Does Chlorhexidine Prevent Complications in Extractive, Periodontal, and Implant Surgery? A Systematic Review and Meta-analysis with Trial Sequential Analysis

Purpose: This systematic review aimed to assess the effect of chlorhexidine (CHX) in preventing complications afterextractive, implant, and periodontal surgery. Materials and Methods: The PICO question set for this systematic reviewwas: “Is the use of chlorhexidine formulations able to prevent complications (safety) in patients undergoing proceduresof either oral surgery, dental implantology, or periodontology compared to treatment procedures in patients without achlorhexidine prescription?” Once inclusion and exclusion criteria were established, a search was carried out independentlyby two researchers on PubMed/MEDLINE, Scopus, and Web of Science. The primary outcomes investigated were the rateof alveolar osteitis and bacteremia after surgical procedures in oral surgery. Meta-analysis and trial sequential analysis(TSA) were performed in order to evaluate the findings. Results: After the selection, the 32 studies that fully met theeligibility criteria were considered in this systematic review. A meta-analysis was only possible for data obtained fromstudies related to extractive surgery. Meta-analysis and TSA showed a statistically significant decrease in the rate ofalveolar osteitis after tooth extraction when CHX was employed compared with placebo treatments or treatments notusing CHX (RR = 0.49; 95% CI: [0.40, 0.60], P < .001; I2 = 8%). Focusing on the rate of bacteremia, meta-analysis and TSAshowed how the employment of CHX (RR = 0.87; 95% CI: [0.79, 0.96], P = .004; I2 = 4%) decreases the rate of bacteremia afterextractive surgery. Data from the literature seem to lack in the evaluation of CHX use for the reduction of complicationsin periodontology and implant dentistry. Conclusion: This systematic review showed with a good power of evidence thatCHX employment reduces alveolar osteitis and bacteremia rates after dental extractions