Comparative Evaluation of Borochip and Chlorhexidine Chip as Adjuncts to Mechanical Therapy in Periodontitis: A Randomized Clinical Trial

Shilpa Kamra¹, Himani Gupta²*, Anurag Bhatnagar³, Shagun Malik⁴, Vidushi Sheokand⁵

¹Reader, Department of Periodontology, Faculty of Dental Sciences, SGT University, Gurugram.

²MDS Student, Department of Periodontology, Faculty of Dental Sciences, SGT University, Gurugram.

³Reader, Department of Periodontology, Faculty of Dental Sciences, SGT University, Gurugram.

⁴Reader, Department of Periodontology, Faculty of Dental Sciences, SGT University, Gurugram.

⁵Professor and Head, Department of Periodontology, Faculty of Dental Sciences, SGT University, Gurugram.

*Corresponding Author E-mail: shilpakamra777@gmail.com., himanigupta2903@gmail.com, anuragbhatnagar61@gmail.com, malikshagun90@gmail.com, vidushi.sheokand@sgtuniversity.org

ABSTRACT:

Background: Chronic periodontitis is a prevalent inflammatory condition that leads to the destruction of periodontal tissues. While scaling and root planing (SRP) remains the gold standard for mechanical debridement, the use of local drug delivery systems (LDDS) can enhance therapeutic outcomes. Boric acid, known for its antimicrobial, anti-inflammatory, and osteogenic properties, has gained attention as a potential adjunct in periodontal therapy. Aim: This randomized clinical trial aimed to compare the clinical efficacy of 0.75% boric acid chip (BoroChip) and chlorhexidine (CHX) chip as adjuncts to SRP in patients with chronic periodontitis. Materials and Methods: 20 systemically healthy subjects aged 30–60 years with generalized chronic periodontitis were selected. Each participant underwent both interventions: one quadrant was treated with SRP + BoroChip, and the other with SRP+CHX chip. Clinical parameters including probing pocket depth (PPD), clinical attachment loss (CAL), and bleeding index (BI) were evaluated at baseline, 3 weeks, and 6 weeks and the results were assessed. Results: Both BoroChip and CHX groups demonstrated significant improvements in all clinical parameters over the 6-week period. The BoroChip group showed a consistent reduction in PPD (from 4.55mm to 3.20mm), gain in CAL (from 2.65mm to 1.60mm), and a significant decrease in BI (from 73.12 to 20.62). Although CHX showed slightly higher CAL gain, the differences between the groups were statistically insignificant (p>0.05). Notably, the BoroChip group showed an earlier and more marked reduction in BI, indicating better inflammation control. Conclusion: Boric acid chip proved to be a safe, effective, and economical adjunct to SRP in managing chronic periodontitis, demonstrating clinical outcomes comparable to chlorhexidine with enhanced anti-inflammatory benefits.

KEYWORDS: Chronic Periodontitis, Boric Acid Chip, Chlorhexidine Chip, Local Drug Delivery, Scaling and Root Planing, Clinical Parameters.

INTRODUCTION:

Periodontitis is an inflammatory condition, caused by specific microorganisms like Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia etc., affecting the teeth and its supporting structure which can lead to the loss of connective tissue, collagen fibers, the periodontal ligament, and alveolar bone and can result in the formation of periodontal pockets and may lead to gingival recession.^1,2 The “Inflammation-Mediated Polymicrobial Emergence and Dysbiotic Exacerbation (IMPEDE)” states that periodontal inflammation arises as a result of the interaction of the host immune system and a dysbiotic subgingival biofilm.³Scaling and root planing (SRP) is key in nonsurgical periodontal therapy, aiming to remove both supragingival and subgingival biofilm and calculus. While effective in reducing inflammation and pocket depth, existing techniques and instruments may not entirely eliminate all biofilm and bacteria.^4,5

Various studies have been conducted with adjunctive therapies such as photodynamic therapy, sustained-release antibiotics, either natural, like gelatin and chitosan, also synthetic, including poly(e-caprolactone), polyurethane, polypropylene⁶, tetracycline fibers, acrylic loaded chips, gels and films for local drug delivery (LDD) or irrigation with antiseptics all of which have shown to improve the periodontal status. However, improvements depend on initial pocket depth, root anatomy, oral hygiene, smoking, environmental factors, instrument design, and operator skills and various other factors.⁷ The use of these agents is associated with antimicrobial resistance, difficulty achieving adequate drug concentration, requirement for reintervention with older long-acting drug delivery systems and high-cost, therefore there is a necessity for further research to determine optimal adjunct treatment type and a need for the development of products that exhibit enhanced sustainability, affordability, and minimized adverse effects.

