# Effects of oral hygiene management containing Cibotium Barometz J. Smith extract on peri-implant mucositis: a randomized clinical trial

## TL;DR

This study shows that a toothpick method with Cibotium barometz extract improves peri-implant mucositis compared to chlorhexidine and saline.

## Contribution

The study introduces Cibotium barometz extract as a novel natural treatment for peri-implant mucositis.

## Key findings

- CBG showed decreased leukocyte and protein levels after treatment compared to baseline.
- CBG had a significant effect on three bacterial species not seen in other groups.
- CB-applied TPM demonstrated potential as a non-surgical treatment for peri-implant mucositis.

## Abstract

The purpose of this study was to confirm the improvement of peri-implant mucositis (PIM) in patients using the toothpick method (TPM) containing a natural ingredient: Cibotium barometz J. Smith (CB).

As a randomized, blind, controlled trial study, there were 21 participants in the CB TPM group (CBG), 20 participants in the chlorhexidine group (CG), and 19 participants in the saline group (SG). All three groups were examined both before and after TPM. We performed a paired t-test to determine the differences between the mean values of the three groups. We used ANOVA to evaluate the mean differences in clinical indicators, saliva tests, and periodontal bacteria.

There were no significant differences in sociodemographic characteristics and oral health status between the three groups, thus ensuring homogeneity among the participants. Occult blood in the saliva test increased for SG and CG and decreased for CBG. Compared to the before-TPM condition, leukocyte and protein levels decreased for CG and CBG after TPM (p < 0.05). As a result of checking the effect size (Cohen’s d) before and after TPM according to the three groups, three species of bacteria were identified that showed a significant effect only on CBG, and two species were identified that showed a significant effect on CBG and CG (Cohen’s d ≥ 0.8).

This study confirmed the efficacy of CB-applied TPM on PIM patients and demonstrated its potential as a non-surgical treatment option. Therefore, practitioners could extensively use CB-applied TPM as a mechanical tool and safe chemical and biological removal agent for post-implant management in clinical settings.

The trial was registered in the International Clinical Trial Registry Platform (ICTRP) under the registration number KCT0008626 on 17/07/2023 and was retrospectively registered.

The online version contains supplementary material available at 10.1186/s12906-025-04900-3.