Efficacy of 0.12% Chlorhexidine Gluconate for Non-Surgical Treatment of Peri-Implant Mucositis

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Journal of Periodontology; Copyright 2016 DOI: 10.1902/jop.2016.160144 
 
 1 
Efficacy of 0.12% Chlorhexidine Gluconate for Non-Surgical 
Treatment of Peri-Implant Mucositis 
Karyna M. Menezes*, Anderson N. Fernandes-Costa*, Reinaldo D. Neto†, Patrícia S. 
Calderon‡, Bruno C. V. Gurgel‡ 
*DDS, MSc, PhD Student, Federal University of Rio Grande do Norte, Natal, Brazil. 
†DDS, MSc, PhD Student, University of São Paulo, São Paulo, Brazil. 
‡DDS, MSc, PhD, Professor, Federal University of Rio Grande do Norte, Natal, Brazil. 
Background: As peri-implant mucositis may progress to peri-implantitis, an effective treatment 
resulting in resolution of inflammation could prevent peri-implantitis. Current treatment protocols for the 
treatment of this condition are still unpredictable. The purpose of this study is to analyze the efficacy of a 
non-surgical treatment for patients with peri-implant mucositis, over a six months follow-up period. 
Materials and Methods: This controlled, randomized, double-blind clinical trial, included 37 
patients diagnosed with peri-implant mucositis, randomly assigned into a test group (basic periodontal 
therapy + 0.12% chlorhexidine) with 61 implants, and control group (basic periodontal therapy + placebo) 
with 58 implants. The therapy consisted of an adaptation of the Full Mouth Scaling and Root Planing 
protocol. Clinical parameters of visible plaque index, gingival bleeding index, probing depth and bleeding 
on probing were measured in implants and were evaluated at baseline and at one, three and six months 
post-therapy. Data were analyzed using the Spanova, and Chi-square tests with a significance level of 5%. 
Results: Intra-group analysis showed that visible plaque index, gingival bleeding index, probing 
depth and bleeding on probing presented statistically significant improvements, compared to baseline. No 
statistically significant differences were found between the test and control groups at any time. 
Conclusion: Both isolated mechanical therapy and its association with 0.12% chlorhexidine 
mouthwash reduced peri-implant mucositis. Therefore, 0.12% of chorhexidine was not more effective 
than placebo. 
KEY WORDS: 
chlorhexidine; dental implants; oral hygiene; dental plaque. 
Long-term studies with 15 and 20 years of follow-up have shown that the rehabilitations 
with implant-supported prostheses are considered a viable treatment option for both the 
maxilla and mandible with partially or totally edentulous areas.1-3 However, the success 
of rehabilitation may be compromised by implant failure. 
Oral health can be affected by failures; these failures can occur early, when they are 
associated with surgical procedures,4,5 or later on when associated with occlusal 
overload6,7 or peri-implant infections, caused by biofilm accumulation.4 In these cases, 
pathological conditions may develop in the peri-implant tissues.8,9 Previous studies have 
shown that bacterial infection plays the a central role in cases of dental implant 
failure.8,5 Dental implants rehabilitated by prostheses are also susceptible to biofilm 
colonization, which constitutes the main etiological factor of periodontal diseases.10-12 
Peri-implant diseases that occur around dental implants consist of peri-implant 
mucositis and peri-implantitis.13 
Peri-implant mucositis is characterized by inflammation in the mucosa around the 
implant without signs of bone loss4. If bone loss also occurs, the condition is designated 
peri-implantitis4. Derks & Tomasi14 reported a prevalence of peri-implant mucositis and 
peri-implantitis, of 43% and 22%, respectively. Peri-implant mucositis is a reversible 
condition, but if left untreated, can progress to peri-implantitis.15 
Journal of Periodontology; Copyright 2016 DOI: 10.1902/jop.2016.160144 
 
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Besides mechanical treatment, others therapies have been used for the treatment of 
peri-implant mucositis. Triclosan-based dentifrice,16 abrasive air blasting with sodium 
carbonate and resin curettes,17 mouth rinses with 0.2% chlorhexidine and 1% gel,18 
0.5% chlorhexidine gel,19 irrigation with 0.12% chlorhexidine solution,20 as well as the 
use of systemic antibiotics,21 have all been employed for such treatments. Chlorhexidine 
is the chemical agent most commonly used to promote biofilm control and prevent its 
accumulation, due to its bacteriostatic and bactericidal activity, its high substantivity 
and broad spectrum.22,23 
A full understanding of the etiology and diagnosis of peri-implant diseases is crucial 
for finding effective treatments for these diseases that are more widely accessible to the 
dentist.24 Several treatment protocols for peri-implant diseases have been proposed, but 
no gold standard has been established, to date.25 Thus, this study aimed to analyze the 
efficacy of 0.12% chlorhexidine gluconate as a chemical adjuvant for the treatment of 
peri-implant mucositis, in a non-surgical treatment protocol with a six-month follow-up. 