Boric acid, a naturally occurring compound known for its therapeutic properties, serves as a promising additional treatment option. Studies show its ability to reduce inflammation and potentially limit bone loss by blocking osteoclast formation, while also possibly promoting osteoblast formation in animal research.⁸ A boron compound, AN0128 (Catalog No. GC63839) was recently acknowledged to have both antibacterial and anti-inflammatory properties.⁹ Boron decreases inflammatory biomarkers like high-sensitivity C-reactive protein (Crp) and tumor necrosis factor (TNF-μ), while increasing levels of antioxidant enzymes like superoxide dismutase, catalase, and glutathione peroxidase.¹⁰ Utilizing Boric Acid in periodontal pockets as a local drug delivery agent yields notable enhancements in both clinical and microbial parameters, proving to be as effective as chlorhexidine.¹¹

Thus, Boric Acid, being naturally occurring and easily available can serve as both safe and cost-effective alternative. With the current evidence, boric acid's antimicrobial, anti-inflammatory, and osteoblastic properties the current study was undertaken with the hypothesis that its localized application within periodontal pockets could result in decreased pocket depth and modulation of microbial populations. The objective of this study is to compare the efficacy of a 0.75% boric acid chip with a chlorhexidine chip as a local drug delivery system in the management of chronic periodontitis.

MATERIALS AND METHODOLOGY:

Data Source:

Data were collected from the 20 patients (males and females) visiting the Department of Periodontology of SGT Dental College, Hospital and Research Institute, Gurugram. Ethical clearance was attained by institutional ethics Committee of SGT Dental College, Hospital and Research Institute (IEC-SGTDCHRI/FDS-PERIO/SS/03). All study subjects were informed about the purpose study and written informed consent was collected from all patients. The study was conducted between May 2024 and March 2025.

Patient Selection criteria:

Systemically healthy individuals aged between 30 to 60 years, diagnosed with Generalized Chronic Periodontitis, having probing pocket depths (PPD) of 4-5 mm and clinical attachment loss (CAL) of 3–4mm without any vertical defects in each quadrant, were included in the study. Only those willing to comply with study procedures and provide informed consent were selected. Patients were excluded if they had a history of hormonal or corticosteroid therapy in the past two months, allergies to study materials, were pregnant or lactating, had aggressive periodontitis, smoked, were medically compromised, or were using medicated toothpastes or antibacterial mouth rinses.

Formulation of 0.75% boric acid in situ chip:

Based on findings derived from previous in vitro cytotoxicity studies, a 0.75% concentration of boric acid was found to be non-toxic to human gingival fibroblasts (HGF) and human periodontal ligament fibroblasts (HPDLF), supporting its safe use for subgingival application.¹² 0.75% concentration of boric acid at pH 4.9, was selected for this study in the form of a chip for localized delivery. The preparation of the boric acid chip was carried out based on the methodology previously employed for the production of chips for local drug delivery,¹³ using a polymer-based method by Ganvir MN et al. This preparation method ensured the formation of a uniform, biocompatible, biodegradable and easily administrable chip with a safe and effective concentration. (Figure 1)

Figure 1: Process of 0.75% Boric Acid Chip Preparation

The preparation process begins with obtaining all the required materials (A), followed by accurately weighing the ingredients using a digital weighing scale (B). The pre-weighed components are then arranged and made ready for transfer into a beaker (C). The mixture is stirred thoroughly using a magnetic stirrer set at approximately 700 RPM with a magnetic bead to ensure uniform dispersion of all ingredients (D). Once a homogenous mixture is achieved, it is carefully transferred into a petri dish to allow solvent evaporation (E). After being left overnight, the dried boric acid chip is obtained, ready to be peeled off and stored for further use (F).

