Diseased Root Surfaces Research Articles

Perio-scopy– A literature review

The recent introduction of the Perioscope has dramatically improved the removal of subgingval calculus during periodontal therapy. The Perioscopy system was initially designed to visualize the subgingival region for diagnosis but has been subsequently adapted to aid the treatment of periodontitis. The perioscope, as it is called, is an endoscope that has been specifically designed to explore and visualize the periodontal pocket in patients with periodontitis. An image on a computer monitor shows the diseased tooth's root surface. The Perioscope consists of a miniature camera placed inside a sleeve and inserted under the gingival sulcus or pocket for visualization and instrumentation subgingivally. The subgingval images from the Perioscope is immediately displayed as real-time videos with a magnification ranging from 24-X to 48-X times on a chair side monitor or video screen disclosing even minute details of the pathologies of the root surface which might be missed under conventional visualization. As this microscopic endoscope provides excellent magnified visualization of the root surface and assures the complete or near complete removal of the bacterial infection, this technology provides the best conservative approach to non-surgical and surgical periodontal care.

Effect of platelet-rich plasma on the attachment of periodontal ligament fibroblasts to the diseased root surface and the attendant collagen formation.

To investigate the effect of different concentrations of platelet-rich plasma (PRP) on collagen formation via periodontal ligament fibroblasts (PDLFs) on the surface of demineralised diseased tooth roots. Various PDLFs were grown from tissue explants, with the cells between the fifth and eighth passage in the culture used. Human whole blood obtained from healthy subjects was collected in tubes containing an anticoagulant (acid-citrate-dextrose) and centrifuged (1300rpm for 10min) before the supernatant PRP layer was removed. A second spin at (2000rpm for 10min) produced the PRP fraction. The effect of PRP of various concentrations on the attachment of PDLFs on the diseased root surface of human teeth demineralised with ethylenediaminetetraacetic acid (EDTA) and treated with the PRP was then investigated in terms of PRP collagen formation, with the formation observed using the Sirius red staining method. The optical density values of the experimental groups were statistically significantly higher than those of the control groups (P < 0.05), while the Sirius red staining returned positive results for both the experimental group (A) and the control group (B). The images were analysed using a histogram, and a statistically significant difference was found (P < 0.05). While PRP could promote the attachment and collagen formation of PDLFs on the diseased root surface of human teeth demineralised with EDTA and treated with PRP, the effect is potentially reduced when the dose exceeds 20%.

Differences of bacterial and fungal communities in the tree and rhizosphere of the healthy and twig blight-diseased bayberry

Twig blight is a serious disease of bayberry, which limits bayberry production. In order to prevent and manage the disease, we used high-throughput sequencing technology to analyze bacterial and fungal community richness and diversity in various organs of the tree, bulk and rhizosphere soil of healthy and diseased bayberry. The results showed significant differences in richness and diversity of bacteria and fungi in bulk soil, rhizosphere soil, roots, trunks, barks, and leaves between twig blight diseased trees and healthy trees. In bulk soil, the richness and diversity of bacteria significantly decreased, while that of fungi significantly increased. In barks of diseased trees, the richness and diversity of bacteria significantly increased, and those of fungi significantly decreased. The relative abundance of dominant bacteria and fungi in various organs, bulk soil, and root surface soil changed significantly at phylum, class, and genus levels in the diseased trees. The relative abundance of Pseudomonas sp. on the trunks, roots, and root surface soils of diseased trees significantly decreased, and Fusarium sp. of the diseased root surface and bulk soils also significantly decreased, while the relative abundance of Penicillium sp. on the diseased root surface and bulk soils significantly increased. Pestalotiopsis sp., from the same genus as the twig blight pathogen, was less abundant in the roots but more abundant in the leaves, trunks, barks as well as root surface soils and bulk soils of the diseased bayberry trees than those of the health trees. The relative abundance of Pestalotiopsis sp. was positively correlated with those of most of the fungi. Our results might provide useful theoretical basis for the development of ecological improvement and healthy-tree cultivation technology, and biological control of bayberry twig blight disease.

LPCGF and EDTA conditioning of the root surface promotes the adhesion, growth, migration and differentiation of periodontal ligament cells.

