Enhanced β‐Tricalcium Phosphate Blended Clot Adhesion to EDTA Biomodulated Periodontally Affected Root Surfaces: In Vivo Scanning Electron Microscopy Evaluation

Abstract

Root conditioning with EDTA gel improves β-TCP blended clot adhesion to periodontally involved root surfaces.

In vitro evaluation of gingival fibroblasts proliferation and smear layer formation in pre-conditioned root surfaces

“…Regarding an alternative to low pH conditioners, EDTA is a chelating agent with a neutral pH 11,14 that is bactericidal 7 and exerts a demineralizing effect 5 , exposing the dentin matrix proteins without changing the biochemical and structural properties of the periodontal tissues 2,12,17 . Therefore, the present study aimed to evaluate, in vitro, the structural morphology of root surfaces conditioned with 10% citric acid gel, 24% EDTA gel, and 50mg/ ml tetracycline hydrochloride, as well as to compare the proliferation of human fibroblasts cultivated on these surfaces.…”

“…Its progression is associated to subgingival bacterial colonization 2 , whose toxins are absorbed and fixed to the cement surface 3 , acting as a barrier to the attachment of periodontal tissues [2][3][4][5][6] , consequently promoting irritation, collagen fiber degradation 3 , progressive alveolar bone, cement and periodontal ligament destruction 7 . Root surface conditioning of a tooth affected by periodontal disease aims to remove dental calculus, bacterial biofims and their toxins 2,[8][9] , which consequently contributes to a reduced inflammatory process, periodontal tissue repair [10][11][12] including formation of new supporting tissues [12][13][14] . However, mechanical debridement procedures are known to create a layer of organic, mineralized waste, also known as smear layer, which covers the prepared root surface and obstructs the dentinal tubules [14][15] , serving as substrate for bacterial growth and making periodontal attachment to the root surface more difficult 11 .…”

“…Root surface conditioning of a tooth affected by periodontal disease aims to remove dental calculus, bacterial biofims and their toxins 2,[8][9] , which consequently contributes to a reduced inflammatory process, periodontal tissue repair [10][11][12] including formation of new supporting tissues [12][13][14] . However, mechanical debridement procedures are known to create a layer of organic, mineralized waste, also known as smear layer, which covers the prepared root surface and obstructs the dentinal tubules [14][15] , serving as substrate for bacterial growth and making periodontal attachment to the root surface more difficult 11 . Therefore, an alternative method to remove the smear layer is the combination of debridment and chemical root conditioning, which may be capable of decontaminating, detoxifying and demineralizing the root surface, thus opening the dentinal tubules and exposing the collagen matrix 2,[11][12][13][14]16 , which is fundamental for recolonization of cells involved in periodontal repair 2,[10][11][12]14 , promoting a urface that is biologically compatible with both epithelial and connective issues 2,12,14,[17][18] .…”

“…Citric acid was the first chelating agent to be used 19 . It features antimicrobial action 10,[19][20] , promotes superior fibrin interlinking 20 and intensifies mesenchymal cell adhesion via biochemical mechanisms 11 , accelerating cementogenesis 12,14 . However, high concentrations of this chemical conditioner must be avoided 5 , since an extremely acidic pH results in necrosis, denatured collagen and unfavorable periodontal repair on adjacent tissues 18 .…”

“…Tetracycline hydrochloride (TTC-HCl) is another chemical conditioner that increases extracellular matrix protein bond to dentin, and stimulates growth and fibroblast fixation [4][5]11 . In addition, it increases the effectiveness of fibronectin, a collagenase inhibitor 21 and it also features presenting anti-inflammatory 19 as well as antibacterial properties 5,12 , all of which are maintained for between 48 hours and 14 days 4,21 , due to adsorption and slow release by dentin 4 .Regarding an alternative to low pH conditioners, EDTA is a chelating agent with a neutral pH 11,14 that is bactericidal 7 and exerts a demineralizing effect 5 , exposing the dentin matrix proteins without changing the biochemical and structural properties of the periodontal tissues 2,12,17 . Therefore, the present study aimed to evaluate, in vitro, the structural morphology of root surfaces conditioned with 10% citric acid gel, 24% EDTA gel, and 50mg/ ml tetracycline hydrochloride, as well as to compare the proliferation of human fibroblasts cultivated on these surfaces.…”