MATERIALS AND METHODS 
Study Design and Ethical Considerations 
The study was conducted at the Department of Dentistry of the Federal University of 
Rio Grande do Norte. This was a double blind, controlled, randomized, longitudinal and 
prospective study, conducted between jun/2012 and dec/2014. The Ethics Committee of 
the Federal University of Rio Grande do Norte approved this study and written consent 
was obtained from all enrolled subjects. CONSORT guidelines26 for clinical trials were 
followed (Fig. 1). This study was registered in Clinical Trials (NCT02605382) on 
november 12, 2015. 
Sampling 
Determination of the sample size was based on the sample calculation for clinical trials, 
estimating a 50% success rate for the control group and 90% for the test group, 
considering the percentage of bleeding on probing (BOP) reduction as primary 
outcome. With a standardized difference and power test of 85%, as well as a 
significance level of 5% (www.openepi.com), a total of 28 subjects per group were 
obtained, by means of the Altman diagram for calculating sample size for clinical 
trials.27 
Inclusion and Exclusion Criteria 
Inclusion criteria included systemically-healthy partially edentulous patients 
rehabilitated with functional dental implants and prostheses for at least 1 year, at the 
Departament of Dentistry, between 2000 and 2011. All patients were selected from a 
convenience sample from a previous study of prevalence with 155 patients detected 
with different peri-implant diagnosis. Patients had been diagnosed with peri-implant 
mucositis, according to Mombelli28, at least at one implant; probing depth up to 5 mm, 
bleeding on probing and no radiographic evidence of bone loss beyond the first two 
threads of the implant. These individuals were required to be non-smokers and not in 
maintenance therapy or to have received periodontal treatment during the last six 
months; nor have used antimicrobial (systemic or topical), anti-inflammatory or 
immunosuppressive drugs during the six months preceding the study. 
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Clinical and Radiographic Evaluations 
Periapical radiographic examinations were performed before the collection of data to 
confirm the absence of bone loss, and threads exposition of the implants. The following 
clinical parameters were evaluated in both test and control groups; visible plaque index 
(VPI)29 and gingival bleeding index (GBI)30 were obtained for each implant (VPI 
implant; GBI implant). For statistical purposes, percentages of faces with visible plaque 
and marginal bleeding at teeth and implants were calculated. These parameters were 
evaluated at baseline and at one, three and six months post-therapy. 
