Eficácia de um verniz de carvacrol e timol no controle do biofilme e parâmetros clínicos periodontais na presença de gengivite: estudo clínico randomizado, cruzado e triplo-cego

Abstract

Mechanical control (MC) of supragingival dental biofilm (SDB) may present limitations due to technical difficulties and challenges in adapting to new devices, potentially favoring the development of gingivitis. Chemical agents are important adjuncts to MC; however, they also present limitations due to adverse effects. New vehicles containing antiplaque and antigingivitis substances have been suggested for localized biofilm control, minimizing adverse reactions. Carvacrol (CAR) and thymol (TIM) have been shown in several studies to possess potent antimicrobial and anti-inflammatory properties. Objective: To evaluate the clinical efficacy of a 10% CAR and TIM varnish (CAR+TIM) in controlling SDB and gingivitis. Materials and Methods: In this randomized, crossover, controlled, triple-blind clinical trial, 14 adult participants were randomly allocated to one of the three intervention arms: CAR+TIM, chlorhexidine (CHX), or placebo (PLB), with a 20-day washout period between each phase. Twenty teeth per participant—both anterior and posterior—were assessed. The treatment sequence assigned to each participant was randomly determined to ensure proper randomization. Treatment efficacy and study outcomes were based on the following clinical parameters: (1) Quigley Hein Index (1970) (PI) for quantifying SDB accumulation; (2) probing depth (PD) using a North Carolina PC15 probe; and (3) dichotomous bleeding on probing (BoP) to identify the presence of gingivitis. These parameters were evaluated at baseline (T0), and subsequently at 7 (T1), 14 (T2), 22 (T3), and 29 (T4) days after the start of the study. All participants received basic periodontal treatment consisting of scaling, root planing, polishing, and oral hygiene instructions, as well as a standardized toothpaste, dental floss, and toothbrush to be used throughout the study. Results: The CAR+TIM group showed statistically significant reductions in PI for anterior teeth, with means ± standard deviations of 1.32 ± 0.46 at T1 and 1.14 ± 0.36 at T4 (p < 0.001). A similar reduction was observed on the interproximal surfaces of anterior teeth, where CAR+TIM presented values of 1.21 ± 0.43 at both T2 and T4 (p < 0.001). At T2, T3, and T4, statistically significant differences were found among groups, with CAR+TIM showing the lowest means: 1.21 ± 0.43 (T2) (p = 0.001); 1.29 ± 0.47 (T3) (p = 0.001); and 1.21 ± 0.43 (T4) (p = 0.002). On the buccal surfaces of posterior teeth, intergroup analysis at T4 showed a significant difference, with means of 1.29 ± 0.47 (CAR+TIM), 1.50 ± 0.52 (CHX), and 1.96 ± 0.50 (PLB) (p = 0.001). For PD at T3 in anterior teeth, a statistically significant difference was observed among the three interventions: CAR+TIM (1.86 ± 0.95), CHX (2.21 ± 0.89), and PLB (3.07 ± 0.83) (p = 0.001). For BoP at T1, the means ± standard deviations (%) were: CAR+TIM (33.09 ± 11.14), CHX (33.96 ± 15.51), and PLB (48.59 ± 12.51) (p = 0.005), with statistically significant reductions compared to T0. At T1, T2, T3, and T4, the test substance (CAR+TIM) showed behavior similar to CHX, differing significantly from placebo with p = 0.005, p < 0.001, p = 0.001, and p < 0.001, respectively. Conclusion: The 10% carvacrol and thymol varnish demonstrated significant clinical efficacy in controlling supragingival biofilm and gingivitis, particularly in the interproximal regions of anterior teeth, suggesting its potential as an adjunct in periodontal management.