The Effect of Adjunctive Oral Irrigation on Self-Administered Oral Care in the Management of Peri-Implant Mucositis: A Randomised Controlled Clinical Trial
Bunk D, Eisenburger M, Hackl S, Eberhard J, Stiesch M, Grischke J. Clin Oral Implant Res 2020; 00:1–13.
DOI: 10.1111/clr.13638.
Study conducted at Hannover Medical School, Hannover, Germany.
Objective
To evaluate the effect of adjunctive oral irrigation, in addition to self-administered oral care, on the prevalence and severity of peri-implant mucositis.
Methodology
Sixty subjects completed this 12-week, randomised, controlled, parallel clinical trial. Participants were divided into three treatment groups:
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Group 1: Standard routine oral hygiene (ROH) — brushing twice daily (with and without toothpaste) and interdental cleaning with a device of choice.
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Group 2: ROH plus daily water flossing with 50 ml of water following toothbrushing and interdental cleaning in the evening.
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Group 3: ROH plus daily water flossing with 50 ml of 0.06% chlorhexidine (CHX) solution following toothbrushing and interdental cleaning in the evening.
Clinical assessments were conducted at baseline, 4, 8, and 12 weeks. Parameters measured included bleeding on probing (BOP), modified plaque index (mPI), and mucositis severity score (MSS).
Results
Water flossing with 0.06% CHX achieved the highest reductions and was significantly more effective than the ROH group for both BOP and MSS. Both water flossing groups reduced mucositis severity from moderate to mild.
No significant differences were found between the CHX and water-only irrigation groups for any measurement. However, water irrigation alone was significantly more effective than ROH for adjusted mucositis severity scores at 12 weeks.
Note: The authors indicated no multiplicity correction was applied, making the findings exploratory. Based on the data provided, increasing the sample size from 20 to 50 would likely have shown a statistically significant difference between the water irrigation and ROH groups — consistent with other published studies.
Conclusion
The Waterpik™ water flosser with plain water was safe and more effective at reducing the severity of mucositis than brushing and interdental cleaning alone. Adding 0.06% CHX provided an additional benefit in improving peri-implant health.