Chlorhexidine in Restorative Dentistry: Evidence, Controversies, and Clinical Implications
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Abstract
Chlorhexidine is widely used in restorative dentistry because of its broad-spectrum antimicrobial activity, substantivity, and low cost. Beyond its antiseptic properties, chlorhexidine has attracted considerable interest due to its ability to inhibit dentin-derived matrix metalloproteinases and its potential to stabilize the resin–dentin hybrid layer. Despite strong mechanistic and in vitro evidence supporting these biological effects, their translation into consistent long-term clinical benefits remains uncertain. This narrative review critically evaluates the role of chlorhexidine in restorative dentistry from the perspectives of rational drug use and health technology assessment. Evidence from laboratory studies, randomized controlled clinical trials, and systematic reviews was synthesized to examine the pharmacological properties of chlorhexidine, its effects on dentin bonding, cytotoxic potential, and overall safety profile. Particular emphasis is placed on the discrepancy between promising in vitro findings and inconsistent clinical outcomes, as well as on concerns related to cytotoxicity, antimicrobial resistance, and adverse effects. The available evidence does not support the routine use of chlorhexidine in restorative procedures, underscoring the need for selective, indication-based application guided by robust clinical data and principles of rational drug use.
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Copyright (c) 2026 Hafize G. Demirbaş, DDS
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