Methodology:

A total of 20 patients were randomly allocated into two treatment groups. In each patient, one site underwent treatment with SRP followed by the local delivery of a 0.75% boric acid chip (BA group), while the contralateral site received SRP with a chlorhexidine chip (CHX group). Clinical parameters, including PPD, CAL, and bleeding index (BI) (Ainamo and Bay, 1975), were assessed at baseline, 3 weeks, and 6 weeks. Measurements were standardized using a UNC-15 color-coded periodontal probe (Hu-Friedy, Chicago, IL, USA). All treatments were administered by a single clinician to ensure consistency, while clinical assessments were performed by an independent examiner who was blinded to both the treatment groups. (Figure 2)

The boric acid chip was carefully placed into the periodontal pocket after thorough debridement with scaling and root planing, the chip was gently inserted into the depth of the pocket using a sterile tweezer, ensuring it fit snugly against the root surface. Care was taken to avoid trauma to the surrounding tissues, and no sutures or periodontal dressing were required due to the chip’s self-retentive nature.

Figure 2: Flowchart showing methodology of the study

RESULTS:

Boric Acid Chip and Chlorhexidine Chip. Both groups had equal mean age (41.65±9.22 years) and gender distribution (11 males and 9 females each), ensuring comparable baseline characteristics. The Independent t-Test was used to compare PPD, CAL and BI in both the groups.

The independent samples t-test results comparing PPD between the boric acid group and the chlorhexidine group at different time intervals showed no statistically significant difference between the two groups at baseline (p = 1.000), at 3 weeks (p = 0.123), or at 6 weeks (p = 0.560), indicating that both treatment modalities showed comparable effectiveness in reducing probing pocket depth over the study period. (Table 1 and Figure 3)

Figure 3: Graph showing comparison of Pocket Probing Depths (PPD) between Boric Acid chip and Chlorhexidine chip groups at baseline, 3 weeks and 6 weeks.

Table 1: Independent t-Test Results for PPD Between Groups

Levene's Test for Equality of Variances
F	t	df	Mean Difference	Std. Error Difference	95% Confidence Interval of the Difference		P-value
F	t	df	Mean Difference	Std. Error Difference	Lower	Upper	P-value
.000	.000	38	.00000	.16141	-.32675	.32675	1.000
.002	1.576	38	.35000	.22213	-.09968	.79968	.123
.117	.588	38	.10000	.17014	-.24443	.44443	.560

Table 2: Independent t-Test Results for CAL Between Groups

	Levene's Test for Equality of Variances
	F	t	df	Mean Difference	Std. Error Difference	95% Confidence Interval of the Difference		P-value
	F	t	df	Mean Difference	Std. Error Difference	Lower	Upper	P-value
CAL_Baseline	.000	.000	38	.00000	.21213	-.42944	.42944	1.000
CAL_3_weeks	.532	1.125	38	.15000	.13328	-.11981	.41981	.267
CAL_6_weeks	3.337	1.763	38	.30000	.17014	-.04443	.64443	.086

In the BA group, the mean PPD reduced from 4.55 mm at baseline to 3.70 mm at 3 weeks and further to 3.20 mm at 6 weeks. The mean CAL improved from 2.65 mm at baseline to 2.10 mm at 3 weeks and 1.60 mm at 6 weeks. Mean BI showed a significant reduction from 73.12% at baseline to 46.50% at 3 weeks and 20.62% at 6 weeks, indicating substantial improvement in clinical parameters and a strong early anti-inflammatory response. (Figure 6) In this study, both the BA and CHX groups showed comparable improvements in PPD and CAL over the 6-week period, with no significant differences between them. However, the BA group demonstrated a significantly greater reduction in BI at 3 weeks, suggesting a stronger early anti-inflammatory effect. Overall, both treatments were effective, with BA showing a slightly better early healing response.

Figure 6: Graph showing comparison of Pocket Probing Depths (PPD), Clinical Attachment Loss (CAL) and Bleeding Index (BI) (Ainamo and Bay, 1975) of Boric Acid chip at baseline, 3 weeks and 6 weeks.

