Full-mouth ultrasonic debridement associated with povidone iodine rinsing in GAgP treatment: a randomised clinical trial

Abstract

Objective

This study evaluated the clinical, immunological and microbiological results of full-mouth ultrasonic debridement (FMUD) with 10 % povidone iodine (PVPI) as the cooling liquid in the treatment of generalised aggressive periodontitis (GAgP).

Material and methods

Twenty-eight patients presenting GAgP were randomly assigned to one of the following groups for evaluation: FMUD + SS (n = 14)—single session of FMUD with 0.9 % saline solution as cooling agent and FMUD + PVPI (n = 14)—single session of FMUD with PVPI solution as cooling agent. Probing depth (PD), relative clinical attachment level (RCAL), relative position of gingival margin, plaque index (FMPI) and bleeding score (FMBS), immunological (interleukin-10 and interleukin-1β concentrations in gingival crevicular fluid) and microbiological (Aa and Pg amounts) parameters were evaluated at baseline, first, third and sixth months after treatment.

Results

The two groups presented reduction of FMPI and FMBS and had statistically significant PD reductions, RCAL gains and gingival recession (p < 0.05). Both therapies reduced Pg levels in deep and in moderate pockets (p < 0.05). FMUD + PVPI reduced Aa levels in deep pockets. However, no inter-group differences in clinical, immunological and microbiological parameters were observed (p > 0.05).

Conclusions

It could be concluded that 10 % PVPI used as an irrigant solution in FMUD decreased Aa levels in deep pockets but had no additional benefits when compared with saline solution irrigation in terms of clinical, microbiological and immunological results.

Clinical relevance

The FMUD is a valid option for the treatment of GAgP, but the use of 10 % PVPI did not improve the results of the periodontal therapy.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1.

    Susin C, Albandar JM (2005) Aggressive periodontitis in an urban population in southern Brazil. J Periodontol 76:468–475

    PubMed  Article  Google Scholar 

  2. 2.

    Armitage GC (1999) Development of a classification system for periodontal diseases and conditions. Ann Periodontol 4:1–6

    PubMed  Article  Google Scholar 

  3. 3.

    Scharf S, Wohlfeil M, Siegelin Y, Schacher B, Dannewitz B, Eickholz P (2014) Clinical results after nonsurgical therapy in aggressive and chronic periodontitis. Clin Oral Investig 18:453–460

    PubMed  Article  Google Scholar 

  4. 4.

    Sigusch B, Beier M, Klinger G, Pfister W, Glockmann E (2001) A 2-step non-surgical procedure and systemic antibiotics in the treatment of rapidly progressive periodontitis. J Periodontol 72:275–283

    PubMed  Article  Google Scholar 

  5. 5.

    Guerrero A, Griffiths GS, Nibali L, Suvan J, Moles DR, Laurell L, Tonetti MS (2005) Adjunctive benefits of systemic amoxicillin and metronidazole in non-surgical treatment of generalized aggressive periodontitis: a randomized placebo-controlled clinical trial. J ClinPeriodontol 32:1096–1107

    Google Scholar 

  6. 6.

    Xajigeorgiou C, Sakellari D, Slini T, Baka A, Konstantinidis A (2006) Clinical and microbiological effects of different antimicrobials on generalized aggressive periodontitis. J ClinPeriodontol 33:254–264

    Google Scholar 

  7. 7.

    Moreira RM, Feres-Filho EJ (2007) Comparison between full-mouth scaling and root planing and quadrant-wise basic therapy of aggressive periodontitis: 6-month clinical results. J Periodontol 78:1683–1688

    PubMed  Article  Google Scholar 

  8. 8.

    Kaner D, Christan C, Dietrich T, Bernimoulin JP, Kleber BM, Friedmann A (2007) Timing affects the clinical outcome of adjunctive systemic antibiotic therapy for generalized aggressive periodontitis. J Periodontol 78:1201–1208

    PubMed  Article  Google Scholar 

  9. 9.

