A cost-effective method utilizing both povidone-iodine irrigations and sodium hypochlorite rinsing solution as supplementary measures in treating severe gum disease, aimed at reducing bacterial infections in patients

Approved 12/10/2020, The Research Ethics Committee of the ‘Victor Babeş’ University of Medicine and Pharmacy Timisoara (Pta Eftimie Murgu nr. 2, Timișoara, 300041, Romania; +40 256204400; esanda2000@yahoo.com), ref: 56/2020

Pocket Depth (PD) reduction. PDs were measured at six sites/tooth using a PCP-UNC calibrated probe (Hu-Friedy, Chicago, IL, USA), at baseline and after 3 months.

1. Full-mouth plaque scores (FMPS) were recorded using six sites per tooth. The presence of plaque was determined using disclosure solution (Dentorama Blue Disclosing Pellets Pro-155, Svenska Dentorama AB, Solna/Stockholm, Sweden), in a dichotomic way, with regard to the percentage of sites with plaque.
2. Bleeding on probing (BOP) was assessed dichotomously in 6 sites per tooth, using a periodontal probe (Force-Control Periodontal Probe WHO DB765R, Aesculap, Tuttlingen, Germany).
3. Recession (REC) were recorded to the nearest millimeter at six sites per tooth.
4. The clinical attachment level (CAL) was calculated using the PD and REC values. Measurements were rounded up to the next whole millimeter value. At the proximal surfaces, the evaluation was done in the proximity of the dental contact point, with moderate pressure. For all clinical measurements the probing force was 0.2N (20 g) using the same standardized periodontal probe.
5. Mobility was recorded in degrees, according to the Miller classification system (1985) (40). The periodontal parameters were recorded in the periodontal chart (http://www.periodontalchart-online.com/uk/), saved in .pdf format, printed and included into each patient’s observation file.

Other secondary outcomes:
6. Microbiological data: In the same appointment, bacterial samples were taken as described below: to detect the 5 major keystone bacteria, Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingi-valis (Pg), Prevotella intermedia (Pi), Tanererella forsythia (Tf), and Treponema denticola (Td), a molecular genetic analysis was performed, using the commercial kit micro-IDent plus (Hain Lifescience GmbH). During the initial evaluation, samples of subgingival plaque were collected from the deepest periodontal pockets in each quadrant and used to identify the existing bacterial strains prior to treatment. This protocol was repeated at the three- month re-evaluation to assess post treatment bacterial suppression. Samples were collected by using four sterile paper points #25 (ProTaper Next® Paper Points X2; Dentsply Sirona) that were inserted into the gingival sulcus after having removed any supragingival plaque with sterile cotton gauzes, isolated the site with cotton rolls, and taken measures to avoid contamination with saliva. After the targeted tooth surface was dried with a gentle air spray, the paper points were left in situ for 30 sec until they were completely soaked. Bacterial analyses were repeated at three months.

Patient-centered data:
7. Patient-centered data regarding the perception of the recommended concentration of hypochlorite were collected using a VAS scale. Perception of the taste during use, tolerance, oral dryness sensation, and esthetic impact of staining after three months of use were evaluated by the patient on a scale from 1 to 10. Other subjective perceptions regarding the taste modifications, oral mucosa irritations, long-term negative effects, the intensity of the sensation of cleanliness, ease of solution preparation, and economic impact were collected and evaluated on a 1 to 5 scale of approval.