Effects of Citric Acid and EDTA on Periodontally Involved Root Surfaces: A SEM Study

Abstract

Aim: Root debridement by scaling and root planing may not completely remove contaminated cementum particularly in more apical areas. The smear layer formed during root planing inhibits cell migration and attachment leading to impaired marginal periodontal healing. The present study was done to compare the morphological effects of root surface demineralization using citric acid and EDTA as root-conditioning agents. Materials and methods:Thirty fragments of human dental roots previously exposed to periodontal disease were scaled and randomly divided into the following groups of treatment: Group I: Hand instrumentation and conditioning with normal saline for 5 minutes as control; group II: Hand instrumentation and conditioning with citric acid (pH 1) for 5 minutes and group III: Hand instrumentation and conditioning with EDTA (pH-7.4) for 5 minutes. Scanning electron microscopy was used to check for the presence of residual smear layer and for measuring the number and area of exposed dentin tubules. Results:The mean efficacy of smear layer removal was compared between groups I and II, groups I and III and groups II and III, it was found to be statistically significant at 5%. When the mean diameter of the dentinal tubules and mean total surface area occupied by the dentinal tubule orifices was compared between groups II and III it was found to be statistically significant at 1% level of significance. Conclusion:Citric acid causes greater degree of morphological alterations than EDTA and is considered to be a better rootconditioning agent. However, the use of EDTA cannot be ruled out.Clinical significance: This study supports the hypothesis that demineralizing agents can be used as an adjunct to the periodontal treatment aiming at restoring the biocompatibility of roots and helps in choosing an appropriate agent for root conditioning.

Effect of Bioconditioning on Surface Characteristics of Periodontally-affected Roots of Diabetic Patients

“…TC is famous for its antibacterial and anticollagenase activities. 6 At the same time, SEM images revealed an evident dissolving effect on the smear debris layer (see Fig. 10) and a sensible effect on roots' surface cuticles (see Fig.…”

“…Accordingly, this in vitro study was designed to assess the ability of three different topicallyapplied chemicals (EDTA, TC and CA), in comparison to normal saline, to condition and biomodify the surfaces of the periodontallyaffected teeth of both healthy and diabetic patients. 6 and their existence interferes with the proper healing and attachment of perio dontal tissue. 2 This inter ference comes through limiting the intimate contact at roottissue interface.…”

“…7 However, these actions appeared to be more depen dent on the morphologic structure of root cementum and the severity of the mechanical instrumentation rather than on the concentration and time of TC application. 11 Prasad et al (2012) 6 reported the success of CA in doing the same conditioning function that EDTA and tetra cycline do. Others demonstrated higher efficacy of CA and recommended its use for root surface conditioning.…”

Does chemical preconditioning contribute to the effectiveness of scaling and root planing? An in vitro pilot investigation

“…Several studies demonstrated the influence of SRP combined with various conditioning agents, such as citric acid, EDTA or tetracycline hydrochlorite on smear layer removal, diameter alteration of dentinal tubules and on the dentin collagen matrix using SEM approach (16,17). These results indicate that root conditioning after SRP is favourable for smear layer removal as well as in exposing the collagen matrix (18).…”

Efeito do protocolo de desmineralização por ácido cítrico na área de superfície radicular recoberta por fibroblastos do ligamento periodontal humano: estudo à microscopia eletrônica de varredura

“…Existe profusão de publicações quanto a diferentes tipos de biomodificadores radiculares químicos, sendo o ácido cítrico considerado o agente de maior efetividade na remoção da smear layer, na exposição das fibras colágenas e na abertura completa dos túbulos dentinários (MINOCHA et al, 2014, CAVASSIM et al, 2012., FONTANARI et al, 2011, AMARAL et al, 2011, PRASAD et al, 2012, ABED et al, 2013. Também tem sido demonstrado que o tratamento com ácido cítrico produz maior adesão e proliferação de fibroblastos do ligamento periodontal humano sobre as raízes (FARDAL; LOWENBERG, 1990, ROMPEN et al, 1999, assim como absorção e adesão de rede de fibrina contendo elementos celulares como eritrócitos e plaquetas, importantes para o reparo dos procedimentos cirúrgicos periodontais (AMIREDDY et al, 2011., BAKER et al, 2000…”