    Haas AN, de Castro GD, Moreno T, Susin C, Albandar JM, Oppermann RV, Rösing CK (2008) Azithromycin as an adjunctive treatment of aggressive periodontitis: 12-months randomized clinical trial. J ClinPeriodontol 35:696–704

    Google Scholar 

  10. 10.

    Yek EC, Cintan S, Topcuoglu N, Kulekci G, Issever H, Kantarci A (2010) Efficacy of amoxicillin and metronidazole combination for the management of generalized aggressive periodontitis. J Periodontol 81:964–974

    PubMed  Article  Google Scholar 

  11. 11.

    Mestnik MJ, Feres M, Figueiredo LC, Duarte PM, Lira EA, Faveri M (2010) Short-term benefits of the adjunctive use of metronidazole plus amoxicillin in the microbial profile and in the clinical parameters of subjects with generalized aggressive periodontitis. J ClinPeriodontol 37:353–365

    Google Scholar 

  12. 12.

    Casarin RC, Peloso Ribeiro ED, Sallum EA, Nociti FH Jr, Gonçalves RB, Casati MZ (2012) The combination of amoxicillin and metronidazole improves clinical and microbiologic results of one stage, full mouth, ultrasonic debridement in aggressive periodontitis treatment. J Periodontol 83:988–998

    PubMed  Article  Google Scholar 

  13. 13.

    Guerrero A, Echeverria JJ, Tonetti MS (2007) Incomplete adherence to an adjunctive systemic antibiotic regimen decreases clinical outcomes in generalized aggressive periodontitis patients: a pilot retrospective study. J ClinPeriodontol 34:897–902

    Google Scholar 

  14. 14.

    Bonito AJ, Lux L, Lohr KN (2005) Impact of local adjuncts to scaling and root planning in periodontal disease therapy: a systematic review. J Periodontol 76:1227–1236

    PubMed  Article  Google Scholar 

  15. 15.

    Schaeken MJ, de Jong MH, Franken HC, van der Hoeven JS (1984) Effect of chlorhexidine and iodine on the composition of the human dental plaque flora. Caries Res 18:401–407

    PubMed  Article  Google Scholar 

  16. 16.

    Fleischer W, Reimer K (1997) Povidone-iodine in antisepsis—state of the art. Dermatology 195(Suppl 2):3–9

    PubMed  Article  Google Scholar 

  17. 17.

    Schreier H, Erdos G, Reimer K, Konig B, Konig W, Fleischer W (1997) Molecular effects of povidone-iodine on relevant microorganisms: an electron-microscopic and biochemical study. Dermatology 195(Suppl 2):111–116

    PubMed  Article  Google Scholar 

  18. 18.

    Spratt DA, Pratten J, Wilson M, Gulabivala K (2001) An in vitro evaluation of the antimicrobial efficacy of irrigants on biofilms of root canal isolates. IntEndod J 34:300–307

    Google Scholar 

  19. 19.

    Higashitsutsumi M, Kamoi K, Miyata H, Ohgi S, Shimizu T, Koide K, Nakajima S, Kojima T, Nishizawa S, Sakamoto M (1993) Bactericidal effects of povidone-iodine solution to oral pathogenic bacteria in vitro. Postgrad Med J 69(Suppl 3):S10–S14

    PubMed  Google Scholar 

  20. 20.

    Lanker Klossner B, Widmer HR, Frey F (1997) Nondevelopment of resistance by bacteria during hospital use of povidone-iodine. Dermatology 195(Suppl 2):10–13

    PubMed  Article  Google Scholar 

  21. 21.

    Slots J (2002) Selection of antimicrobial agents in periodontal therapy. J Periodontal Res 37:389–398

    PubMed  Article  Google Scholar 

  22. 22.

    Slots J (2012) Low cost periodontal therapy. Periodontol 2000(60):110–137

    Article  Google Scholar 

  23. 23.

    Zanatta GM, Bittencourt S, Nociti FH Jr, Sallum EA, Sallum AW, Casati MZ (2006) Periodontal debridement with povidone-iodine in periodontal treatment: short-term clinical and biochemical observations. J Periodontol 77:498–505

    PubMed  Article  Google Scholar 

  24. 24.