Liquid-phase concentrated growth factor (LPCGF), a new-generation platelet concentrate, may potently stimulate human periodontal ligament (PDL) cells. This study assessed the effectiveness of ethylenediaminetetraacetic acid (EDTA) and/or LPCGF on periodontally diseased root surfaces through their effects on PDL cells. Dentin blocks prepared from periodontal teeth were divided into four groups and treated as follows: group I, scaling and root planning (SRP); group II, SRP + EDTA; group III, SRP + LPCGF; and group IV, SRP+EDTA + LPCGF. PDL cells were cultured on dentin blocks, and LPCGF-induced biological effects were evaluated by migration and cell adhesion/proliferation assays. Furthermore, PDL cell differentiation was assessed by real-time polymerase chain reaction (PCR). Significantly more adherent cells were observed in the EDTA, LPCGF and combination treatment groups than in the control group. Root conditioning with EDTA and/or LPCGF enhanced cell proliferation and migration more than SRP did. Compared with the control group, the combined treatment group exhibited significant upregulation of cell differentiation-related genes. Electron microscopy of the tooth surface revealed removal of the smear layer and exposed dentin holes in the EDTA-treated group but not in the control group. EDTA and LPCGF application to periodontitis-affected root surfaces forms a surface suitable for cell attachment, growth, migration and differentiation. Thus, LPCGF is promising in clinical periodontics applications. Further studies to support these results are necessary.

Effect of 940 nm Diode Laser as Adjunct Treatment to Mechanical Instrumentation on Root Surface Gingival Fibroblast Adhesion in Periodontally Compromised Extracted Teeth : An in vitro Study

Introduction: Mechanical debridement of diseased root surfaces produces a smear layer that encompass microorganisms and residual cementum which may interfere with periodontal healing and regeneration of connective tissue attachment. Accordingly, this study aimed to determine impact of 940nm diode laser on adhesion of fibroblasts to root surface of extracted teeth from patients with chronic periodontitis. Methods: Twenty extracted single-rooted teeth with hopeless prognosis were collected and debrided with hand curettes. Afterward, two specimens were obtained from each tooth by splitting them with a sterile diamond disk. Samples were submerged in fibroblast suspension and randomly divided into two groups. Group A comprised of 20 specimens subjected to scaling and root planing only and group B included 20 specimens which received SRP and and 940 nm diode laser irradiation. The adhesion of fibroblasts was investigated by MTT and cell morphology was assessed with scanning electron microscopy (SEM). Results: The extent of adhesion was higher in group B compared with group A, though this difference was not statistically significant. In the laser group, fibroblast cells showed more elongated morphology and a smaller number of rounded forms was found. But no significant difference was observed between the two groups. Conclusion: A diode laser with a wavelength of 940 nm has a negligible effect on adhesion of fibroblasts to the root surface of teeth extracted because of chronic periodontitis

Evaluation of Remaining Cementum Thickness Following the Use of Hand and Ultrasonic Curettes of Periodontally Diseased Root Surface - An in-vitro Study

Background: Scaling and root planing are the most predictable treatment outcomes for periodontal disease. However root planing with hand curettes removes excess of cementum as compared to ultrasonic curettes. Hence the purpose of this study was to evaluate the effectiveness of remaining cementum thickness following the use of ultrasonic and hand curettes. Aim: To evaluate the remaining cemental thickness following the use of hand and ultrasonic curettes on periodontally diseased root surface using a stereomicroscope. Materials and Methods: Thirty single rooted teeth were extracted due to advanced periodontitis and were randomly divided into two groups: Group 1 (SRP with hand curettes) and Group 2 (SRP with ultrasonic curettes). The proximal surfaces of the teeth (mesial and distal) were subjected to root planning. one surface served as a test site where instrumentation was done and no instrumentation was done on the other surface (control site). Following instrumentation, midroot region of instrumented specimen was cross-sectioned and prepared for stereomicroscopic study. The data gathered from stereomicroscopic study was subjected to statistical analysis by Mann Whitney test. Results: The results of our study showed that in both the groups, the mean cemental thickness in scaled group was significantly lower than unscaled group. Clinically, teeth treated with the ultrasonic scaler showed less tooth substance removal than hand curettes but the difference between the two groups were statistically non-significant. Conclusion: Both the therapies i.e. SRP with hand curettes and ultrasonic curettes seemed to be effective in the removal of diseased cementum.