DISCUSSION:

Local drug delivery systems (LDDS) have proven highly effective in the management of periodontitis due to their ability to provide high bioavailability of the drug directly at the site of infection.^14,15,16They offer controlled drug release, bypass hepatic metabolism and gastrointestinal issues, and reduce the need for frequent dosing.^17,18Their minimally invasive nature enhances patient compliance, and they allow the use of agents like chlorhexidine that may not be suitable for systemic administration, all while avoiding interactions with other systemic medications.¹⁹

Boric acid, when used as a local drug delivery agent, presents a promising adjunct to non-surgical periodontal therapy due to its antimicrobial, anti-inflammatory, and wound-healing properties.²⁰Its targeted application allows for enhanced therapeutic outcomes by directly reducing microbial load and inflammation at the site, thereby supporting improved periodontal healing.²⁰

A study by Mamajiwala A et al. compared LDD of 0.75% boric acid gel and 1% chlorhexidine gel as adjuncts to SRP in chronic periodontitis. Both showed significant improvement, with no statistically significant difference between them, indicating equal effectiveness.¹¹Parmar P et al assessed the comparative effectiveness of boric acid and chlorhexidine irrigation as an adjunct to SRP and concluded that the boric acid group demonstrated a greater reduction in plaque index, gingival index, BOP, probing depth, and CAL compared to the CHX group, suggesting that boric acid was more effective than CHX in managing chronic periodontitis.²¹Based on clinical evidence from comparative studies, the local application of boric acid has shown promising results in effectively reducing inflammation and improving periodontal parameters, highlighting its potential as a beneficial adjunct in the management of chronic periodontitis. Balci Yuce H et al, in 2014, also suggested that systemically introduced BA can reduce alveolar bone loss in a diabetic rat model.²²Singhal S et al. investigated the use of boric acid (BA) gel as a LDDS alongside SRP for the treatment of class II furcation defects in chronic periodontitis patients. The study demonstrated significant improvements in both clinical and radiographic outcomes, including a reduction in bone defect depth and a notable increase in bone fill. These favorable results are largely attributed to the osteoblastic properties of boron, which enhance bone regeneration by stimulating osteoblast activity.²³

In the present study, 0.75% boric acid chip as a local drug delivery agent demonstrated notable clinical improvements in patients with chronic periodontitis. Over a period of 6 weeks, the BA group showed a consistent reduction in mean PPD and CAL. Additionally mean BI significantly decreased, with a marked reduction observed as early as 3 weeks. These results are consistent with findings from previous studies, which have also highlighted the positive effects of boric acid in promoting bone regeneration and improving periodontal healing.^21,22

The chlorhexidine chip also proved to be an effective local drug delivery agent, showing comparable clinical improvements in chronic periodontitis patients. Over the 6-week period, it led to a reduction in mean PPD and an improvement in mean CAL, slightly outperforming the boric acid group in these parameters. The reduction in mean BI, was nearly identical to that seen with boric acid. However, the differences between the two groups were not statistically significant indicating that both agents were equally effective in clinical outcomes. Notably, boric acid demonstrated a more pronounced reduction in BI at the 3-week interval, targeting bleeding—a key indicator of active periodontal disease.²⁴This suggests that boric acid may contribute to a stronger early anti-inflammatory response due to being an active ingredient, potentially enhancing the initial healing process when compared to chlorhexidine.²⁰

One of the limitations of our study is that while BA chips are effective in treating larger periodontal pockets due to their wider structure, they face challenges in accessing deeper or narrower areas of the gums.²⁵This restricts their utility in certain periodontal sites. To overcome this, newer, smaller local drug delivery systems LDDS, such as nanoparticles, microspheres, and gels, are gaining attention due to their ability to target and deliver drugs more effectively to difficult-to-reach areas.²⁶ Additionally, the safety data for BA is limited, with significant gaps in information, particularly regarding its use during pregnancy, as highlighted by the study by Mittelstaedt R et al. The lack of standardized dosing and the potential for systemic absorption or toxicity further emphasize the need for caution, underscoring the necessity for more research to establish its safety profile.²⁷Hence, there is a clear need for additional research to address these limitations, particularly to explore alternative delivery systems and to further evaluate the safety profile of boric acid, ensuring its efficacy and safety for broader clinical applications.

