RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
Dr. SINDHURA H.
1. Name of the candidate and address DEPARTMENT OF PERIODONTICS,
(in block letters) THE OXFORD DENTAL COLLEGE,
HOSUR MAIN ROAD,
2. Name of the institution THE OXFORD DENTAL COLLEGE,
HOSPITAL AND RESEARCH CENTRE,
3. Course of the study and subject MASTER OF DENTAL SURGERY
4. Date of admission to course 30-5-2010
5. Title of the topic:
EFFICACY OF SUB GINGIVAL IRRIGATION WITH 1O% POVIDONE IODINE
AS AN ADJUNCT TO SCALING AND ROOT PLANING:
A CLINICAL AND MICROBIOLOGICAL STUDY.
6. BRIEF RESUME OF INTENDED WORK
6.1 NEED FOR THE STUDY
Periodontitis is a multifactorial inflammatory disease process, which leads to the
destruction of the supporting structures of the teeth in a susceptible host. Periodontal
destruction occurs when the microbial load within the periodontal pocket surpasses the
local and systemic host defense mechanism. Such an imbalance can result either from
specific increase in the total amount of bacteria or increase in pathogenic species above a
certain threshold level.
Evolutions in microbiological fields have made it possible to identify the periodontal
pathogens. Bacterial species such as Porphyromanas gingivalis, Aggregatibacter
actinomycetemcomitans and Prevotella intermedia are shown to be increased in
The main goal of treatment in patients with periodontitis is to establish infection control
and to reduce the bacterial load. Nonsurgical therapy which includes scaling and root
planing constitutes the initial step in the management of periodontal disease, but routine
scaling cannot completely eliminate the sub gingival pathogenic bacteria. Therefore in
addition to mechanical therapy a chemical antimicrobial adjunct is often used in
preventive periodontal therapy.1
This may be augmented by use of sub gingival irrigation which may reduce the total
number of cultivable bacteria in untreated periodontitis lesions. Many irrigants have
been used out of which, 10% povidone-iodine is a highly efficient microbicide having a
wide range of action against bacterial, viral and fungal organisms. This also exerts a
considerable antibacterial activity in periodontal infection.2,3
Thus, the primary aim of this study is to determine the effectiveness of 10% povidone
iodine irrigation with scaling and root planing as compared to scaling and root planing
alone along with microbial analysis using Real Time Polymerase Chain Reaction.
6.2 Review of literature
A comparative study was done to evaluate the efficacy of 10% povidone - iodine and
0.2% Chlorhexidine irrigants. The blood samples were drawn before and after
administration of irrigants into the gingival sulcus. There was a decrease in incidence of
bacterimia among patients treated with 10% of povidone iodine irrigation compared with
Chlorhexidine treated patients.4
Slots et al have shown that sub gingival irrigation with 10% povidone-iodine has a
beneficial effect in periodontitis patients.1
A first known case report used a Polymerase chain reaction (PCR) to identify the oral
micro flora in chronic neutropenia patients. The study showed the presence of
periodontal pathogens which included Prevotella intermedia, Bacteriodes forsythus
and Prevotella intermedia.5
In a study conducted with topically applied 0.1% of povidone-iodine, it resulted in
signiﬁcant decrease in probing pocket depth and more gain in clinical attachment level
which may improve the outcome of nonsurgical periodontal therapy.6
A randomized, split mouth study design to determine the clinical and microbiological
effect of 10% povidone- iodine sub gingival irrigation in periodontitis patients showed
that at 5 weeks post treatment, sub gingival irrigation of 10% povidone iodine along
with scaling and root planing reduced the total sub gingival counts of periodontal
pathogens and there was a gain in probing depth.2
Another study was done to evaluate 10% of povidone-iodine irrigation in 30 patients
with generalized severe chronic periodontitis with more than 5 mm of periodontal
pocket. The study revealed that sub gingival irrigation with 10% povidone iodine leads
to the reduction in probing depth, gain in attachment level and reduction in gingival
6.3OBJECTIVES OF THE STUDY
1. To evaluate the effectiveness of sub gingival irrigation with 10% of povidone
iodine as an adjunct to SRP.
2. To evaluate the effectiveness of 10% povidone iodine in reducing periodontal
pathogens -Porphyromanas gingivalis, Prevotella intermedia and
7. MATERIALS AND METHODS
7.1 SOURCE OF DATA
Patients visiting the Department of Periodontics at The Oxford Dental College Hospital
and Research Centre, Bommanahalli, Bangalore.
