Root Biomodification in Periodontics - The Changing Concepts

Bhushan K,Prakash S,Chauhan G

doi:10.15744/2454-3276.2.105

Abstract

Periodontitis is a multifactorial chronic inflammatory disease characterized by destruction of tooth supporting tissues. Repair of the periodontium and the regeneration of periodontal tissues remains a major goal in the treatment of periodontal disease and is an area still in need of major research attention. Periodontal regeneration has come to the forefront of periodontal research and practice. Research regarding periodontal therapy has made it clear that standard treatment techniques do not result in periodontal regeneration. It has become apparent that, if the goal of periodontal regeneration is to be realized, the problem of regeneration needs to be approached from a biological perspective. One important consideration in periodontal regenerative attempts is the root surface which has become exposed to the oral cavity as a result of Periodontitis. In regenerative attempts the root surface functions as one of the wound margins and must provide an appropriate surface for cell attachment and fiber development if regeneration is to occur. Changes in the pathologically exposed root surface are well documented. Varying results from clinical and histological studies have created controversies about the clinical effectiveness of biomodification of root surfaces. This review attempts to provide an insight into the present scenario of root biomodification in clinical conditions along with an overview of related studies.

Highlights

Periodontitis involves an inflammatory process of bacterial origin, affecting the periodontal tissues and provoking the destruction of the supporting tissues of the teeth
The mechanism by which these chemicals operate on the root surface is not well understood, but it has been hypothesized that demineralizing agents act by exposing collagen fibers within the root matrix thereby facilitating attachment by other fibers in the periodontium, and/or by decontaminating the root surface via elimination of endotoxin and bacteria, and/or by removal of the root debris allowing for the unobstructive attachment of regenerative cells to the root surface [8]
The results demonstrated that citric acid combined with platelet derived growth factor-BB showed better results than ethylenediamine tetraaceticacid (EDTA) and tetracycline hydrochloride on attachment of periodontal ligament cells on root surfaces [58]

Summary

Introduction

Periodontitis involves an inflammatory process of bacterial origin, affecting the periodontal tissues and provoking the destruction of the supporting tissues of the teeth. Sture Nyman, Lindhe, and Karring studied the healing following surgical treatment and root demineralization in monkeys with periodontal disease reported that citric acid conditioning of the root dentin surface did not promote cementum formation and new connective tissue attachment [18]. These findings have provided the basis for later studies using root surface demineralization in periodontal regeneration attempts in both in vitro and in vivo model systems. In addition to chemical conditioning, the applicability of different laser systems, such as the CO2, Nd:YAG diode, and Er:YAG laser in the removal of the smear layer has been demonstrated

Mechanical methods

Chemical methods

Findings

Conclusion