Comparison among four commonly used demineralizing agents for root conditioning: a scanning electron microscopy

Nathalia Godoy do Amaral,Marcus Gustavo Silva Rodrigues,Sebastião Luiz Aguiar Greghi,Fabiana Hirata,Adriana Campos Passanezi Sant'Ana,Maria Lúcia Rubo de Rezende,Euloir Passanezi

doi:10.1590/s1678-77572011000500006

Nathalia Godoy do Amaral, Marcus Gustavo Silva Rodrigues + Show 5 more

Open Access

https://doi.org/10.1590/s1678-77572011000500006

Copy DOI

Abstract

Dental roots that have been exposed to the oral cavity and periodontal pocket environment present superficial changes, which can prevent connective tissue reattachment. Demineralizing agents have been used as an adjunct to the periodontal treatment aiming at restoring the biocompatibility of roots.ObjectiveThis study compared four commonly used demineralizing agents for their capacity of removing smear layer and opening dentin tubules. MethodsFifty fragments of human dental roots previously exposed to periodontal disease were scaled and randomly divided into the following groups of treatment: 1) CA: demineralization with citric acid for 3 min; 2) TC-HCl: demineralization with tetracycline-HCl for 3 min; 3) EDTA: demineralization with EDTA for 3 min; 4) PA: demineralization with 37% phosphoric acid for 3 min; 5)Control: rubbing of saline solution for 3 min. 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. ResultsSmear layer was present in 100% of the specimens from the groups PA and control; in 80% from EDTA group; in 33.3% from TC-HCl group and 0% from CA group. The mean numbers of exposed dentin tubules in a standardized area were: TC-HCl=43.8±25.2; CA=39.3±37; PA=12.1±16.3; EDTA=4.4±7.5 and Control=2.3±5.7. The comparison showed significant differences between the following pairs of groups: TC-HCl and Control; TC-HCl and EDTA; CA and Control; and CA and EDTA. The mean percentages of area occupied by exposed dentin tubules were: CA=0.12±0.17%; TC-HCl=0.08±0.06%; PA=0.03±0.05%; EDTA=0.01±0.01% and Control=0±0%. The CA group differed significantly from the others except for the TC-HCl group. ConclusionThere was a decreasing ability for smear layer removal and dentin tubule widening as follows: AC>TC-HCl>PA>EDTA. This information can be of value as an extra parameter for choosing one of them for root conditioning.

Highlights

One of the goals of periodontal therapy is the predictable regeneration of the periodontium in areas previously affected by periodontal disease5,23,27
Histological and ultrastructural studies have demonstrated that dental roots that have been exposed to the oral cavity or to the periodontal SRFNHW SUHVHQW UHGXFHG FROODJHQ ¿EHU LQVHUWLRQ1, changes in their mineral density27 and root contamination by bacteria and its products1
Scaling and root planing alone are not able to fully eliminate the etiological contaminants and produce a compact smear layer covering the instrumented surface2,5 ZKLFK LQKLELWV SHULRGRQWDO WLVVXH UHDWWDFKPHQW5. These alterations have become the rationale for the use of demineralizing agents as adjunct to periodontal therapy due to their potential for removing smear layer and exposing the underlying UDGLFXODU FROODJHQ ¿EULOV IXQQHOLQJ GHQWLQ WXEXOHV and modifying dentin permeability, restoring the biocompatibility of the roots9,26

Summary

Introduction

One of the goals of periodontal therapy is the predictable regeneration of the periodontium in areas previously affected by periodontal disease. Scaling and root planing alone are not able to fully eliminate the etiological contaminants and produce a compact smear layer covering the instrumented surface ZKLFK LQKLELWV SHULRGRQWDO WLVVXH UHDWWDFKPHQW5 These alterations have become the rationale for the use of demineralizing agents as adjunct to periodontal therapy due to their potential for removing smear layer and exposing the underlying UDGLFXODU FROODJHQ ¿EULOV IXQQHOLQJ GHQWLQ WXEXOHV and modifying dentin permeability, restoring the biocompatibility of the roots. Clinical trials have provided insufficient evidence that acid conditioning of GLVHDVHG GHQWDO URRWV SUHVHQW DQ\ DGGLWLRQDO QHZ DWWDFKPHQW ZKHQ FRPSDUHG WR QRQFRQGLWLRQHG RQHV 7KH RQO\ V\VWHPDWLF UHYLHZ IRXQG RQ WKLV VXEMHFW ZDV SXEOLVKHG E\ 0DULRWWL19 ZKR concluded that the use of citric acid, tetracycline or EDTA to modify the root surface provides no EHQH¿W RI FOLQLFDO VLJQL¿FDQFH WR UHJHQHUDWLRQ LQ SDWLHQWV ZLWK FKURQLF SHULRGRQWLWLV 2Q WKH RWKHU KDQG WKH DXWKRU LGHQWL¿HG WKDW VHYHUDO IDFWRUV DV lack of controls, non-calibrated examiners, masked reference standards and small sample sizes, among others, reduced the observational quality of relevant studies. Mariotti (2006) stated WKDW WKH RYHUDOO FRQFOXVLRQ RI KLV UHYLHZ PXVW EH carefully considered

Objectives

Methods

Results

Conclusion