Keratinized mucosa width (KM), probing depth (PD implant), and bleeding on 
probing (BOP implant) were collected for allimplants with a North Carolina 
periodontal probe§§ at six sites (mesiobuccal, buccal, distobuccal, mesiolingual/palatal, 
lingual/palatal and disto-lingual/palatal). After data collection, arithmetic averages of 
the sites with bleeding on probing, probing depths, and keratinized mucosa were 
calculated at baseline, three and six months. The peri-implant biotype for each implant 
was rated as thin or thick, according to probe transparency during probing depth.31 
Clinical parameters were collected by two operators (examiner I – KMM, and II - 
ANFC), calibrated by the Kappa test for the keratinized mucosa (intra-examiner I and 
II: 0.959 and 0.991, respectively, and inter-examiner: 0.936), peri-implant biotype 
(intra-examiner I and II: 1.000 and 1.000, respectively, and inter-examiner: 0.783), and 
probing depth (intra-examiner I and II: 0.848 and 0.821, respectively, and inter-
examiner: 0.783). 
Treatment Protocol 
After inclusion of the patients, anamnesis and initial examination were performed. The 
subjects were randomly divided, using a simple draw, in the following two groups: Test 
- (0.12% chlorhexidine digluconate associated with periodontal basic therapy) and 
Control - (placebo associated with periodontal basic therapy). 
Periodontal basic therapy consisted of oral hygiene instruction, motivation, retentive 
factor removal and an adaptation of the protocol of Full Mouth Scaling and Root 
Planing (FMSRP),32 0.12% chlorhexidine mouthwash was used instead of 1% 
chlorhexidine gel). Plastic curettes were used to instrument the implants, as well metal 
curettes to instrument the teeth. Immediately after instrumentation, chemical solutions, 
chlorhexidine or placebo, both handled in the same pharmacy¶ in an aqueous alcoholic 
medium, with menthol flavor and blue color, were used and distributed, according to the 
previous randomization. Immediately after instrumentation, those solutions were used 
for brushing the dorsum of the tongue during 1 minute; rinsing (the last 10 seconds, the 
patient should gargle); and subgingival irrigation 3x within 10min. A prescription 
indicating the correct manner in which to use the solution was also given (twice a day, 
15 ml of solution every 12 hours, 30 minutes after brushing, for 14 days). 
Individual guidance on oral hygiene was performed for each patient with the use of 
soft toothbrushes, tuft and interdental brushes, dental floss or superfloss# and tongue 
cleaner, when indicated. Patients were further motivated with respect to oral hygiene 
habits during the entire period of the study. 
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Statistical Analysis 
Data were analyzed using descriptive and inferential statistics, with parametric tests, 
through a software application∗∗. The implant was considered the unit of analysis and 
means of the parameters were calculated for each implant, and then for each group. The 
Spanova test was used to compare the interaction between treatment groups and time of 
evaluation, and if any significant differences were observed, the Student t Test was 
performed as post-test. Chi-Square test was used to evaluate probing depth and bleeding 
on probing, according to the independent variables of interest: age, sex, treatment group, 
keratinized mucosa, peri-implant biotype, mean of VPI implant and GBI implant. 
Spearman correlation was also used to correlate probing depth and bleeding on probing 
after six months of follow-up. A value of p<0.05 was used to represent a statistically 
significant difference. 
RESULTS 
Eighty-three individuals with peri-implant mucositis were identified with potential for 
participating in this study. Mean age for both groups was 57.4 (±9.1 test group and 
±13.0 control group). All these patients were contacted, and a total of 57 individuals 
were initially included, but 6 did not fulfilled the inclusion criteria. A total of 51 were 
able to participate and were randomized. Of these individuals, 14 declined to participate 
(4 in test group, and 10 in control group). To analyze the clinical parameters and results 
of this study, the participants were divided into two groups; the test group – 0.12% 
digluconate chlorhexidine and control group - placebo. However, only 37 patients with 
119 implants completed the six month follow-up (Figure 1). 
Six of the patients were men and 31 were women. A total of 119 implants were 
evaluated (61 in test group, and 58 in control group). Males had 15.1% of the implants 
while women had 84.9% of the implants. Table 1 also demonstrates frequency and 
percentage of the implants in relation to the treatment group and other variables of 
interest. Only 73 dental implants presented keratinized mucosa, thus it was not possible 
to evaluate the peri-implant biotype in the whole sample. 