Evaluation of Effect of Carisolv, EDTA-S and EDTA on Periodontally Diseased Root Surfaces: An In-vitro Scanning Electron Microscopic Study

Evaluation of Effect of Carisolv, EDTA-S and EDTA on Periodontally Diseased Root Surfaces: An In-vitro Scanning Electron Microscopic Study

Kronik Periodontitisli Bir Hastada Kemik İçi Defektlerin Rejeneratif Tedavisi: Vaka Raporu

New attachment achieved by conventional periodontal surgery performed to gain access to diseased root surfaces and to remove local factors such as plaque and endotoxins, usually results in the formation of long junctional epithelium. On the contrary, guided tissue regeneration procedure in which a barrier is utilized to exclude gingival epithelium and connective tissue from the root surface, has been shown to partially regenerate lost periodontal tissues. This case report presents regenerative periodontal treatment of a 38-year old female attending with a complaint of painless swelling in the mandibular left second molar region. The patient was diagnosed as chronic periodontitis based on clinical and radiographic findings and intrabony defects were observed at teeth #14, #15, #16, #25 and #37. After initial periodontal treatment, flap operation with the principles of guided tissue regeneration was performed for treatment of intrabony defects. After 4-year follow-up period, evidence of bone fill and no sign of recurrence were seen at defect sites. It was concluded that regenerative treatment of intrabony periodontal defects by the use of bovine xenograft and collagen membrane combination provides favourable clinical and radiographic outcomes in chronic periodontitis patients and could be maintained up to 4 years successfully.

Effectiveness of dual-wavelength (Diodes 980 Nm and 635 Nm) laser approach as a non-surgical modality in the management of periodontally diseased root surface: a pilot study

Conventional periodontal therapies have been widely discussed in the literature. The results of these therapies, surgically and non-surgically, have demonstrated high predictability and stable maintenance over time. With some clinical indications, such as inflamed sites with consistent bleeding on probing (BOP), it can be challenging for the root planning procedure to achieve predictable outcomes. Therefore, the aim and objectives of the present study were to evaluate whether the dual-wavelength (980 and 635 nm) laser therapy at lower power settings can be beneficial as a combined non-invasive modality in the management of periodontally diseased root surface in terms of improving the periodontal parameters. Thirty-five healthy patients were enrolled in this study. All patients had at least one pocket in the anterior and posterior teeth with initial periodontal pocket depth (PPD) > 6 mm associated with evidence of clinical inflammation, i.e. bleeding on probing (BOP++ or BOP+++) with no gingival recession. The treatment protocol utilized combined therapy of conventional debridement immediately followed by application of dual-wavelength laser therapy (photo-ablation and photodynamic therapies) at lower power settings. The results showed that all the pockets of involved teeth had an average gain of 3 mm of the clinical attachment level with no sign of BOP and reduction in the mobility of the teeth 35 days post-operatively. Thus, the utilization of the dual-wavelength approach of laser-assisted therapy at lower power settings appears to provide a promising and predictable non-invasive clinical approach in the management of compromised periodontally involved teeth.

PR442: In‐vitro evaluation of the effects of different root conditioning agents on diseased root surfaces: a SEM analysis

PR442: In‐vitro evaluation of the effects of different root conditioning agents on diseased root surfaces: a SEM analysis

Immunohistochemical Localization of Osteopontin - A Comparative Study on Periodontally Healthy and Diseased Tooth Root Surface

