Comparative Evaluation Of Different Concentrations Of Povidone Iodine As Subgingival Irrigant In The Management Of Chronic Periodontitis
Karthik V1, Arvina Rajasekar2*
1 Graduate Student, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai-
77, India.
2 Senior Lecturer, Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences [SIMATS], Saveetha University, Chennai- 77, India.
*Corresponding Author
Dr. Arvina Rajasekar,
Senior Lecturer, Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences [SIMATS], Saveetha University, Chennai-
77, India.
Tel: +91 9486442309
E-mail: arvinar.sdc@saveetha.com
Received: September 13, 2021; Accepted: September 22, 2021; Published: September 23, 2021
Citation:Karthik V, Arvina Rajasekar. Comparative Evaluation Of Different Concentrations Of Povidone Iodine As Subgingival Irrigant In The Management Of Chronic Periodontitis. Int J Dentistry Oral Sci. 2021;8(9):4606-4610. doi: dx.doi.org/10.19070/2377-8075-21000930
Copyright: Dr. Arvina Rajasekar©2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
Background: Mechanical plaque control is the first line of management of chronic periodontitis. In recent years, a variety of
adjuncts including irrigants, chemical plaque controlling agents, vitamin supplements, systemic and local antibiotics, local drug
delivery, herbal extracts, probiotics are gaining importance. Povidone iodine is one of the most broad spectrum and potent
antiseptics available at various concentrations.
Aim: The aim of the study was to assess and compare the efficacy of various concentrations of povidone iodine as sub gingival
irrigant in the management of chronic periodontitis.
Materials And Methods: The present double blinded, parallel designed, randomized clinical trial was carried out in the
Department of Periodontics, Saveetha Dental College and Hospitals, Chennai, India. A total of 66 patients with generalised
chronic periodontitis (22 participants in each group [Group 1 (povidone iodine 2%), Group 2 (povidone iodine 10%) and
Group 3 (povidone iodine 0.1%)]) were enrolled. Scaling and root planing was done for all the participants and then the pocket
was irrigated with respective irrigant. The clinical parameters including Loe and Silness Gingival Index (GI) and Probing
Pocket Depth (PPD) were recorded at baseline and after 1 month. The data was analyzed using Statistical Package for Social
Sciences (SPSS Software, Version 23.0). One-way ANOVA was used to compare the mean values of GI and PPD between
the groups. Tukey’s HSD post hoc test was done to find means that are significantly different from each other. Also, student’s
paired t-test was used to compare the mean values of GI and PPD within the groups.
Results: One-way ANOVA showed that there was no statistically significant difference between the baseline GI and PPD
values as compared to the three mouthwash groups (p=0.865), but there was a statistically significant difference (p=0.000)
observed between the three concentrations when compared after 1 month. Student’s paired t-test showed that the difference
between the baseline and post GI and baseline and the post PPD was statistically significant in both Group 1 and Group 2
with the p value of 0.000.
Conclusion: Significant improvement in gingival index and pocket depth suggests that subgingival povidone iodine irrigation
could be an effective adjunct to scaling and root planing in the management of chronic periodontitis. Also, as the concentration
of povidone iodine increases, the improvement in clinical parameters also increases.
2.Introduction
3.Materials and Methods
3.Results
4.Discussion
5.Conclusion
5.References
Keywords
Povidone Iodine; Pocket Depth; Innovative; Gingivitis; Periodontitis; Subgingival Irrigation.
Introduction
Periodontitis is a chronic inflammatory disease of the oral cavity
which affects both the soft and hard tissues. If it is left untreated,
it leads to increased pocket depth, clinical attachment loss, recession,
mobility, bone loss, pathologic migration of the teeth and
tooth loss [1-5]. It is a multifactorial disease. Even though plaque
is the primary etiology, the disease is aggravated by a variety of
risk factors including age, systemic diseases, gender, genetic factors,
smoking, stress, hormones [6-15].
Scaling and root planing (SRP) therapy is considered as the gold standard for periodontal disease [16]. However, SRP is subjected
to certain restrictions, such as the failure to insert deeper periodontal
pockets, bifurcations and the failure to eliminate microorganisms
because of their tissue invading nature [17, 19]. To
overcome this, variety of adjuncts including irrigants, chemical
plaque controlling agents, vitamin supplements, systemic and local
antibiotics, local drug delivery, herbal extracts, probiotics and
LASER are gaining importance.