7.2 METHOD OF COLLECTION OF DATA
20 patients of which10 patients with Chronic periodontitis of mild to moderate type7
and 10 patients with Generalized aggressive periodontitis will be included in this
Informed consent will be obtained from all the subjects participating in the study.
Age group of 18 - 60 years with systemically healthy individuals.
Patients with at least 20 teeth.
Patients diagnosed as chronic periodontitis and aggressive
periodontitis with 4mm to 6mm of periodontal pocket depth.
Patients allergic to iodine.
Patients who have not undergone any periodontal treatment or received
systemic antibiotics in the last 3 months.
Pregnant and lactating women.
7.3 STUDY DESIGN
Subjects satisfying the above mentioned criteria will be recruited and categorized
randomly into 2 arches (maxillary and mandible), with control arch and an experimental
Control arch will receive scaling and root planing at first visit, excluding the
The experimental arch will receive scaling and root planing after 15 days along with
10% of povidone-iodine sub gingival irrigation for 5 minutes.
At the base line visit, the clinical parameters will be recorded and the selected site prior
to sampling will be isolated by placement of cotton rolls and then gently dried with
compressed air to prevent contamination from saliva. A sterile curette will be inserted
into the selected pockets and sub gingival pooled plaque sample will be collected. The
teeth of control arch will then receive scaling and root planing and oral hygiene
instruction will be given.
Patients will be recalled after 15 days wherein clinical parameters will be recorded again
and the plaque samples will be collected and re assessed for the teeth in the control arch.
During the same recall visit the teeth of experimental arch will be scaled and root planed
followed by sub gingival irrigation with 1ml of 10% povidone iodine using endodontic
double side vented syringe for 5 minutes in periodontal pockets of 4mm to 6mm. Oral
hygiene instructions will be reinforced.
Clinical parameters and plaque samples will be re-assessed for the teeth in experimental
arch after 15 days of completion of treatment.
The following clinical parameters will be recorded for all the subjects.
1. Plaque index - Silness and Loe.8
2. Gingival index - Loe and Silness.9
3. Bleeding index.10
4. Periodontal status:
a. Pocket depth will be assessed by using a Florida probe.TM
b. Clinical attachment loss.
Plaque samples will be transferred to the transport media and will be sent to the
laboratory for microbial analysis.
Specific periodontal pathogens -Porphyromanas gingivalis, Prevotella intermedia and
Actinobacillus actinomycetemcomitans will be analysed by Real Time Polymerase Chain
The statistical analysis will be done by using General Linear Mixed model.
Duration of the study:
The entire study will be completed within one year.
7.3 Does the study require any investigation or intervention to be
conducted on patients or other humans or animals?
Yes, plaque samples will be collected.
7.4 Has ethical clearance been obtained from your institution?
Yes, a certificate has been attached.
8. LIST OF REFERENCES:
1. Slots J, Jorgensen MG. Efficient antimicrobial treatment in periodontal
maintenance care. J Am Dent Assoc 2000;131(9):1293-1304.
2. Hoang T, Jorgensen MG, Keim RG, Pattison AM, Slots J. Povidine iodine as
a periodontal pocket disinfectant. J Periodont Res 2003;38(3):311-7
3. Kotsilkov K, Emilov D, Papova C. Sub gingival irrigation with povidone
iodine as adjunctive treatment of chronic periodontitis. Journal of IMAB
2009(scientific papers) Book 2.
4. Rahn R, Scheinder S, Diehl O, Schafer V.Shah PM. Preventing post treatment
bactermia comparing topical povidone iodine and chlorhexidine. J Am Dent
5. Okada M, Kobayashi M, Hino T, KurharaH, Miura K. Chronic periodontitis
findings and microflora profiles in children with chronic neutropenia under
supervised oral hygiene. JPeriodontol2001;72:945-52.
6. Rosling B, Hellstrom MK, Ramberg P, Socransky SS, Lindhe J. The use of
povidone iodine as an adjunct to non-surgical treatment of chronic
periodontitis. J Clin Periodontol 2001;28:1023-31.
. 7. Armitage GC. Developoment of a classification system for periodontal disease
and Conditions. Ann Periodontal 1999;4(1):1-6.
8. Silness J, Loe H. Periodontal disease in pregnancy. Correlation between oral
hygiene and periodontal conditions. Acta Odontol Scand 1964;22:121-35.
9. Loe H, Silness J. Periodontal disease in pregnancy. I Prevalence and severity.
Acta Odontol Scand 1963;21:533-51.
10. Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque.
Int Dent Journal 1975;25:229-35.