ABBREVIATIONS:

CHX – Chlorhexidine, LDD – Local Drug Delivery, SRP – Scaling and Root Planing, PPD – Probing Pocket Depth, CAL – Clinical Attachment Loss, BI – Bleeding Index, The Inflammation-Mediated Polymicrobial Emergence and Dysbiotic Exacerbation- IMPEDE, tumor necrosis factor- TNF-μ, HGF – Human Gingival Fibroblasts, HPDLF – Human Periodontal Ligament Fibroblasts, Local drug delivery systems- LDDS

CONCLUSION:

This study demonstrated that the use of boric acid as a local drug delivery agent, alongside SRP, significantly improved clinical outcomes in patients with chronic periodontitis compared to conventional therapy. Boric acid showed promising effects in reducing probing PPD, CAL and reducing BI. Therefore, it can be concluded that boric acid is a safe, beneficial and cost-effective adjunct to SRP in the management of chronic periodontitis.

REFERENCES:

1. Soesilawati P, Ummah NI, Syahnia SJM, Arini NL, Oki AS. The role of Porphyromonas gingivalis in oral biofilm: pathophysiology in chronic periodontitis. Res J Pharm Technol. 2023; 16: 1754.

2. Loos BG, Van Dyke TE. The role of inflammation and genetics in periodontal disease. Periodontol 2000 2020; 83: 26-39.

3. Kumar SB. Occurrence of bacteremia in patients with chronic periodontitis. Res J Pharm Technol. 2015; 8: 1605-6.

4. Murthy KK, Varghese S. Effect of nonsurgical periodontal therapy on serum lipid profile: prospective study. Res J Pharm Technol. 2019; 12: 3664-8.

5. Mombelli A. Microbial colonization of the periodontal pocket and its significance for periodontal therapy. Periodontol 2000 2018; 76: 85-96.

6. Shetty ND, Kamath DG, Shetty NJ. Chitosan – a promising agent for site specific drug delivery in periodontics. Res J Pharm Technol. 2023; 16: 6105-9.

7. Adriaens PA, Adriaens LM. Effects of nonsurgical periodontal therapy on hard and soft tissues. Periodontol 2000 2004; 36: 121-45.

8. Shalehin N, Hosoya A, Takebe H, Hasan MR, Irie K. Boric acid inhibits alveolar bone loss in rat experimental periodontitis through diminished bone resorption and enhanced osteoblast formation. J Dent Sci 2020; 15: 437-44.

9. Luan Q, Desta T, Chehab L, Sanders VJ, Plattner J, Graves DT. Inhibition of experimental periodontitis by a topical boron-based antimicrobial. J Dent Res 2008; 87: 148-52.

10. Pizzorno L. Nothing Boring About Boron. Integr Med (Encinitas) 2015; 14: 35- 48.

11. Mamajiwala A, Sethi KS, Mahale SA, Raut CP, Karde PA, Kale AM. Comparative Evaluation of Boric Acid Gel versus Chlorhexidine Gel in the Treatment of Chronic Periodontitis: Randomized, Placebo-Controlled Clinical Study. Contemp Clin Dent 2019; 10: 457-64.

12. Sağlam M, Arslan U, Buket Bozkurt Ş, Hakki SS. Boric acid irrigation as an adjunct to mechanical periodontal therapy in patients with chronic periodontitis: a randomized clinical trial. J Periodontol 2013; 84: 1297-308.

13. Ganvir MN, Parwani SR, Chaudhary DS, Parwani R, Dadlani H, Vikey AK, et al. Comparative Evaluation of Azadirachta indica (Neem) Chip and Soft Tissue Diode Lasers as a Supplement to Phase I Periodontal Therapy in Localized Chronic Moderate Periodontitis: A Randomized Controlled Clinical Trial. Int J Dent 2022; 2022: 6109040.

14. John J, Emmadi P, Ambalavanan N, Verma E. Comparative evaluation of adjunctive use of locally delivered tetracycline fiber (Actisite) with scaling and root planning in the treatment of chronic periodontitis: a clinical study. Res J Pharm Technol 2013; 6: 90-5.

