Root Surface Conditioning Research Articles

Effect of root surface conditioning on gingival recession coverage with a connective tissue graft. A retrospective comparative study of three different agents

Different root modifiers have been proposed in the literature with an attempt to improve the healing process and the success rate of root coverage procedures. The aim of the present retrospective study was to evaluate the effect of three different types of root surface conditioning, namely, tetracycline (TTC), ethylene-di-amino-tetra-acetic acid (EDTA) and saline, on the outcome of root coverage procedures applying the same surgical technique. Twenty-nine patients with 60 Classes I, II, or III recession defects were treated using connective tissue with a partial-thickness double-pedicle graft. In 21 recession defects root surface was treated with TTC and, in other 21, with EDTA, while in the remaining, saline solution was applied. Statistical analysis consisted of descriptive statistics and Kruskal-Wallis, Mann-Whitney, and chi-square tests. Differences between pre- and postoperative values were statistically significant only within but not between groups. Mean root coverage was 73.25%, 69.19%, and 82.17% in the TTC, the EDTA, and the saline groups, respectively. The study revealed no statistically significant differences for all evaluated parameters between groups. Within the limits of this study, root conditioning, prior to root coverage procedures, does not significantly affect their outcome. Clinical outcome of root coverage procedures is not related to the type of root surface conditioning.

EFFECTIVITY OF 2.1% MINOCYCLINE OINTMENT AND 24% ETHYLENEDIAMINETETRAACETIC ACID GEL AS A ROOT SURFACE CONDITIONING MATERIAL (A STUDY OF FIBRIN CLOT ADHESION WITH SCANNING ELECTRON MICROSCOPE)

Objective: A stable fibrin clot adhesion on the root surface of the teeth is the start of periodontal regeneration. We aimed to observe the differencebetween fibrin clot adhesion on root surfaces after root surface conditioning using minocycline and ethylenediaminetetraacetic acid (EDTA).Methods: We divided 30 root surfaces into three groups – namely, the minocycline group, the EDTA group, and the saline group as a control. Wedropped fresh human blood on the root surface and allowed it to coagulate. We evaluated the fibrin clots using a scanning electron microscope.Results: We found no significant differences between the minocycline and the EDTA applications (p=0.759).Conclusions: EDTA and minocycline demonstrated equal capability in producing fibrin clots on the root surface.

Experimental and clinical studies on regenerative periodontal therapy.

The recognition of a periodontal therapy as a regenerative procedure requires the demonstration of new cementum, periodontal ligament, and bone coronal to the base of the defect. A diversity of regenerative strategies has been evaluated, including root surface conditioning, bone grafts and bone substitute materials, guided tissue regeneration, enamel matrix proteins, growth/differentiation factors, combined therapies and, more recently, tissue-engineering approaches. The aim of this chapter of Periodontology 2000 is to review the research carried out in Latin America in the field of periodontal regeneration, focusing mainly on studies using preclinical models (animal models) and randomized controlled clinical trials. This review may help clinicians and researchers to evaluate the current status of the therapies available and to discuss the challenges that must be faced in order to achieve predictable periodontal regeneration in clinical practice.

Efficacy of flapless intentional replantation with enamel matrix derivative in the treatment of hopeless teeth associated with endodontic-periodontal lesions: A 2-year prospective case series.

In this prospective case series, the effects of flapless intentional replantation (IR) with root surface conditioning with enamel matrix derivative (EMD) was evaluated for the treatment of periodontally-endodontally involved hopeless teeth. A total of 17 teeth (17 patients, aged 40 to 73) with ≥ 10 mm attachment loss and radiographic bone loss to the apex were included in the study. The affected teeth were atraumatically extracted using a flapless approach, then granulation tissues, calculus, and necrotic cementum on the root surfaces were removed. EMD was applied for 5 minutes to the root surfaces. The teeth were reinserted to the socket without any bone grafts and splinted. After 2 years, clinical healing was uneventful in 16 cases and the radiographs revealed no root resorption or ankylosis. IR with EMD treatment provided statistically significant reduction in probing depth (6.4 ± 2.6 mm), gain in clinical attachment level (5.9 ± 2.5 mm), and gain in radiographic bone level (48.2 ± 26.1%) compared to baseline values (P < .01). Within the limitations of the study, flapless IR with EMD treatment appeared to act as an alternative strategy to extraction of severely compromised teeth with endodontic-periodontal lesions beyond the root apex.

