|Year : 2019 | Volume
| Issue : 2 | Page : 58-62
A comparative clinicomicrobiological study to evaluate efficacy of superoxide solution with povidone-iodine irrigation in chronic periodontitis patients
Dipali Chaudhari, Swapna Mahale, Pooja Kadam, Shradha Shimpi, Lavanya Kalekar, Prasad Sonar
Department of Periodontology, MGVM K.B.H. Dental College and Hospital, Nashik, Maharashtra, India
|Date of Submission||03-Jan-2019|
|Date of Acceptance||06-Feb-2019|
|Date of Web Publication||15-Jul-2019|
Post Graduate Student, MGVM K.B.H. Dental College and Hospital, Nashik, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: Oxum is a stable, nonflammable, and noncorrosive bactericidal, virucidal, fungicidal, and sporicidal solution that is ready to use with no further dilution or mixing. Superoxidized solutions have shown to be both safe and efficient as a wound care product that moistens, lubricates, debrides, and reduces the microbial load of various types of lesions. Superoxidized solutions are electrochemically processed aqueous solutions manufactured from pure solutions which are rich in reactive oxygen species with neutral pH and longer half-life (>12 months).
Aim and Objective: The aim of the present study was to compare superoxide solution with povidone-iodine by means of clinical parameters and microbiologically by colony-forming units.
Materials and Methods: A total of 20 sites with chronic periodontitis were selected for study and randomly divided into two groups (ten sites per group). In each patient, sites were selected having probing depth ≥5 mm.
The patients were randomly allotted into one of the following groups prior to treatment.
Group 1 (study group – irrigation with superoxidized solutions)
Group 2 (study group – irrigation with povidone-iodine [Betadine]).
The study period of 30 days was divided into baseline (0 day) and 30th day. Periodontal pockets were irrigated with superoxidized solution (oxum) and povidone-iodine (Betadine) from 10 ml syringe having blunt metallic cannula. A total time of 5–10 min was spent for irrigation of the sites. Samples of subgingival plaque from periodontal pockets were obtained with sterile curette at baseline and 1 month for colony-forming units.
Results: Group A showed comparable improvement in all the clinical parameters (probing pocket depth and sulcus bleeding index) than Group B.
Conclusion: Superoxidized water irrigation as an adjunct to scaling and root planing proved to be effective in the treatment of periodontitis. They allowed better retention and were biologically accepted without any side effects.
Keywords: Povidone-iodine, scaling and root planing, subgingival irrigation, superoxide solution
|How to cite this article:|
Chaudhari D, Mahale S, Kadam P, Shimpi S, Kalekar L, Sonar P. A comparative clinicomicrobiological study to evaluate efficacy of superoxide solution with povidone-iodine irrigation in chronic periodontitis patients. J Oral Res Rev 2019;11:58-62
|How to cite this URL:|
Chaudhari D, Mahale S, Kadam P, Shimpi S, Kalekar L, Sonar P. A comparative clinicomicrobiological study to evaluate efficacy of superoxide solution with povidone-iodine irrigation in chronic periodontitis patients. J Oral Res Rev [serial online] 2019 [cited 2020 May 30];11:58-62. Available from: http://www.jorr.org/text.asp?2019/11/2/58/262765
| Introduction|| |
Chronic periodontitis is a complex disease which involves intricate interactions of the biofilm with the inflammatory response and subsequent alterations in bone and connective tissue metabolism.
To eliminate the focus of infection, chronic periodontitis is treated by mechanical debridement, and to enhance its effect, chemotherapeutic agents are used either systemically or locally. Various disadvantages of the systemic antibiotic therapy led to the use of more site-targeted delivery systems. To overcome these disadvantages, a variety of new drugs are under research.
Subgingival irrigation may be done by different agents such as water, saline, and antiseptics/antimicrobial agents. These irrigants can be delivered to the site with the commercially available subgingival irrigation systems. These systems developed to deliver the antiseptic/antimicrobial agents deep into the periodontal pocket.
Superoxidized solution (99.9% W/V) has shown to be both safe and efficient as a wound care agent that moistens, lubricates, debrides, and reduces the microbial load of various types of lesions. They are electrochemically processed aqueous solutions manufactured from pure solutions which are rich in reactive oxygen species with neutral PH and longer half shelf life (>12 months). It is a stable, nonflammable, and noncorrosive bactericidal, fungicidal, sporicidal, and virucidal solution which is ready to use with no further dilution or mixing. Superoxidized solution exerts an antibacterial effect on cariogenic and periodontopathic bacteria, suggesting its potential as a disinfectant in the prevention of bacterial contamination of dental equipment.
Superoxidized solution which has highly reactive superoxide ion i.e. O2 − which is a common form of oxygen that is created when molecular oxygen gains a single electron. Superoxide radicals can attack susceptible biological targets, including lipids, proteins, and nucleic acids.