Table 2 shows statistically significant reductions in the parameters (VPI and GBI of 
the implants, PD and BOP) within each of the treatment groups. The statistical analysis 
also showed that there was not interaction between treatment groups and time for all 
parameters. Post-tests showed statistical differences only from baseline to each other 
follow-up period. Figures 2 and 3 illustrate the changing over time for probing depth 
and bleeding on probing. 
Age, keratinized mucosa, VPI and GBI of the implant were categorized for 
statistical purposes. Improvements in PD and BOP at the end of the study are shown in 
Table 3, indicating differences between “final” and “baseline” periods. Decreases in 
probing depth or in bleeding on probing were considered as improvements. When the 
values did not decrease or remained the same, these parameters were considered to have 
worsened. Results showed no statistical significances, regardless of the variables tested. 
Additionally, differences between final and initial probing depth values were 
correlated with differences between final and initial bleeding on probing values. A 
statistical significant weak positive correlation was observed, showing that a directly 
proportional reduction occurred between this parameter (rho = 0.321; p=<0.001). 
Journal of Periodontology; Copyright 2016 DOI: 10.1902/jop.2016.160144 
 
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DISCUSSION 
Previous studies have shown that the mechanical removal of biofilm is an effective 
treatment for peri-implant mucositis.33,34 The present study aimed to evaluate a 
treatment protocol consisting of the use of 0.12% chlorhexidine as an adjunct to non-
surgical basic therapy, compared to a placebo group. Results showed that both 
treatments were effective for significantly reducing inflammation and peri-implant 
mucositis within 6 months of follow-up; however, no statistical differences between the 
test and control groups were observed. 
Other clinical studies have also demonstrated similar results when evaluating the 
efficacy of chlorhexidine for peri-implant mucositis treatment.19,20,34 A systematic 
review on the treatment of peri-implant mucositis indicated that statistically significant 
improvements can be detected after one month of treatment; however, these 
improvements are not always observed in subsequent evaluations.35 
Improvements in the oral hygiene conditions of the subjects could be observed 
throughout the study, as shown by the median reductions in VPI and GBI. Subjects 
presented a satisfactory oral hygiene at the last follow-up consultation. However, during 
the last follow-up periods, these differences were not found. At the end of the study, in 
both groups, most implants had reduction at visible biofilm. It has been suggested that 
the amount of biofilm is not a predictor of peri-implant disease, as it only demonstrates 
the condition of hygiene at the time of the VPI examination35,36. In this study, the 
reduction in the VPI may be attributed to the positive effect of oral hygiene orientation 
andmotivation which was performed individually for each patient. 
The present study also showed that complete resolution of inflammation was not 
achieved, although the majority of implants demonstrated a reduction in inflammation 
as reductions in BOP (in 60.35% of the test group and 60.82% of the control group) and 
in PD (0.36mm in the test group and 0.23mm in the control group) were observed. 
Heitz-Mayfield et al.,19 in a similar clinical trial, using mechanical treatment with and 
without the use of 0.5% chlorhexidine gel, found PD and BOP reduction at three 
months follow-up. However, only 38% of the implants with peri-implant mucositis 
showed no bleeding on probing at the end of the study. 
A systematic review did not find complete resolution of peri-implant inflammation 
in all analyzed studies.35 Salvi & Ramseier37 also showed that complete resolution of 
peri-implant mucositis was not reported in any study, and the effectiveness of protocols 
including the use of toothbrushes, dentifrice with triclosan and other chemical devices 
was not established. Furthermore, Graziani et al.38 also stated that BOP does not 
diminish completely in all cases of peri-implant mucositis. However, bleeding on 
probing is always present in mucositis and is globally accepted, even as part of the 
definition for the diagnosis of the disease.39 BOP is easily checked during probing depth 
examination.28 
Reversibility of peri-implant mucositis is not necessarily related to probing depth 
reduction. This study showed statistical significant differences between baseline and the 
follow-up points, although no interaction between groups were found. Therefore, results 
showed a statistically significant weak positive correlation between PD and BOP, since 
both increased and decreased accordingly. Overall, there was a interdependent 
relationship between these variables in reducing the inflammatory process. 
