ROOT CONDITIONING BEFORE PERIO SURGERIES

[Anonymous]

The tissue healing after periodontal therapy includes epithelial and connective tissue repair by producing biocompatible root surface. Objective: The objective of this study was investigate whether etching solutions such as Tetracycline-hydrochloride (TTC-HCl) or citric acid associated with mechanical treatment in rats may enhance the healing after periodontal therapy. Methods: A cotton ligature was placed around the 2nd maxillary molar in 33 animals. After 5 weeks the ligature was removed and the teeth were treated by scaling plus TTC-HCl 10% solution (10 animals), or by scaling plus citric acid 8% solution (11 animals) or by scaling plus NaCl 0,9% solution (12 animals). In order to delineate the area for histological analysis, a reference notch was made on the root surface at the level of the bottom of the pocket. Animals were sacrificed at 3rd, 7th and 21st day after treatment. Specimens were histomorphometrically analyzed to determine the percentage of tissue which filled the notch and which tissue had filled it. Data was statistically analyzed by ANOVA-two way, with a General Linear Model at significant level of 5%. Results: The results showed that the percentage mean of reparative tissue which has filled the notch was 43,80 ± 12,9 for TTC-HCl solution, 46,6 ± 18,5 for citric acid solution and 64,8 ± 11,8 for NaCl solution. The difference of the percentage of reparative tissue between all the sacrifice periods and the interaction between sacrifice periods and solutions were not statistically significant. Conclusion: This results indicated that in this study the acid solutions used for root conditioning could not enhance the healing after periodontal therapy.

        

[Drsumitra]

Materials used for root conditioning include
FIBRONECTIN
TETACYCLINE
CITRIC ACID

Of these most widely used is citric acid
CItric acid have the following actions
Accelerated healing and new cementum formation after surgical detachment of gingival tissues and demineralisation of root surface by means of citric acid
It has no effect on non planed roots however when applied on planed roots, it leads to producing a 4micromm deep demineralised zone with exposed collagen
Removes debris as also smear layer and makes the exposed dentinal tubules appear wider and funnel shaped orifices
Eliminates bacteria and endotoxins from the root surface
Early fibrin linkage to collagen fibres exposed by the citric acid prevents epithelium migration over treated roots

REcommended technique is as follows::
Raise mucoperiosteal flap
Thoroughly plane the root surface
Apply cotton pledgets soaked in saturated citric acid pH 1 for 2-5 mins
Remove pledgets and irrigate thoroughly
REplace flap and suture

        

[sushantpatel_doc]

The effect of citric acid conditioning of the root surface in conjunction with gingival flap surgery including barrier membranes (expanded polytetrafluoroethylene) was clinically evaluated in 26 intrabony periodontal defects in 23 patients. Control treatment included gingival flap surgery with barrier membranes alone. Twelve defects were treated with the experimental and 14 with the control protocol. Healing was evaluated 12 months after surgery. Initial probing depths approximated 6.9 mm and defect depths measured during surgery exceeded 4 mm. The patients exhibited good oral hygiene over the study interval as substantiated by low plaque and bleeding scores. Acid conditioning of the root surface did not enhance periodontal healing in this study, similar amounts of defect resolution were observed following either treatment protocol. Probing depth reduction generally approximated 1.8 mm; gain of clinical attachment, 0.8 mm; and defect bone fill, 1.2 mm. Under the prevailing conditions, the barrier membrane procedure apparently gave a healing result beyond which further improvement could not be achieved by root surface conditioning.

        

[Author]

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