Efficacy and clinical indications of adjunctive chlorhexidine mouthrinses in nonsurgical and surgical periodontal therapy: A systematic review and meta‐analysis

AIM: To evaluate the adjunctive effects of chlorhexidine (CHX) mouthrinses in nonsurgical and surgical periodontal therapy on periodontal parameters and postoperative wound healing, and to define their clinical indications. MATERIALS AND METHODS: Two PICOS frameworks guided the inclusion of randomized controlled trials assessing CHX versus placebo/no rinse as an adjunct in nonsurgical and surgical periodontal therapy. A systematic search was conducted in Medline, EMBASE, Cochrane Library, Scopus, and Web of Science. Random-effects meta-analyses were performed for nonsurgical therapy; heterogeneity precluded quantitative synthesis for surgical outcomes. Risk of bias, sensitivity analyses, influence diagnostics, and GRADE assessments were applied. RESULTS: Twenty RCTs were included. In nonsurgical therapy, CHX produced statistically significant but clinically modest improvements in probing pocket depth (PPD) (MD -0.30 mm; 95% CI -0.50 to -0.09) and BOP (MD -9.35 percentage points; 95% CI -14.17 to -4.53), while no meaningful benefit was observed for CAL. Prediction intervals indicated limited reliability of PPD effects. In surgical therapy, CHX was associated with improved early postoperative inflammatory control, without evidence of superior long-term wound healing. CONCLUSIONS: Adjunctive CHX in nonsurgical periodontal therapy provides modest but outcome-specific benefits, mainly limited to inflammatory parameters, with no clear additional effect on attachment outcomes. In surgical therapy, the qualitative analysis seems to support early postoperative plaque control and inflammation control, while evidence for an effect on later healing remains limited.