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Thöne-Mühling et al.34 showed no difference between the groups, and all implants 
showed statistically significant reductions in PD after eight months. Authors suggest 
that subgingival single-session treatment, with and without chlorhexidine, is effective in 
reducing, temporarily, microbial shift; however, the added value of chlorhexidine is still 
unclear. The absence of the additional effect of chlorhexidine in these previous studies 
could be justified by a suggestion by Trejo et al.40 that the impact of chlorhexidine may 
be insignificant as the peri-implant pockets are mechanically decontaminated at 
mucositis sites. Mechanical decontamination may be so effective in removing 
pathogenic microorganisms that the antibacterial effect of chlorhexidine is lost. 
Possibly, for deeper pockets (>4 mm), where the surface of the implant is rougher and 
inaccessible for mechanical decontamination, chemical adjuvants could be necessary. 
The present study showed a mean of PD that was not greater than 4 millimeters at any 
time of assessment in either of the groups. Some previous studies17,21 using others 
adjuvants did not show statistically significant differences between the groups. It could 
be postulated that there is no justification for adding these methods to treat peri-implant 
mucositis, as an excess of treatment would be applied unnecessarily. 
Graziani et al.38 in a systematic review, evaluated the quality of methodologies and 
showed that available studies have limited quality and there is no consensus with regard 
to the study design and choice of intervention in control groups. In addition to the 
heterogeneity found in clinical protocols for the treatment of peri-implant mucositis, 
available studies using chlorhexidine show different monitoring times of eight weeks,41 
three months18-20 and eight months.34 
Renvert & Polyzois42 stated that there is no evidence of the benefits of oral 
antiseptic in peri-implant disease and effective biofilm control by patients is an 
important factor in the success of treatment. After six months, a reduction in peri-
implant inflammation could be due to the effect of non-surgical treatment and the 
quality of oral hygiene achieved through guidance and motivation (as given to all 
participants), emphasizing the importance of the daily use of interdental and single tufts 
brushes, and dental floss. 
The clinical relevance of follow-up determines not only the effect of treatment, but 
also the duration of this effect.35 Furthermore, Lindhe et al.41 suggested that revaluation 
should be performed at six to eight weeks after the last stage of initial treatment, to 
allow the healing of the peri-implant tissues. This time of revaluation was observed in 
this study, in which the initial results for PD and BOP were collected from the three 
month follow-up appointment. Although some previous studies do not include subjects 
with untreated periodontitis,18,19 or exclude them,20 this trial also included partially 
edentulous subjects with chronic periodontitis. It is known that bacteria from 
periodontal pockets can migrate and colonize the peri-implant sites;10,11,44,45 thus, full 
mouth decontamination is required, as adopted in a single session through an adaptation 
of Quirynen’s protocol.32 Results showed similar outcomes to those reported by Thöne-
Mühling et al.34 which also included subjects with chronic periodontitis and full mouth 
decontamination performance in one session. 
Recent studies have discussed the role of periodontal biotype in relation to the 
aesthetic predictability of rehabilitation with dental implants.31,46 Individuals with thick 
periodontal biotype are more susceptible to periodontal pocket formation, while thin 
biotype presents a greater risk for gingival retractions47. This assessment of periodontal 
biotype could be used for implants.31 However, in the present study, a comparison 
between the peri-implant biotype and means of PD and BOP did not show any 
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statistically significant association. Only 73 implants in this study presented keratinized 
mucosa, allowing the analysis of peri-implant biotype. Absence of a more representative 
sample could explain no statistical difference.48 If the sample were larger, it would be 
possible to evaluate whether thin biotype provides greater difficulty in controlling for 
peri-implant inflammation. However, to date no available clinical studies have shown 
any association between peri-implant biotype and the peri-implant mucositis. 
