodontal maintenance patients. There were no significant differences across time for smoking status or frequency of tray use.”
Do you use a tray delivery system that utilized 1.7% hydrogen peroxide gel? If so, have you noticed an improvement in the periodontal status of your patients that use it? Would you consider implementing this adjunct for periodontally involved patients?
- Cochrane RB, Sindelar B. Case Series Report of 66 Refractory Maintenance Patients Evaluating the Effectiveness of Topical Oxidizing Agents. J Clin Dent. 2015;26(4):109-14. PMID: 26856017.