15. Penmetsa GS, Bhavana P, Arunbhupati P, Meghana K, Kausalya P, Venkatalakshmi M. Comparative evaluation of the clinical efficacy of 3% satranidazole and 1% ornidazole (Ornigreat™) gel through local drug delivery system in the treatment of chronic periodontitis. Res J Pharm Technol. 2020; 13: 3675-80.

16. Asha A, MLV Prabhuji, Rashmi P, Roja Y, Shaeesta Khaleelahmed Bhavikatti. Pocket reduction with High Concentrated oxygen oral gel: A Preliminary Case Report. Research Journal of Pharmacy and Technology. 2022; 15: 4367-1.

17. Sharma B, Soundrapandian C, Bhutia S. Formulation, characterization and in-vitro evaluation of prolonged local drug delivery of antimicrobial on bone tissue formation. Res J Pharm Technol. 2023; 16: 1147.

18. Bhatt P, Bhargava A, Kamath V, Khurana C, Mukherjee P, Chhabra M. Active Leptospermum honey as a local drug delivery agent in patients with chronic periodontitis: a clinico-biochemical study. Res J Pharm Technol. 2022; 15: 5449-54.

19. Larasati DM, Darjanki CM, Krismariono A, Aljunaid MA, Qaid HR, Alkadasi B. Host modulation therapy (HMT), an indispensable part of periodontitis treatment: case report. Res J Pharm Technol. 2025; 18: 3101-4.

20. Abdel-Fatah R, Elhusseiny G.A, Saleh W. Therapeutic potential of boric acid as a local drug delivery agent in periodontitis: a comprehensive systematic review and meta-analysis. BMC Oral Health 2025; 25: 88.

21. Parmar P, Gubbihal R, Raju R. Comparing the effectiveness of boric acid and chlorhexidine irrigation as an adjunct to mechanical periodontal therapy in chronic periodontitis patients – A randomized clinical trial. International Journal of Oral Health Sciences. 2022; 12: 58-64.

22. Balci Yuce H, Toker H, Goze F. The histopathological and morphometric investigation of the effects of systemically administered boric acid on alveolar bone loss in ligature-induced periodontitis in diabetic rats. Acta Odontol Scand 2014; 72: 729-36.

23. Singhal S, Pradeep AR, Kanoriya D, Garg S, Garg V. Boric acid gel as local drug delivery in the treatment of class II furcation defects in chronic periodontitis: a randomized, controlled clinical trial. J Investig Clin Dent 2018; 9: e12279.

24. Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J 1975; 25: 229-35.

25. Joshi D., Garg T., Goyal A.K., Rath G. Advanced drug delivery approaches against periodontitis. Drug Deliv 2016; 23: 363–77.

26. Esposito E, Cortesi R, Cervellati F, Menegatti E, Nastruzzi C. Biodegradable microparticles for sustained delivery of tetracycline to the periodontal pocket: Formulatory and drug release studies. J. Microencapsul 1997; 14: 175–87.

27. Mittelstaedt R, Kretz A, Levine M, Handa VL, Ghanem KG, Sobel JD, et al. Data on Safety of Intravaginal Boric Acid Use in Pregnant and Nonpregnant Women: A Narrative Review. Sex Transm Dis 2021; 48: e241-7.

Received on 18.08.2025 Revised on 16.12.2025

Accepted on 09.02.2026 Published on 01.07.2026

Available online from July 04, 2026

Research J. Pharmacy and Technology. 2026;19(7):3351-3356.

DOI: 10.52711/0974-360X.2026.00476

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.

	Levene's Test for Equality of Variances
	F	t	df	Mean Difference	Std. Error Difference	95% Confidence Interval of the Difference		P-value
	F	t	df	Mean Difference	Std. Error Difference	Lower	Upper	P-value
BI_Baseline	.002	.433	38	1.25000	2.88912	-4.59873	7.09873	.668
BI_3_weeks	.027	-2.111	38	-4.75000	2.25000	-9.30489	-.19511	.041
BI_6_weeks	3.036	.000	38	.00000	2.32089	-4.69839	4.69839	1.000