The Effects of Adjunctive Subgingival Irrigation With Slightly Acidic Electrolyzed Water in Periodontitis Treatment: A Randomized Controlled Clinical Trial

Objectives To evaluate the adjunctive effects of subgingival irrigation with slightly acidic electrolyzed Water (SAE-Water) during scaling and root planing (SRP) on clinical outcomes, gingival crevicular fluid (GCF) inflammatory mediators, subgingival microbiota, and postoperative pain in patients with stage II/III, grade B/C periodontitis. Methods This prospective, parallel-group, open-label, randomized controlled trial included 39 patients with stage II/III, grade B/C periodontitis. The patients were randomly assigned to the test group ( n = 20) or the control group ( n = 19). During ultrasonic subgingival scaling in maxillary teeth, subgingival irrigation was performed with SAE-Water in the test group or distilled Water in the control group, followed by root planing in both groups. Periodontal parameters, including probing depth (PD), clinical attachment level (CAL), bleeding index (BI), bleeding on probing (BOP), and plaque index (PLI), were recorded at baseline, 4 weeks, and 12 weeks. Inflammatory cytokines in GCF were measured by Luminex technology, subgingival plaque was analyzed by 16S rRNA gene sequencing. GCF and subgingival plaque samples were both collected at the same time as periodontal parameters, and postoperative pain was assessed using a visual analogue scale (VAS). Results The reductions in BI and BOP from baseline to 4 and 12 weeks were greater in the test group than in the control group (BI: P = .033 and P = .031; BOP: both P < .01). Both groups showed significant reductions in PD and CAL at 4 and 12 weeks, but the differences between the two groups were not significant. GCF levels of interleukin-8 (IL-8) were significantly lower in the test group than in the control group at 4 and 12 weeks (both P < .01), accompanied by significant reductions from baseline. Tumour necrosis factor-alpha (TNF-α) levels were also lower in the test group at 4 weeks ( P < .05), whereas in the control group, only IL-6 showed a significant reduction from baseline at 12 weeks ( P < .01). The relative abundances of Treponema, Fusobacterium , and Prevotella decreased to a greater extent in the test group. VAS pain scores at 24 hours were significantly lower in the test group. Conclusions Adjunctive SAE-Water irrigation during SRP improved bleeding-related outcomes, reduced selected inflammatory and microbiological markers, and alleviated early postoperative pain.