    Sahrmann P, Puhan MA, Attin T, Schmidlin PR (2010) Systematic review on the effect of rinsing with povidone-iodine during nonsurgical periodontal therapy. J Periodontal Res 45:153–164

    PubMed  Article  Google Scholar 

  25. 25.

    Ribeiro Edel P, Bittencourt S, Zanin IC, Bovi Ambrosano GM, Sallum EA, Nociti FH, Gonçalves RB, Casati MZ (2009) Full-mouth ultrasonic debridement associated with amoxicillin and metronidazole in the treatment of severe chronic periodontitis. J Periodontol 80:1254–1264

    PubMed  Article  Google Scholar 

  26. 26.

    Ainamo J, Bay I (1975) Problems and proposals for recording gingivitis and plaque. Int Dent J 25:229–235

    PubMed  Google Scholar 

  27. 27.

    Mühlemann HR, Son S (1971) Gingival sulcus bleeding—a leading symptom in initial gingivitis. HelvOdontolActa 15:107–113

    Google Scholar 

  28. 28.

    Smith M, Seymour GJ, Cullinan MP (2010) Histopathological features of chronic and aggressive periodontitis. Periodontol 2000 53:45–54

    PubMed  Article  Google Scholar 

  29. 29.

    Purucker P, Mertes H, Goodson JM, Bernimoulin JP (2001) Local versus systemic adjunctive antibiotic therapy in 28 patients with generalized aggressive periodontitis. J Periodontol 72:1241–1245

    PubMed  Article  Google Scholar 

  30. 30.

    Sakellari D, Vouros I, Konstantinidis A (2003) The use of tetracycline fibers in the treatment of generalized aggressive periodontitis: clinical and microbiological findings. J Int Acad Periodontol 5:52–60

    PubMed  Google Scholar 

  31. 31.

    Matthews DC (2006) Adjunctive antibiotics in the treatment of generalized aggressive periodontitis. Evid Based Dent 7:67

    PubMed  Article  Google Scholar 

  32. 32.

    de Oliveira RR, Schwartz-Filho HO, Novaes AB Jr, Taba M Jr (2007) Antimicrobial photodynamic therapy in the non-surgical treatment of aggressive periodontitis: a preliminary randomized controlled clinical study. J Periodontol 78:965–973

    PubMed  Article  Google Scholar 

  33. 33.

    Cortelli SC, Cortelli JR, Holzhausen M, Franco GC, Rebelo RZ, Sonagere AS, Queiroz Cda S, Costa FO (2009) Essential oils in one-stage full-mouth disinfection: double-blind, randomized clinical trial of long-term clinical, microbial and salivary effects. J ClinPeriodontol 36:333–342

    Google Scholar 

  34. 34.

    Rosling B, Hellström MK, Ramberg P, Socransky SS, Lindhe J (2001) The use of PVP-iodine as an adjunct to non-surgical treatment of chronic periodontitis. J ClinPeriodontol 28:1023–1031

    Google Scholar 

  35. 35.

    Del Peloso Ribeiro E, Bittencourt S, Ambrosano GM, Nociti FH Jr, Sallum EA, Sallum AW (2006) Povidone-iodine used as an adjunct to non-surgical treatment of furcation involvements. J Periodontol 77:211–217

    PubMed  Article  Google Scholar 

  36. 36.

    Leonhardt A, Bergström C, Krok L, Cardaropoli G (2006) Healing following ultrasonic debridement and PVP-iodine in individuals with severe chronic periodontal disease: a randomized, controlled clinical study. Acta OdontolScand 64:262–266

    Article  Google Scholar 

  37. 37.

    Leonhardt A, Bergström C, Krok L, Cardaropoli G (2007) Microbiological effect of the use of an ultrasonic device and iodine irrigation in patients with severe chronic periodontal disease: a randomized controlled clinical study. Acta Odontol Scand 65:52–59

    PubMed  Article  Google Scholar 

  38. 38.

    Krück C, Eick S, Knöfler GU, Purschwitz RE, Jentsch HF (2012) Clinical and microbiologic results 12 months after scaling and root planing with different irrigation solutions in patients with moderate chronic periodontitis: a pilot randomized trial. J Periodontol 83:312–320

    PubMed  Article  Google Scholar 

  39. 39.

