Comparison of The Effect of the Preoperative Use of Chlorhexidine, Essential Oil, and Cetylpyridinium Chloride Mouthwashes on Bacterial Contamination During Dental Implant Placement: A Randomized Controlled Clinical Trial

Introduction: There is a linkage between the presence of bacteria and peri-implantitis as well as the long-term success rate of implant and a favorable response to antimicrobial agents. Failure to achieve and maintain a successful osseointegration around dental implants is caused by several factors, one of them is microbial infection. There is an agreement on the role of chlorhexidine and other mouthwashes after periodontal treatment, but scarce information can be found about the use of it as a preoperative mouthrinse routinely before surgeries, especially in periodontal procedures, including placement of dental implants.;Aim: The aim of this study was to evaluate and compare the efficacy of preoperative rinse with Chlorhexidine, Essential Oil-based, and Cetylpyridinium Chloride mouthwashes on bacterial contamination at the time of implant placement.;Materials and Methods: Patients who were qualified for dental implants placement and met the inclusion criteria were included in the study. They were randomly divided into four groups according the mouthwash used: (1) 15 ml of 0.12% Chlorhexidine for 60 seconds, (2) 15 ml of Essential oil-based for 60 seconds, (3) 15 ml of Cetylpyridinium Chloride for 60 seconds, and (4) 15 ml of saline solution for 60 seconds as the control group. On the day of the implant placement, three saliva samples were collected: before the procedure and before the rinse with any of the mouthwashes (pre), immediately after the use of the mouthwash but before the procedure (post), and at the end of the procedure and after suturing the flap (end). Real-time PCR (qPCR) was used to analyze the samples and quantify the targeted periodontal pathogens with the utilization of Propidium monoazide (PMA(TM)) dye.;Results: Forty patients were included in the study. Real-time PCR analysis showed that all mouthwashes resulted in a significant reduction in the number of the pathogens in the saliva samples collected after the use of the mouthwashes compared to the saline group. There was a statistically significant difference between the groups for pre-post and pre-end samples (P<0.001, P< 0.001, respectively) but not for post-end (P= 0.203). There was a statistically significant difference between the chlorhexidine and the saline, essential oil and saline, and CPC and saline groups (P< 0.001, P< 0.001, P< 0.001, respectively). The use of PMA TM dye showed a significant difference in the bacterial counts compared to samples without the dye.;Conclusions: Within the limitations of this study, pre-operative use of examined mouthwashes could be advantageous in terms of reducing the bacterial load at the time of implant placement which may reduce the possibility of implant-related complications. PMA(TM) dye should be used with the qPCR to overcome the limitation of inability to distinguish dead and live bacteria. Additional randomized clinical trials with a larger sample size are needed to confirm the effect of the pre-operative use of mouthwashes.