Irrigants are effective at flushing out plaque, bacteria and their
toxins that become trapped in the small spaces between teeth and
under the gumline, preventing the buildup of harmful bacteria.
The most widely studied subgingival irrigants are chlorhexidine
and various concentrations of povidone iodine solution [20].
Chlorhexidine (CHX) is considered a “gold standard” antibacterial
solution and is extensively used as a mouthwash and irrigating
solution [21]. However, it has certain side effects on long term
usage such as loss of taste sensation, staining of the teeth and in
some cases, parotid swelling. Povidone iodine is the most broadspectrum
and potent antiseptic available [22].
It has a bactericidal effect against most bacteria including putative
periodontal pathogens, fungi, mycobacteria, viruses, and protozoa.
Povidone-iodine remains an effective antibacterial agent
when used directly into the periodontal pocket even at low concentrations
[23].
Elemental iodine or its derivatives polyvinylpyrrolidone-iodine
complex (Povidone-I) is the most broad-spectrum and potent
antiseptics available. This Povidone-I has a bactericidal effect
against most bacteria including putative periodontal pathogens,
fungi, mycobacteria, viruses, and protozoa [24, 25]. Povidoneiodine
remains an effective antibacterial agent when used directly
into the periodontal pocket even at low concentrations [26, 16].
Recent studies had used 0.1% Povidone iodine as sub gingival
irrigant and compared the antimicrobial efficacy and also it had
shown that, when 2% concentration of povidone iodine is used
as a subgingival irrigant there is a increased antimicrobial activity
with reduced gingival inflammation [17].
Our team has extensive knowledge and research experience that
has translated into high quality publications [27-46]. Through extensive
literature search, it was revealed that there is a lack of
adequate studies comparing various concentrations of povidone
iodine as sub gingival irrigant in the management of chronic periodontitis.
In this context, the aim of the study was to assess and
compare the efficacy of various concentrations of povidone iodine
as sub gingival irrigant in the management of chronic periodontitis.
Materials and Methods
Study Population:
The present double blinded, parallel designed, randomized
clinical trial was carried out in the Department of Periodontics,
Saveetha Dental College and Hospitals, Chennai, India. A total of
66 patients with generalised chronic periodontitis were enrolled.
The ethical clearance was obtained from the Institutional Ethical
Committee and a written informed consent was obtained from all
the study participants.
Inclusion Criteria:
Participants within the age group of 20-25 were systematically
healthy, presence of at least 20 teeth, probing depth of 4-5 mm,
presence of bleeding on probing (BOP) in at least 30% of the
sites were included in the study.
Exclusion Criteria:
Participants who were under orthodontic treatment, smokers,
pregnant or lactating mothers, patients under long term medications,
systemically compromised patients were excluded from the
study.
Test group:
Group 1: Povidone iodine 2 %
Group 2: Povidone iodine 10 %
Group 3: Povidone iodine 0.1%
Study Design:
The sample size was 66 with 22 participants in each group [Group
1 (povidone iodine 2%), Group 2 (povidone iodine 10%) and
Group 3 (povidone iodine 0.1%)]. Participants were assigned to
the groups by a person not involved in the study. Scaling and root
planing was done for all the participants using Gracey curettes
and then the pocket was irrigated with respective irrigant using
a syringe. The syringe was gently inserted into the depth of periodontal
pockets to assure delivery of irrigant solution. Repeated
irrigation ensured that irrigant solution filled up pockets for a period
of 5 min and oral hygiene instructions were reinforced. The
clinical parameters including Loe and Silness Gingival Index (GI)
and Probing Pocket Depth (PPD) were recorded (baseline). All
the subjects were recalled after 1 month and the same parameters
were recorded.
Statistical Analysis:
The data was analyzed using Statistical Package for Social Sciences
(SPSS Software, Version 23.0). Descriptive and inferential statistics
were done for data summarization and presentation. One-way
ANOVA was used to compare the mean values of GI and PPD
between the groups. Tukey’s HSD post hoc test was done to find
means that are significantly different from each other. Also, student’s
paired t-test was used to compare the mean values of GI
and PPD within the groups.
Results
A total of 66 study participants were enrolled in this study and
were divided into three groups each of 22 participants. Group 1 -
2% povidone iodine, Group 2 - 10% povidone iodine and Group
3 - 0.1% povidone iodine.
