Clinical Efficacy of Chlorhexidine versus Hyaluronic Acid as a Coating on Elastomeric-Ligatures in Managing Gingival and Periodontal Conditions during Orthodontic Treatment

Awad, El Sayed Mohamed; Nadim, Mohamed Adel; Awad, Mohamed Ali

doi:10.21608/dsu.2025.366077.1294

Clinical Efficacy of Chlorhexidine versus Hyaluronic Acid as a Coating on Elastomeric-Ligatures in Managing Gingival and Periodontal Conditions during Orthodontic Treatment

Document Type : Original Article

Authors

¹ Orthodontics department, Faculty of Dentistry, Suez Canal University, Ismailia, Egypt

² Professor of Orthodontics, Faculty of Dentistry, Suez Canal University, Ismailia, Egypt

³ Lecturer of Oral Medicine and Periodontology, Faculty of Dentistry, Suez Canal University, Ismailia, Egypt.

10.21608/dsu.2025.366077.1294

Abstract

Introduction: Keeping a healthy gingival and periodontal environment is an
important concern during fixed orthodontic treatment. Chlorhexidine (CHX), being the
gold standard, was compared to Hyaluronic acid (HA) which is thought, nowadays,
to be a rising agent regarding the healing effects on human tissues, including gingival
and periodontal tissues. Aim: The main objective of this trial was the assessment of
efficacy of chlorhexidine versus hyaluronic acid as a coating on elastomeric ligatures in
managing gingival and periodontal conditions during orthodontic treatment. Materials
and methods: Chlorhexidine gluconate and hyaluronic acid 0.88 gels from the same
manufacturer (EZ-Pac®) have been applied on plain elastomeric ligatures (Dentaurum®).
Three groups of 57 cases in all were created (19 each). Group I received Chlorhexidine
(CHX) coated elastomeric ligatures and was called CHX group. Group II received
Hyaluronic acid (HA) coated elastomeric ligatures and was called HA group. Group
III received plain elastomeric ligatures and was called control group. Recall visits
were every month; T0 (pre-appointment assessment), T1 (after one month), T2 (after
two months), T3 (after three months). Plaque.index (PI) and gingival.index (GI) have
been measured at time intervals; T0, T1, T2 and T3 using Wiliams periodontal probe.
Results: A statistically significant drop in PI (0.0381) and GI (P=0.024) was observed in
HA than CHX and control group at T3. Conclusion: When compared to chlorhexidine,
hyaluronic acid demonstrated a significant reduction in gingival index with a relatively
weak correlation between PI and GI in HA group compared to CHX group

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