Povidone-iodine (polyvinylpyrrolidone-iodine complex) might constitute a valuable adjunct to the current periodontal therapy because of its broad-spectrum antimicrobial activity, low potential for developing resistance and adverse reactions, wide availability, ease of use, and low financial cost. In any event, subgingival application of antimicrobials may be most useful in conjunction with mechanical removal of subgingival biofilms and infected calculus that might shield pathogenic bacteria from the action of antimicrobial agents.
Mechanism of action
Superoxidized solution molecules are broken to form ions and free radicals, which denature proteins of the bacterial cell wall. They produce an unbalanced osmolarity; it is a difference between the concentration of the ions in the solution and the concentration of the same ions in the cell that damages a single-cell organism. Povidone-iodine (polyvinylpyrrolidone-iodine complex [PVP-iodine]) are probably the most broad-spectrum and potent antiseptics available. Dilute PVP-iodine may be able to kill Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and other periodontal pathogens.
The aim of the present study was to compare the superoxide solution with povidone-iodine by means of clinical parameters and microbiologically by colony-forming units.
| Materials and Methods|| |
A total of 20 sites with chronic periodontitis were selected for the study and randomly divided into two groups (ten sites per group) by odd–even numbers. In each patient, sites were selected having probing depth ≥5 mm.
The inclusion criteria for this study were patients having periodontal pocket depth ≥5 mm and systemically healthy patients. Exclusion criteria were patients unable to perform routine oral hygiene procedures, patients who are known smokers, any uncontrolled local or systemic disease patients, pregnant or lactating women, and acute gingival or periodontal disease patients.
The patients were randomly allotted into one of the following groups prior to treatment.
- Group A (study group – irrigation with superoxidized solutions)
- Group B (study group – irrigation with povidone-iodine (Betadine).
In each patient, full-mouth scaling and root planing (SRP) was performed. The study period of 30 days was divided into baseline (0 day) and 30th day. Periodontal pockets were irrigated with superoxidized solution (oxum) and povidone-iodine (Betadine) from 10-ml syringe having blunt metallic cannula. A total time of 5–10 min was spent for irrigation of the sites.
Samples of subgingival plaque from periodontal pockets were obtained using sterile Gracey curette of respected tooth numbers. Samples were collected at baseline and 1 month to check the colony-forming units. Collected plaque was diluted in 5 ml saline and kept for 24 h. After that plaque sample from saline were spreaded on agar plates and then incubated at 37°C for 24 h. As shown in [Figure 1], [Figure 2], [Figure 3], [Figure 4]. Probing pocket depth (PPD) and sulcus bleeding index (SBI) were recorded on baseline and after 1 month [Table 1].
Data were entered into Microsoft Excel and analyzed using the Intrastat software (European office) by applying unpaired t-test. Statistical significance was set at P < 0.05.
| Results|| |
The mean PPD at baseline and 30 days was observed to be 1.716 ± 0.351 and 0.683 ± 0.274, respectively, for Group A and 1.700 ± 0.380 and 1.00 ± 0.00, respectively, for Group B [Table 2].
|Table 2: Comparative analysis of clinical parameters at different time intervals|
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The mean gingival sulcus bleeding scores at baseline and 30 days were observed to be 1.726 ± 0.351 and 0.603 ± 0.274, respectively, for Group A and 1.700 ± 0.380 and 1.25 ± 0.00, respectively, for Group B [Table 3].
There was a statistically significant reduction in colony-forming units in Group A after 1 month as compared to Group B, as shown in [Graph 1].
| Discussion|| |
The primary role of bacteria in the etiology of periodontal diseases is unequivocal. Various treatments have been used for it, yet traditional mechanical debridement to disrupt the subgingival flora and provide clean, smooth, and biologically compatible root surfaces is still the mainstay. Even though the outcome of mechanical debridement usually satisfies in terms of reduction in probing depth and bleeding on probing, difficulties reaching the bottom of the pocket can lead to its failure. As a consequence, supplementary treatment becomes inevitable.
Moreover, it has also been demonstrated that the time spent on therapy, the number of sites that require instrumentation, and the experience of the clinician may influence the success of SRP. These findings indicate that SRP is a technique-sensitive method for treating periodontitis. Furthermore, some microbiota simply cannot be mechanically eradicated. Indeed, bacterial invasion in cementum, radicular dentin, and the surrounding periodontal tissues has been reported. Issac et al. stated that ozonized water subgingival irrigation can improve the clinical and microbiological parameters in patients with chronic periodontitis when used as an adjunct to scaling and root planing. The idea of subgingival irrigation of a superoxidized water as an adjunct to SRP was to compensate for the shortcomings of the former, thereby improving the treatment outcome.