One-way ANOVA showed there was no statistically significant
difference between the baseline GI and PPD values as compared
to the three mouthwash groups (p=0.865), but there was a statistically
significant difference (p=0.000) observed between the
three concentrations when compared after 1 month. The baseline values between the three groups were statistically not significant
(p=0.865), whereas after 1 month, there was a statistically significant
difference (p=0.000). (Table 1).
Tukey’s HSD post hoc test was done to find means that are significantly
different from each other. A statistically significant difference
between Group 1 and Group 3 was observed in terms of
post GI (p=0.000) and post PPD (p=0.000) but statistically no
significant difference was observed between Group 1 and Group
2 in terms of post GI (p=0.171) and post PPD (p=0.338). (Table
2).
Student’s paired t-test was done to compare the mean values of
GI and PPD within the groups. The mean difference between the
baseline and post GI and baseline and the post PPD was statistically
significant in both Group 1 and Group 2 with the p value
of 0.000. Whereas, no statistically significant difference was observed
between the baseline and post GI (0.24) and baseline and
post PPD (0.27) in Group 3. (Table 3).
Table 1. One-way ANOVA comparison of mean GI and PPD between the study groups.
Table 2. Tukey's HSD post Hoc pairwise comparison of mean GI and PPD.
Table 3. Mean comparison of GI and PPD within the study groups using student’s paired t-test.
Discussion
The present study was done to assess the different concentrations
of povidone iodine as a subgingival irrigant in the management
of chronic periodontitis.
The present study showed that the mean PPD at baseline was
statistically not significant between the three groups (p=0.47).
However, the mean PPD after 1 month was highly significant between
2% povidone iodine and 0.1% povidone iodine (p=0.000)
and 10% povidone iodine and 0.1% povidone iodine (p=0.000);
showing that both 2% povidone iodine and 10% povidone iodine
were equally effective in preventing plaque formation (p=0.338).
Selvagii et al., studied the clinical efficacy of povidone iodine as
a subgingival irrigant and observed that there was a significant
reduction in pocket depth after one month of usage [47]. Hoang
et al., revealed that there are three main mechanisms such as antiinflammatory,
antiseptic and bone formation through which povidone
iodine is effective in reducing periodontitis [48].
Also, the present study revealed that the mean GI after 1 month
was highly significant between 2% povidone iodine and 0.1% povidone iodine (p=0.000) and 10% povidone iodine and 0.1%
povidone iodine (p=0.000); showing that both 2% povidone iodine
and 10% povidone iodine were equally effective in reducing
inflammation (p=0.171). This might be due to the substantivity
of 2% povidone iodine and 10% povidone iodine, which adhere
to the tissues such as oral mucosa and teeth. This helps to maintain
a potent sustained release, which, in turn, reduces the bacterial
count and prevents the accumulation of dental plaque and so
the gingivitis.
Berkelmen et al., studied the clinical efficacy of povidone iodine
towards periodontitis and revealed that there was a reduction
in pocket depth after one month of usage [49]. Sindhura
H et al., studied the clinical efficacy of 0.1% of povidone iodine
and showed significant reduction in gingival index scores after 1
month of usage [17]. Similar results were obtained in the studies
of Perayil et al., [50] and Eid Alroudhan et al., [51]. Our findings
are in accordance with the previous studies.
From the study results, it can be stated that 10% povidone iodine
showed significant improvement in gingival index and pocket
depth and hence it could be an effective adjunct to scaling and
root planing in the management of chronic periodontitis. Also, as
the concentration of povidone iodine increases, the improvement
in clinical parameters also increases. However, further long term
follow-up studies are needed to substantiate the present finding
and hence can be used as an adjunct to scaling and root planning
in the management of periodontal diseases.
Conclusion
Significant improvement in gingival index and pocket depth suggests
that subgingival povidone iodine irrigation could be an effective
adjunct to scaling and root planing in the management
of chronic periodontitis. Also, as the concentration of povidone
iodine increases, the improvement in clinical parameters also increases.
Acknowledgement
The authors would like to acknowledge the help rendered by
Saveetha Dental College and Hospitals, Saveetha Institute of
Medical and Technical Sciences, Saveetha University, Chennai.
Source of Funding
The present project was sponsored by
• Saveetha Institute of Medical and Technical Sciences,
• Saveetha Dental College and Hospitals,
• Saveetha University,
• VKK building contractors.
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