A Great deal of effort has been focused on trying to determine the presence and localization of factors responsible for cementogenesis, as well as in repair and regeneration of periodontal tissues. Bone sialoprotein and osteopontin are the two major non-collagenous proteins in cementum that appeared to have important roles in cementogenesis and regeneration. Aim: To investigate the expression and distribution of osteopontin on diseased root surface in comparison with healthy non-diseased root surface in by immunohistochemical technique using osteopontin mouse monoclonal antibody [NCL-O-PONTIN] (Novocastra) Materials and Methods: Fifty-Five teeth which included 25 permanent healthy human teeth and 30 permanent teeth affected by advanced periodontitis were collected. All teeth were initially fixed in 10% neutral buffered formalin. Following fixation and demineralization, specimens were embedded in paraffin, sectioned and exposed to antibodies against osteopontin. Stained sections were assessed using digital photomicroscope. Results: In healthy root surface staining intensity was found to be mild to moderate in the cemental surface and matrix. Moderate staining was found in relation to periodontal ligament. In diseased root surface there was absence of immunostaining for osteopontin (OPN) in exposed cementum. In, the apical part of the diseased tooth, a strong staining for OPN was seen along the cementum surfaces adjacent to the periodontal ligament. Conclusion: The absence of staining for OPN in all areas of exposed cementum (absence of overlying periodontal ligament) in diseased teeth can affect the ability for regeneration and new connective tissue attachment onto the previously denuded root surface.

Modulatory effects by neodymium-doped yttrium aluminum garnet laser on fibroblast attachment to single rooted tooth surfaces following ultrasonic scaling and root planning: An in vitro study.

Context:One of the most important goals of periodontal therapy is connective tissue reattachment to previously diseased root surfaces. In the recent years, laser therapy has been considered as an important tool in improving the treatment of periodontal disease.Aims:To evaluate the neodymium-doped yttrium aluminum garnet (Nd: YAG) lasers effects on root surfaces affected by periodontal disease and compare this treatment with scaling and root planning (SRP) in terms of fibroblast attachment.Materials and Methods:A sample of 30 single-rooted human teeth extracted because of advanced periodontal disease was used in this study. Sixty specimens obtained by longitudinal sectioning were randomly divided in three groups. Group A control (untreated); Group B SRP; Group C laser (Nd: YAG) and ultrasonic scaling. All specimens were incubated with fibroblast suspension and then fixed and observed under scanning electron microscope.Results:With a median of 8, the control group (Group A) exhibited the least number of total fibroblasts among all the three groups. The laser and scaling - treated group (Group C) showed the highest number of fibroblasts (median = 49, mean ± standard deviation [SD] = 48.28 ± 17.18), followed by SRP only (Group B, median = 22, mean ± SD = 22.24 ± 8.67).Conclusions:Nd: YAG laser irradiation at specific energy densities can be used as a useful tool to condition the root surfaces, enhancing fibroblast attachment. Hence aiding in re-establishment of the connective tissue attachment to the root surfaces of previously diseased teeth.

Minimally-invasive non-surgical periodontal therapy

Periodontitis is a complex disease that has both oral and systemic consequences. The treatment of periodontitis may be both surgical and non-surgical but, in recent years, there has been a shift towards managing disease non-surgically in preference to surgery. Fundamental to all types of therapy is the patient's role in disease control, in the form of self-performed plaque control, and it is important that the patient understands this. Non-surgical periodontal therapy has a long history and has traditionally been carried out using a variety of hand and powered instruments, the objective being root surface disinfection by the removal of plaque, calculus and contaminated root cementum. However, over the last 30 years or so, it has become apparent that calculus does not cause disease, cementum does not become significantly infected and bacteria and their toxins are only loosely adherent to the diseased root surface. This has led to the development of less invasive instrumentation principles which may be better for patients, more cost-effective and more easily applied in different clinical settings. This paper aims to describe and justify a minimally-invasive approach to the management of the diseased root surface in periodontitis, to clarify the terminology used and to suggest how these principles may be applied in general practice.