A limitation of this study that could be addressed is that 37 patients concluded the 
follow-up from those 51 in the beginning. It could mean that the study would be 
underpowered because of the difficulty to obtain and maintain all patients, however, low 
variability of the results and low risk of bias were detected49, and could guarantee that 
null hypothesis was not accepted. Additionally, even if the study has low power, it may 
be valuable when aggregated in a meta-analysis. 
Different methodologies and clinical parameters employed in the studies hamper a 
more accurate comparison. To date, few controlled clinical trials evaluating the 
treatment of peri-implant disease have been conducted. Other clinical studies and 
randomized controlled trials with longer follow-up and different methods of chemical 
adjuvants use may help in determining the best treatment choice for peri-implant 
mucositis. 
CONCLUSION 
In conclusion, non-surgical mechanical therapy reduced peri-implant mucositis, with 
decreases in VPI, GBI, PD and BOP observed at six months post therapy. However, the 
use of 0.12% chlorhexidine was not more effective than placebo. 
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Journal of Periodontology; Copyright 2016 DOI: 10.1902/jop.2016.160144 
 
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Corresponding Author. Karyna de Melo Menezes, 1787 Senador Salgado Filho Ave., 
Lagoa Nova , Natal, Rio Grande do Norte, BR 59056-000, +55 (0xx84) 3215-4107, 
karynamenezes@hotmail.com 
Submitted March 07, 2016; accepted for publication June 14, 2016. 
Figure 1. 
Diagram of patient selection analyzed. 
Figure 2. 
Illustration of PD evolution according follow-up periods 
Figure 3. 
Illustration of BOP evolution according follow-up periods 
Table 01 – 
Description of categorical data. 
 Test (Chlorhexidine) Control (Placebo) 
 n % n % 
Sex 
 Male 13 21.3 5 8.60 
 Female 48 78.7 53 91.4 
Peri-implant biotype 
 Fine 30 46.9 34 53.1 
 Thick 31 56.4 24 43.6 
Number of teeth 
 381 61.25 241 38.75 
Number of implants 
 61 56.25 58 43.75 
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Table 2 – 
Median and standard deviation values for visible plaque index (VPI) and gingival bleeding (GBI), probing depth (PD) and bleeding on probing (BOP) and 
intragroup –analysis (Spanova and Student t tests). 
 Baseline 1 month 3 months 6 months Time Interaction Treatment Group X Time 
 Mean ± SD Mean ± SD Mean ± SD Mean ± SD p Effect Size p Effect Size 
VPI implant (%) 
 Test 38.52 ± 34.02a 11.06 ± 21.17b 10.24 ± 20.09b 13.11 ± 21.21b <0.001 0.545 0.115 0.050 Control 52.15 ± 32.20a 9.48 ± 17.41b 13.79 ± 25.72b 12.06 ± 21.58b 
GBI implant (%) 
 Test 36.88 ± 32.47a 6.96 ± 14.52b 10.24 ± 22.07b 10.24 ± 19.02b <0.001 0.351 0.086 0.056 Control 28.01 ± 32.47a 13.36 ± 17.66b 9.48 ± 14.68b 10.77 ± 18.80b 
PD implant (mm) 
 Test 2.85 ± 0.60a - 2.34 ± 0.54b 2.49 ± 0.60b <0.001 0.348 0.315 0.020 Control 2.72 ± 0.68a - 2.37 ± 0.60b 2.49 ± 0.67b 
BOP implant (%) 
 Test 75.82 ± 33.98a - 40.44 ± 35.64b 45.76 ± 34.85b <0.001 0.395 0.212 0.027 Control 67.54 ± 34.38a - 44.59 ± 36.10b 41.08 ± 41.00b 
Keratinized Mucosa 
(mm) 
 
 Test 1.61 ± 1.76a - 1.29 ± 1.71a 1.27 ± 1.80a 0.402 0.016 0.100 0.040 Control 1.68 ± 1.61a - 1.74 ± 1.56a 1.82 ± 2.27a 
Different letters in the lines indicate statistically significant difference. Empty cells mean there were no evaluations at this time point for these parameters. 