    Sahrmann P, Imfeld T, Ronay V, Attin T, Schmidlin PR (2014) Povidone-iodine gel and solution as adjunct to ultrasonic debridement in non surgical periodontitis treatment: an RCT pilot study. Quintessence Int 45:281–290

    PubMed  Google Scholar 

  40. 40.

    Koshy G, Kawashima Y, Kiji M, Nitta H, Umeda M, Nagasawa T, Ishikawa I (2005) Effects of single-visit full-mouth ultrasonic debridement versus quadrant-wise ultrasonic debridement. J ClinPeriodontol 32:734–743

    Google Scholar 

  41. 41.

    Hughes FJ, Syed M, Koshy B, Marinho V, Bostanci N, McKay IJ, Curtis MA, Croucher RE, Marcenes W (2006) Prognostic factors in the treatment of generalized aggressive periodontitis: I. Clinical features and initial outcome. J ClinPeriodontol 33:663–670

    Google Scholar 

  42. 42.

    Yoshinari N, Kawase H, Mitani A, Ito M, Sugiishi S, Matsuoka M, Shirozu N, Ishihara Y, Bito B, Hiraga M, Arakawa K, Noguchi T (2004) Effects of scaling and root planing on the amounts of interleukin-1 and interleukin-1 receptor antagonist and the mRNA expression of interleukin-1beta in gingival crevicular fluid and gingival tissues. J Periodontal Res 39:158–167

    PubMed  Article  Google Scholar 

  43. 43.

    Moore KW, O’Garra A, de Waal Malefyt R, Vieira P, Mosmann TR (1993) Interleukin 10. Annu Rev Immunol 11:165–190

    PubMed  Article  Google Scholar 

  44. 44.

    Górska R, Gregorek H, Kowalski J, Laskus-Perendyk A, Syczewska M, Madalioski K (2003) Relationship between clinical parameters and cytokine profiles in inflamed gingival tissue and serum samples from patients with chronic periodontitis. J ClinPeriodontol 30:1046–1052

    Google Scholar 

  45. 45.

    Rescala B, Rosalem W Jr, Teles RP, Fischer RG, Haffajee AD, Socransky SS, Gustafsson A, Figueredo CM (2010) Immunologic and microbiologic profiles of chronic and aggressive periodontitis subjects. J Periodontol 81:1308–1316

    PubMed  Article  Google Scholar 

  46. 46.

    Teles RP, Gursky LC, Faveri M, Rosa EA, Teles FRF, Socransky SS, Haffajee AD (2010) Relationship between subgingivalmicrobiota and GCF biomarkers in generalized aggressive periodontitis. J Clin Periodontol 37:313–323

    PubMed  PubMed Central  Article  Google Scholar 

  47. 47.

    Sahrmann P, Sener B, Ronay V, Attin T, Schmidlin PR (2012) Clearance of topically-applied PVP-iodine as a solution or gel in periodontal pockets in men. Acta Odontologica Scandinavica 70:497–503

    PubMed  Article  Google Scholar 

  48. 48.

    Eakle WS, Ford C, Boyd RL (1986) Depth of penetration in periodontal pockets with oral irrigation. J Clin Periodontol 13:39–44

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

The authors thank the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) for scholarship support (grant number 2008/56359-9).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures in this study were performed in accordance with the ethical standards of the Ethics Committee of Piracicaba Dental School (protocol 024/2006), and written informed consent was obtained from all individual participants included in the study.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Márcio Zaffalon Casati.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

do Vale, H.F., Casarin, R.C.V., Taiete, T. et al. Full-mouth ultrasonic debridement associated with povidone iodine rinsing in GAgP treatment: a randomised clinical trial. Clin Oral Invest 20, 141–150 (2016). https://doi.org/10.1007/s00784-015-1471-y

Download citation

Keywords

  • Aggressive periodontitis
  • Povidone iodine
  • Non-surgical periodontal therapy
  • Full-mouth ultrasonic debridement