The effect of root surface conditioning on smear layer removal in periodontal regeneration (a scanning electron microscopic study)

The role of root surface conditioning treatment on smear layer removal of human teeth is affected by periodontitis in periodontal regeneration. The objective of this study is to analyze the smear layer on root surface conditioned with 2.1% minocycline HCl ointment (Periocline), and 24% EDTA gel (Prefgel). A total of 10 human teeth indicated for extraction due to chronic periodontitis were collected and root planed. The teeth were sectioned in thirds of the cervical area, providing 30 samples that were divided into three groups – minocycline ointment treatment, 24% EDTA gel treatment, and saline as a control. The samples were examined by scanning electron microscope. No significant differences in levels of smear layer were observed between the minocycline group and the EDTA group (p=0.759). However, there were significant differences in the level of smear layer after root surface treatment in the minocycline and EDTA groups, compared with the control group (p=0.00). There was a relationship between root surface conditioning treatment and smear layer levels following root planing.

Sub-epithelial connective tissue graft and enamel matrix derivative in the management of a localized gingival recession defect: A case report

Within the past 20 years, clinicians have successfully performed mucogingival surgeries to restore periodontal defects. This article describes the application of enamel matrix derivative (EMD) in combination with connective tissue graft (CTG) for the repair of localized mucogingival defect. The procedure was performed to observe the clinical success of autogenous CTG in the treatment of moderate facial recession defect combined with the usage of an EMD. The management involved scaling and root planning, root surface conditioning, elevation of full-thickness flap, application of EMD, shaping and application of CTG at the recession site. Eight-month observations showed root coverage of 3 mm (>75%) with attachment level gain of 4 mm and a gingival margin that was harmonious with adjacent teeth. From a clinical observation, it emerges that root coverage and soft tissue attachment is possible with the use of autogenous CTG in combination with EMD in the management of moderate gingival recession defects.

Effect of Bioconditioning on Surface Characteristics of Periodontally-affected Roots of Diabetic Patients

ABSTRACT Objective Advanced glycosylated end products (AGEs) in type II diabetic patients are usually precipitated on the periodontallyaffected root surfaces. The presence of periodontopathic microbes, at the same time, may also add a negative impact on the prognosis of the regenerative periodontal surgery. This in vitro study aimed to evaluate the effect of chemical conditioning on surface characteristics of periodontally-affected roots of diabetic patients. Methods Three groups (n = 25) of freshly-extracted teeth were collected from the outpatient clinics, College of Dentistry, King Khalid University. In group 1, teeth were collected from healthy individuals for orthodontic purpose. Teeth of group 2 were collected from healthy patients with chronic periodontitis, while those of group 3 were collected from diabetic patients with chronic periodontitis. Roots of the collected teeth were examined using the scanning electron microscope (SEM) before and after mechanical surface planning and chemical treatment using normal saline, EDTA gel, Tetracycline HCL (TC) or citric acid (CA) each for 4 minutes (n = 5 from each group). Results Interpretation of SEM images revealed undesirable etching effect of the chemicals used on the surfaces of healthy roots. Although EDTA showed an effective cleanse of the smear debris, it seemed to have no power on surface cuticles existed on roots of diabetic individuals. Tetracycline HCl provided acceptable conditioning of periodontally-affected root surfaces. Citric acid showed a powerful removal of both smear debris and cuticle layers off the periodontally-affected roots of diabetic individuals. Conclusion Topical application of EDTA, TC or CA shows sensible effect on the periodontally affected root surfaces. However, each of these chemicals exhibits different conditioning power. Citric acid is a promising agent to biomodify the periodontally-affected root surfaces of diabetic patients. Clinical relevance Citric acid is an acceptable biomodifier for the periodontally-affected root surfaces. This approach may improve the prognosis of periodontal therapies especially in type II diabetic patients. How to cite this article Abdelaziz KM, Eid HA, Eid RA. Effect of Bioconditioning on Surface Characteristics of Periodontally- affected Roots of Diabetic Patients. World J Dent 2014;5(2):81-86.