Journal of Periodontology; Copyright 2016 DOI: 10.1902/jop.2016.160144 
 
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Table 3 – 
Distribution of implants in relation to clinical Probing depth and Bleeding on Probing, according to 
the independent variables of interest - chi-square test. 
 PD 
p 
BOP 
P Worsen n 
(%) 
Improvement 
n (%) Worsen n (%) 
Improvement n 
(%) 
Age 
 33 to 51 years old 14 (36.8) 24 (63.2) 
0.579 
17 (44.7) 21 (55.3) 
0.711 52 to 61 years old 13 (33.3) 26 (66.7) 14 (35.9) 25 (64.1) 
 62 to 75 years old 11(26.2) 31 (73.8) 16 (38.1) 26 (61.9) 
Sex 
 Male 7 (38.9) 11 (61.1) 0.680 5 (27.8) 13 (72.2) 0.400 Female 31 (30.7) 70 (69.3) 42 (41.6) 59 (58.4) 
Treatment Group 
 Chlorhexidine 16 (26.2) 45 (73.8) 0.241 21 (34.4) 40 (65.6) 0.331 Placebo 22 (37.9) 36 (62.1) 26 (44.8) 32 (55.2) 
Keratinized Mucosa t0 
 Up to 2 mm 25 (31.6) 54 (68.4) 1.000 33 (41.8) 46 (58.2) 0.758 Above 2 mm 12 (31.6) 26 (68.4) 14 (36.8) 24 (63.2) 
Keratinized Mucosa t3 
 Up to 2 mm 26 (32.5) 54 (67.5) 1.000 32 (40.0) 48 (60.0) 0.710 Above 2 mm 11 (31.4) 24 (68.6) 12 (34.3) 23 (65.7) 
Keratinized Mucosa t6 
 Up to 2 mm 25 (30.9) 56 (69.1) 1.000 29 (35.8) 52 (64.2) 0.134 Above 2 mm 10 (29.4) 24 (70.6) 18 (52.9) 16 (47.1) 
Peri-implant Biotype 
 Thin 2 (11.1) 16 (88.9) 0.064 11 (61.1) 7 (38.9) 0.309 Thick 21 (38.2) 34 (61.8) 24 (43.6) 31 (56.4) 
VPI implant 
 Low VPI (up to 10%) 10 (28.6) 25 (71.4) 0.770 9 (25.7) 26 (74.3) 0.075 High VPI (> 10%) 28 (33.3) 56 (66.7) 38 (45.2) 46 (54.8) 
GBI implant 
 Low VPI (up to 10%) 19 (39.6) 29 (60.4) 0.204 15 (31.2) 33 (68.8) 0.186 High GBI (> 10%) 19 (26.8) 52 (73.2) 32 (35.1) 39 (54.4) 
§ PCP-UNC 15, Hu-friedy, Chicago, Illinois, USA 
|| Plastic scaling instruments for implants, Hu-friedy, Chicago, Illinois, USA 
¶ Homeofórmula – Compounding Pharmacy, Natal, RN, Brazil 
# Ora-B, Procter & Glambe, Rio de Janeiro, RJ, Brazil 
∗∗ Statistical Package Social Sciences software (SPSS) (IBM, New York, USA), version 17.0, free version 
Conflict of Interest Statement 
The authors declare that there is no conflict of interests in this study. No funding has been available. 
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Journal of Periodontology; Copyright 2016 DOI: 10.1902/jop.2016.160144 
 
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	Study Design and Ethical Considerations
	Sampling
	Inclusion and Exclusion Criteria
	Clinical and Radiographic Evaluations
	Treatment Protocol
	Statistical Analysis