Effect of various concentrations of tetracycline hydrochloride demineralization on root dentin surface: A scanning electron microscopic study

Introduction:Within the last 20 years root demineralization has attracted attention as a periodontal regenerative technique. Topical tetracycline application has been widely reported for use as a conditioner, to decontaminate the root surface and to promote periodontal regeneration. The purpose of this scanning electron microscopic (SEM) study is to evaluate the surface characteristics of demineralized diseased and non-diseased dentine root surfaces using different concentrations of tetracycline hydrochloride (TTC-HCl).Material and Methods:This SEM study was carried out in 20 dentin samples obtained from non-diseased human premolars and 20 dentin samples obtained from diseased human premolars. Pure TTC-HCl was applied to the dentin surface at 50 mg/ml, 100 mg/ml and 150 mg/ml concentrations for 3 min in experimental groups while distilled (0 mg/ml) water was applied to the control groups.Statistical Analysis:Mean and standard deviation were estimated from the sample for each study group. Mean values were compared by either one-way ANOVA with Tukey-Honestly significant difference procedure or Kruskal - Wallis one way ANOVA with Mann-Whitney u-test. Further Student′s independent t-test/Mann-Whitney u-test was used appropriately to compare the mean values between two independent groups.Results:In the present study using 100 mg/ml tetracycline seems to be more effective on both diseased and non-diseased dentin surfaces.Conclusions:The results of this study confirm that pure TTC-HCl conditioning produced comparable surface characteristics on dentin of both diseased and non-diseased roots with 100 mg/ml concentration for 3 min.

Cementomimetics-constructing a cementum-like biomineralized microlayer via amelogenin-derived peptides.

Cementum is the outer-, mineralized-tissue covering the tooth root and an essential part of the system of periodontal tissue that anchors the tooth to the bone. Periodontal disease results from the destructive behavior of the host elicited by an infectious biofilm adhering to the tooth root and left untreated, may lead to tooth loss. We describe a novel protocol for identifying peptide sequences from native proteins with the potential to repair damaged dental tissues by controlling hydroxyapatite biomineralization. Using amelogenin as a case study and a bioinformatics scoring matrix, we identified regions within amelogenin that are shared with a set of hydroxyapatite-binding peptides (HABPs) previously selected by phage display. One 22-amino acid long peptide regions referred to as amelogenin-derived peptide 5 (ADP5) was shown to facilitate cell-free formation of a cementum-like hydroxyapatite mineral layer on demineralized human root dentin that, in turn, supported attachment of periodontal ligament cells in vitro. Our findings have several implications in peptide-assisted mineral formation that mimic biomineralization. By further elaborating the mechanism for protein control over the biomineral formed, we afford new insights into the evolution of protein–mineral interactions. By exploiting small peptide domains of native proteins, our understanding of structure–function relationships of biomineralizing proteins can be extended and these peptides can be utilized to engineer mineral formation. Finally, the cementomimetic layer formed by ADP5 has the potential clinical application to repair diseased root surfaces so as to promote the regeneration of periodontal tissues and thereby reduce the morbidity associated with tooth loss.

A comparative evaluation of the efficacy of manual, magnetostrictive and piezoelectric ultrasonic instruments: an in vitro profilometric and SEM study

ObjectivesThe debridement of diseased root surface is usually performed by mechanical scaling and root planing using manual and power driven instruments. Many new designs in ultrasonic powered scaling tips have been developed. However, their effectiveness as compared to manual curettes has always been debatable. Thus, the objective of this in vitro study was to comparatively evaluate the efficacy of manual, magnetostrictive and piezoelectric ultrasonic instrumentation on periodontally involved extracted teeth using profilometer and scanning electron microscope (SEM). Material and Methods30 periodontally involved extracted human teeth were divided into 3 groups. The teeth were instrumented with hand and ultrasonic instruments resembling clinical application. In Group A all teeth were scaled with a new universal hand curette (Hu Friedy Gracey After Five Vision curette; Hu Friedy, Chicago, USA). In Group B CavitronTM FSI - SLITM ultrasonic device with focused spray slimline inserts (Dentsply International Inc., York, PA, USA) were used. In Group C teeth were scaled with an EMS piezoelectric ultrasonic device with prototype modified PS inserts. The surfaces were analyzed by a Precision profilometer to measure the surface roughness (Ra value in µm) consecutively before and after the instrumentation. The samples were examined under SEM at magnifications ranging from 17x to 300x and 600x. ResultsThe mean Ra values (µm) before and after instrumentation in all the three groups A, B and C were tabulated. After statistically analyzing the data, no significant difference was observed in the three experimental groups. Though there was a decrease in the percentage reduction of Ra values consecutively from group A to C. ConclusionWithin the limits of the present study, given that the manual, magnetostrictive and piezoelectric ultrasonic instruments produce the same surface roughness, it can be concluded that their efficacy for creating a biologically compatible surface of periodontally diseased teeth is similar.

