Synergistic effects of chlorhexidine and chymotrypsin on post-extraction healing and implant osseointegration: The role of tongue microbiota

Abstract

Objective: This study evaluated the effects of chlorhexidine and chymotrypsin, alone or combined, on post-extraction wound healing and implant osseointegration, and assessed their relationship with tongue microbiota structure.

Methods: This integrative experimental study combined laboratory and clinical research. In vitro, human gingival fibroblasts and osteoblast-like cells were treated with chlorhexidine (0.12–0.2%), chymotrypsin, or both to assess cell viability, collagen production, and osteogenic markers. Clinically, post-extraction patients were randomised into four groups (chlorhexidine rinse, chymotrypsin therapy, combined therapy, or control with standard care). Outcomes included pain, healing rate, and implant stability. Tongue swabs were analysed for microbial composition.

Results: Combined therapy enhanced epithelialization (90 ± 4%) vs. chlorhexidine alone (70 ± 5%), chymotrypsin alone (75 ± 6%), and control (60 ± 5%) (p < 0.05). Wound closure time was reduced (4–6 days) vs. control (10–12 days). Combined therapy showed the lowest inflammatory infiltration and the highest fibroblast proliferation. Microbiological analysis revealed reduced pathogenic load with preserved commensal microbiota. In vitro findings confirmed improved fibroblast activity and collagen deposition with the combination.

Conclusion: The synergistic antimicrobial and anti-inflammatory properties of chlorhexidine and chymotrypsin may improve post-extraction healing and implant osseointegration. Tongue microbiota composition may also contribute to oral wound healing and implant success.