There are several ways of delivering chemical agents. One of the ways such as the subgingival irrigation interferes with the complex ecosystem required for the initiation and continued destruction of the compromised periodontium in the susceptible host. The effects of irrigation on gingival bleeding and plaque include change in plaque composition, flushing out of inflammation-inducing factors, and physical change in tissue integrity. Krck et al. studied clinical and microbiologic results 12 months after scaling and root planing with different irrigation solutions in patients with moderate chronic periodontitis. They concluded that no differences were seen among the groups in the clinical results after 12 months. Regarding the microbiologic results, a slight benefit seemed to derive from the use of povidone-iodine. Sindhura et al. concluded that 10% povidone-iodine irrigation as an adjunct to SRP favored the nonsurgical periodontal therapy, due to its broad-spectrum antimicrobial activity. Hence, it could be considered as an adjunctive treatment approach in the treatment of chronic periodontitis.
The results of the present investigation show that superoxidized water irrigation in Group A is better than Betadine irrigation in Group B. This could be attributed to the substantivity and antimicrobial property imparted by superoxidized water.
However, Group A showed comparable improvement in all the clinical parameters (PPD and SBI) than Group B. These results suggest the effective usage of superoxidized water irrigation which could aid in the treatment of periodontal disease. It proved to be a more effective treatment modality than SRP alone, as demonstrated by the clinical parameters.
Many studies have been conducted which have proved its efficacy and safety of superoxidized water in diverse conditions such as diabetic foot ulcer, venous stasis ulcers, bed sores, burns, cuts, absasions, postoperative infective wounds, cellulitis, and abscesses.
The limitation of the present clinical trial was the small sample size and the short duration for determining the efficacy of the experimental drug. Thus, further longitudinal studies are recommended with a larger sample size for the evaluation of the efficacy of superoxidized water in the treatment of chronic periodontitis patients.
| Conclusion|| |
Within the limitations of the present study, superoxidized water irrigation as an adjunct to SRP proved to be effective in the treatment of periodontitis. They allowed better retention and were biologically accepted without any side effects. Moreover, it was simple to use and required less chairside time. Hence, it appears as a viable and an inexpensive option for the common man and can be incorporated as a treatment modality in day-to-day life.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Allenspach-Petrzilka GE, Guggenheim B. Bacterial invasion of the periodontium; an important factor in the pathogenesis of periodontitis? J Clin Periodontol 1983;10:609-17.
Landa-Solis C, González-Espinosa D, Guzmán-Soriano B, Snyder M, Reyes-Terán G, Torres K, et al
. Microcyn: A novel super-oxidized water with neutral pH and disinfectant activity. J Hosp Infect 2005;61:291-9.
Dhusia H. Comparative efficacy and tolerability of microcyn superoxidized solution (oxum) against povidone iodine application in orodental infections. Indian Med Gaz 2008;69-75.
Yamada K, Yama M, Takaku Y, Kakizawa T, Kimizuka R, Okuda K, et al
. Antimicrobial activity of super-oxidised water against oral microorganisms. Arch Oral Biol 2010;55:397-400.
Kapur V, Marwaha AK. Evaluation of effect and comparison of superoxidised solution (oxum) v/s. povidone iodine (betadine). Indian J Surg 2011;73:48-53.
Sreenivasan PK, Meyer DH. Fives-Taylor PM. Requirements for invasion of epithelial cells by Actinobacillus actinomycetemcomitans. Infect Immun 1993;61:1239-45.
Rossi-Fedele G, Figueiredo JA, Steier L, Canullo L, Steier G, Roberts AP, et al
. Evaluation of the antimicrobial effect of super-oxidized water (Sterilox®
) and sodium hypochlorite against Enterococcus faecalis in a bovine root canal model. J Appl Oral Sci 2010;18:498-502.
Rathakrishnan M, Sukumaran VG, Subbiya A. To evaluate the efficacy of an innovative irrigant on smear layer removal – SEM analysis. J Clin Diagn Res 2016;10:ZC104-6.
Issac AV, Mathew JJ, Ambooken M, Kachappilly AJ, Pk A, Johny T, et al
. Management of chronic periodontitis using subgingival irrigation of ozonized water: A clinical and microbiological study. J Clin Diagn Res 2015;9:ZC29-33.
Aragón-Sánchez J, Lázaro-Martínez JL, Quintana-Marrero Y, Sanz-Corbalán I, Hernández-Herrero MJ, Cabrera-Galván JJ, et al
. Super-oxidized solution (Dermacyn wound care) as adjuvant treatment in the postoperative management of complicated diabetic foot osteomyelitis: Preliminary experience in a specialized department. Int J Low Extrem Wounds 2013;12:130-7.
Brownstein CN, Briggs SD, Schweitzer KL, Briner WW, Kornman KS. Irrigation with chlorhexidine to resolve naturally occurring gingivitis. A methodologic study. J Clin Periodontol 1990;17:588-93.
Sindhura H, Harsha RH, Shilpa RH. Efficacy of subgingival irrigation with 10% povidone-iodine as an adjunct to scaling and root planing: A clinical and microbiological study. Indian J Dent Res 2017;28:514-8.
] [Full text]
Sekiya S, Ohmori K, Harii K. Treatment of infectious skin defects or ulcers with electrolyzed strong acid aqueous solution. Artif Organs 1997;21:32-8.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3]