Advances in Calculus Detection and Removal Technologies- A Review

The essential component of conventional periodontal therapy is the effective removal of bacterial deposits from the root surface, along with calculus deposits, in order to create a biologically compatible root surface. Subgingival root debridement currently comprises the systematic treatment of all diseased root surfaces using hand and or ultrasonic instruments, until the root surface feels smooth and clean. However, traditional tactile perception of the subgingival environment without visible access before and after treatment frequently lacks sensitivity, specificity and reproducibility, and thus may lead to the unwanted removal of cementum.Current advance technologies for calculus identification include detection-only systems (a miniaturized endoscope, a device based on light reflection and a laser that activates the tooth surface to fluoresce) as well as combined calculus-detection and calculus-removal systems. The present paper focuses on the latest advances in calculus detection technologies.

Effect of human beta-defensin-3 on the proliferation of fibroblasts on periodontally involved root surfaces

Human beta-defensin-3 (HBD-3) has versatile antibacterial activity against oral bacteria and can promote the proliferation of fibroblasts. The goal of the present study was to investigate the effect of HBD-3 on attachment and proliferation of periodontal ligament cells (PDL) onto the periodontitis affected root surfaces. PDL cells were seeded onto healthy and diseased root specimens with scaling and root planing (SRP), SRP & HBD-3 (100 ng/ml), or SRP & HBD-3 (200 ng/ml) treatment for 1, 3, and 7 days incubation. The results showed that HBD-3, especially in the 200 ng/ml group, significantly promoted fibroblast attachment and proliferation onto the diseased root surfaces. The cell number in the HBD-3 group was much greater than in the group treated with SRP alone. On day 7, the cells in the HBD-3 were well-spread and formed a network similar to those on the surfaces of the healthy root specimens. These results suggest that HBD-3 could play an important role in antibacterial activity and fibroblast proliferation, thus promoting periodontal regeneration. Meanwhile, HBD-3 might act as a potent regeneration-promoter in infectious diseases.

A scanning electron microscopy study of diseased root surfaces conditioned with EDTA gel plus Cetavlon after scaling and root planing

In the present investigation, a scanning electron microscopy analysis was performed to evaluate the effects of the topical application of ethylenediaminetetraacetic acid (EDTA) gel associated with Cetavlon (EDTAC) in removing the smear layer and exposing collagen fibers following root surface instrumentation. Twenty-eight teeth from adult humans, single rooted and scheduled for extraction due to periodontal reasons, were selected. Each tooth was submitted to manual (scaling and root planing) instrumentation alone or combined with ultrasonic instruments, with or without etching using a 24% EDTAC gel. Following extraction, specimens were processed and examined under a scanning electron microscope. A comparative morphological semi-quantitative analysis was performed; the intensity of the smear layer and the decalcification of cementum and dentinal surfaces were graded in 12 sets using an arbitrary scale ranging from 1 (area covered by a smear layer) to 4 (no smear layer). Root debridement with hand instruments alone or combined with ultrasonic instruments resulted in a similar smear layer covering the root surfaces. The smear layer was successfully removed from the surfaces treated with EDTAC, which exhibited numerous exposed dentinal tubules and collagen fibers. This study supports the hypothesis that manual instrumentation alone or instrumentation combined with ultrasonic instrumentation is unable to remove the smear layer, whereas the subsequent topical application of EDTAC gel effectively removes the smear layer, uncovers dentinal openings and exposes collagen fibers.

Erratum to: In vitro studies of the ablation mechanism of periodontopathic bacteria and decontamination effect on periodontally diseased root surfaces by erbium:yttrium–aluminum–garnet laser

Erratum to: In vitro studies of the ablation mechanism of periodontopathic bacteria and decontamination effect on periodontally diseased root surfaces by erbium:yttrium–aluminum–garnet laser