root conditioning agents
TRANSCRIPT
By,T.MYTHREYEE
ROOT CONDITIONING AGENTS
Periodontium-Gingiva,Alveolar bone,Periodontal ligament,Cementum.
Periodontal diseases-main etiological agent-’’BACTERIA’’.
On the root surface bacteria are mostly gram –ve bacteria.
These bacteria in the cementum of teeth with untreated periodontal disease
Endotoxins(have potent inflammatory agents)
Prevent the growth of FIBROBLASTS and are CYTOTOXIC.
These changes create obstacle to new ATTACHMENT.
So the root must be cleaned of cementum bound endotoxins.
In vitro mechanical removal of cementum is possible and showed new growth of cells(Aleo,et al 1975;Cogen et al 1983,1984)
ATTACHMENT LOSS
Root planing removes diseased cementum but it produces a ‘’smear layer’’.
In vivo total removal of cementum is not possible and trace amounts of endotoxins are left behind(JONES and O’HEARY,1978).
TOPICAL CHEMOTHERAPUTIC AGENTS:for detoxification and enhancement of new attachment in:
Cosmetic gingival reconstruction(Miller,1985)
Bone augmentation(Yukna,1980)Overcome rapid rate of epithelial
proliferation down along the root.
Use of acids-1st reported in NEWYORK DENTAL RECORD in 1846,later YOUNGER(1893)
Several substances have been used for ROOT CONDITIONING-
These include Citric acid,Fibronectin,Tetracycline.
CITRIC ACIDStudies by Urist
showed formation of new bone or cementum on partially or totally demineralised dentin matrix or allogenic bone.
pH-1.0-1.4Application time-
2or 3 min.
MODE OF ACTIONRemoval of smear layer formed after root
planing
This creates a mat like collagen surface with exposed dentinal tubules
PDL cells and gingival FIBROBLASTS adhere better to demineralized root surface.
CITRIC ACID MECHANISM FOR GAINING ROOT COVERAGEEXPOSED ROOT SURFACE
CITRIC ACID Ph 1.0
4microns DEMINERALIZED SURFACE EXPOSED COLLAGEN FIBRILS +EXPOSED COLLAGEN FIBRILS OF FLAP OR GRAFT.
PLASMA FIBRONECTIN FACTOR,FACTOR 13
FIBRIN COVALENT LINKAGE
COLLAGEN FIBRILS OF ROOT
NEWLY SYNTHESIZED COLLAGEN FIBERS
COLLAGEN FIBRILS OF GRAFT
ACTIONSAccelerated healing and new cementum
formation.No significant action on non-root planed
roots,after root planing-4mm deep demineralized zone is created.
Antibacterial effect.(Daly,1982)Root detoxification(Aleo et al,1975)Prevents migration of epithelium .Enhanced fibroblast growth and
stability(Boyko et al ,1980)Attachment by direct linkage.
TECHNIQUE OF APPLICATION
TETRACYCLINE HCLActions-• Antibacterial,expos
ure of root collagen and opening of the dentinal tubules
DemineralizationDetoxificationAttachment by
direct linkage
Other advantages
DISADVANTAGESRequires high concentrations(>0-5%)Longer application times(>5min)Not so effective as CA in root
demineralization and removal of smear layer.
No human histologic or clinical studies show +ve results as CA.
FIBRONECTINIt is a glycoprotein that fibroblasts require
to attach to root surfaces.Addition of fibronectin-promotes new
attachment.Fibronectin-fibrin sealing system helps in
healing of PERIODONTAL SURGICAL WOUNDS
Commercially available in Europe as ‘’TISSUCOL’’.
ACTIONSEnhances the effect of demineralization
with regard to new attachmentEnhances cell proliferation from PDL and
SUPRACRESTAL areaConc-0.38/ml saline,has also been used as
a substitute for suturesChemotactic effect on fibroblasts and
mesenchymal cells.
APPLICATIONSCOSMETIC GINGIVAL RECONSTRUCTIONPRIOR TO PLACEMENT OF BONE IMPLANTSINFRABONY DEFECTSIMPLANT ADDITIVE(TTC)PRIMARY TREATMENT FOR CL2
FURCATIONS.
CONCLUSIONAlthough not yet fully supported by
research on humans,CA and TTC have significant benefits that cannot be achieved by scaling and root planing alone.
In future they may provide a surface substrate for use of’’ PROTEIN MODIFIERS’’.
Note:’’SYNTHETIC BIOLOGIC PROTEIN MODIFIERS’’-artificially stimulate tissue regeneration.
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