Subgingival Periodontal Pre-Treatment Irrigation with 0.75% Boric Acid as an Adjunct to Mechanical Periodontal Therapy in Localised Chronic Periodontitis

Introduction: Dental plaque is the primary aetiological factor for periodontal disease. Scaling and root planing may fail to eliminate periodontal pathogenic species because of limited access to the root surface and tissue-invading properties of some periodontal pathogens. Considerable attention has been devoted to the possibility of using antimicrobial agents such as chlorhexidine to eliminate periodontal pathogens with limited success. Studies show that boric acid has antibacterial and anti-inflammatory properties. Objective: The aim of the study was to evaluate the efficacy of 0.75% boric acid when used as a subgingival irrigation agent as an adjunct to oral prophylaxis in treatment of localised chronic periodontitis. Methods: A total of 40 individuals who reported to the dental college with localised periodontitis (pocket depth of ≥ 6 mm) participated in the study. Plaque Index, Gingival Index and Probing Pocket Depth were recorded at baseline and one month post irrigation with either 0.75% boric acid (Group I) or 0.2% chlorhexidine (group II). Intragroup comparison was done using student “t” test. Results: Intra-group comparison in Group I and Group II showed significant results for reduction in Plaque Index, Gingival Index and Probing Pocket Depth. Significant results observed for reduction of Probing Pocket Depth (<0.025) between the two groups Plaque Index (>0.54) and Gingival Index (>0.93) were non-significant one month postoperatively. Conclusion: The results of this study suggest that 0.75% boric acid has similar efficacy as 0.2% chlorhexidine as a coadjuvant in the treatment of periodontitis.


INTRODUCTION
Dental plaque is the primary aetiological factor for periodontal disease. Plaque control plays a significant role in eliminating pathogenic organisms. Scaling and root planing may fail to eliminate periodontal pathogenic species because of limited access to the root surface and tissueinvading properties of some periodontal pathogens. 1,2 Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia are present in greater numbers in subgingival plaque from patients with periodontitis compared with healthy individuals. 3 Considerable attention has been devoted to the possibility of using antimicrobial agents to eliminate periodontal pathogens. Antimicrobial agents like chlorhexidine, have been used with limited success in the treatment of periodontal disease. 4,5 Chlorhexidine, which has often been used as an adjunct to mechanical therapy has a broad spectrum antimicrobial activity. However, clinical benefits on the subgingival microflora were shown to be limited. 6 Boric acid [H3BO3-B(OH)3] is a colourless crystal/ white powder that dissolves in water. In mineral form, it is called sassolite. It has been used as an antiseptic, antibacterial,

RESULTS
In Group I, the mean plaque index score at baseline was 2.13 ± 0.70 which reduced to 1.53 ± 0.50, one month postoperatively. The reduction in mean plaque index score was found to be significant ( p< 0.0) In Group II, the mean Plaque index score at baseline was 2.24 ± 0.74 which reduced to 1.6 ± 0.35, one month postoperatively which was also found to be significant (p< 0.02, Table 1). Intergroup comparison showed non-significant differences in PI scores at baseline and 1 month post-therapy. (Table 2, 3, Figure 1) The mean gingival index score in Group I at baseline was 1.19 ± 0.56 which reduced to 0.814 ± 0.22, one month postoperatively. On Intragroup comparison, the reduction in gingival index score between baseline and one month postoperatively was found to be significant (p < 0.01). In Group II, the mean gingival index score at baseline was 1.09 ± 0.58 which reduced to 0.80 ± 0.28 one month postoperatively.
The reduction in gingival index score between baseline and 1 month post-operatively was found to be significant (p < 0.006, Table 1). On intergroup comparison gingival index score at baseline was non-significant (p = 0.59) and at one month postoperatively was found to be non-significant (p=0.93, Table 2, 3, Figure 2).  The mean probing pocket depth was 6 mm in both the group at baseline, which reduced to 5.60 mm ± 0.55 mm at the end of one month postoperatively in Group I. This reduction of probing pocket depth from baseline to one month was significant (p< 0.002). Whereas, in Group II it reduced to 5.25 mm ± 0.44 mm and reduction of probing pocket depth was significant from baseline to one month (p<0.01, Table 1 ).
On intergroup comparison probing pocket depth at baseline was significant and 1 month postoperatively (p< 0.025) significant ( Table 2,3, Figure 3).   Pre-operative Pre-operative 1 month Post-operative 1 month Post-operative  and fewer analgesics were used for relieving pain. 13 Saglam et al also reported in a study that the use of boric acid or chlorhexidine in periodontal pockets as an adjunct to non-surgical periodontal treatment produces a significant improvement in clinical parameters. 10 In the present study also the mean probing depth at baseline in both the groups was 6 mm. After one month, 1 mm reduction was recorded clinically in both the groups. On Intragroup comparison, boric acid shows significant reduction in probing depth.

DISCUSSION
The reduction which occurs is due to the anti-inflammatory effect of boron. Plaque index and Gingival index also was seen to improve over a period of one month confirming with the study of Saglam et al they also observed significant reduction result in plaque index while using boric acid as an adjunct of scaling and root planing. 10 In the present study a significant reduction was noticed in plaque index, gingival index and probing pocket depth with the use of chlorhexidine. Similar result was observed in a study conducted by Vignarajah et al. 14 The reduction in all parameters which occurs due to the anti-inflammatory effect of boron. In the present study follow-up period is a limitation. It seems that boric acid is effective in the early healing period. So further studies with longer follow-up periods are required to prove the efficacy of 0.75% boric acid as an adjunct to nonsurgical treatment.

CONCLUSION
The results of the present study suggest that 0.75% boric acid as a pocket irrigant has effect similar to that of 0.2% chlorhexidine in resolving periodontitis. Boric acid irrigation as an adjunct to non-surgical periodontal treatment seems to be a safe and effective in the treatment of patients with chronic localised periodontitis.
Banerjee et al : Subgingival Periodontal Pre-Treatment Irrigation with 0.75% Boric Acid as an Adjunct to Mechanical Periodontal Therapy in Localised Chronic Periodontitis