Clinical Efficacy of a Chlorhexidine-Based Mouthrinse Containing Citrox (Citrus Aurantium Amara Extract) and Hyaluronic Acid in Early Wound Healing of Patients Undergoing Periodontal Surgery: A Triple-Blind, Parallel-Arm, Randomized Controlled Trial

Background: Chlorhexidine (CHX) is the reference chemical plaque control agent used after periodontal surgery, but higher concentrations are associated with adverse effects that can reduce patient compliance. This randomized controlled trial evaluated whether a mouthrinse combining a reduced CHX concentration (0.09%) with Citrox and hyaluronic acid (HA) could match the clinical performance of conventional 0.12% CHX after periodontal flap surgery, while improving tolerability. Methods: Thirty-two patients undergoing open flap debridement with an experimental vertical releasing incision randomly received a mouthrinse containing 0.09% CHX with Citrox and HA (TEST group) or conventional 0.12% CHX (CONTROL group) twice daily for 14 days. The primary outcome was the presence of edema; secondary outcomes were the Early Wound Healing Score (EHS) and its components, the plaque index (TQHPI), the gingival index (GI), the tooth/tongue staining index (SI), and the adverse events of oral ulcers and dysgeusia, assessed at baseline and at 3, 7, and 14 days. Results: Edema, EHS, and the GI did not differ significantly between the groups at any time point (edema at day 3: 37.5% in both groups; risk difference 0.0%; 95% CI −30.5% to 30.5%). The plaque index was significantly higher in the TEST group from day 7 (p = 0.003; median difference 0.20, 95% CI 0.10 to 0.40) to day 14 (p = 0.005; median difference 0.30, 95% CI 0.10 to 0.40). The distribution of staining scores differed significantly at day 14 (p = 0.008), with heavy staining observed only in the control group. Conclusions: No statistically significant differences between the reduced-concentration, multi-component mouthrinse, and 0.12% CHX were detected in the assessed wound-healing outcomes; the test formulation was associated with higher plaque scores from day 7 and with a different distribution of staining scores at day 14, without heavy staining. These preliminary findings require confirmation in larger trials.