Endodontic-periodontal microsurgery for combined endodontic-periodontal lesions: An overview.

Endodontic and periodontal microsurgery has surpassed the success rates for traditional endodontic and periodontal surgical procedures. Excellent healing results are being attributed to both the techniques, when employed, for isolated endodontic or periodontal defects. Combined endodontic-periodontal lesions have been referred to as a true challenge, requiring not only endodontic microsurgical management but also concurrent bone grafting and membrane barriers techniques. The prevention of epithelial downgrowth and regeneration of periodontal cementum, fiber, and bone seals the fate of these cases. Achieving primary closure with submergence of grafts has a positive effect on GTR outcome. New techniques of periodontal microsurgery, such as minimally invasive papilla preserving flaps with passive internal mattress suturing, have managed to obtain 90% primary flap closure over grafted sites. Root surface treatment and conditioning has also shown to be beneficial for GTR. Endodontic microsurgery for the combined lesion has not integrated these advances yet. These advances, along with a recently suggested treatment strategy, are ushering in the level next in management of the combined lesions. This article offers an overview of the combined lesion, the disease, its classification, treatment strategy, regenerative tools, microsurgical recommendations, and outcome studies.

Early root surface colonization by human periodontal ligament fibroblasts following treatment with different biomaterials

Objectives. The present in-vitro study examined the effects of different biomaterials on early root surface colonization by human periodontal ligament (PDL) fibroblasts using confocal-laser-scanning-microscopy (CLSM). Materials and methods. Fifteen periodontally-diseased teeth were extracted, treated with scaling/root planing and longitudinally cut to obtain 30 root fragments. Fragments were treated either with 24% EDTA following application of enamel matrix derivative (EMD), 24% EDTA or EMD only, nanocrystalline hydroxyapatite (NHA) paste or oily calcium hydroxide suspension (OCHS) for 1 h each. The analogue untreated root specimens served as controls. Root fragments were incubated with human PDL fibroblasts and cellular proliferation and morphology were evaluated after 1, 3, 5 and 8 days using CLSM-visualization and image recognition software. Results. The rate of cellular proliferation was different among treatment modalities examined (p = 0.019). Except treatment with NHA paste all treatment modalities improved cellular proliferation on root surfaces at all different points of time compared with the control specimens. A significant difference between treatment modalities was observed between EMD and NHA paste (p = 0.008). No synergistic effect could be demonstrated comparing root surface conditioning with 24% EDTA and EMD application compared to 24% EDTA or EMD application only. Conclusion. The present results suggest that initial root surface colonization by PDL fibroblasts may be enhanced by root surface conditioning with 24% EDTA and application of EMD, application of 24% EDTA or EMD alone and OCHS. The addition of 24% EDTA for root surface conditioning prior to EMD application provided no synergistic effects in terms of early root surface colonization by PDL fibroblasts.

The effect of MTAD, an endodontic irrigant, on fibroblast attachment to periodontally affected root surfaces: A SEM analysis

Background:Root surface debridement (RSD) is necessary to create an environment suitable for reattachment of the periodontium. Root surface conditioning may aid the formation of a biocompatible surface suitable for cell reattachment. BioPure™ MTAD (mixture of Doxycycline, citric acid and a detergent) is an endodontic irrigant with antibacterial properties and the ability to remove smear layer. It was hypothesized that MTAD may be useful for root surface conditioning. The efficacy of MTAD as a conditioner was measured by examining fibroblast attachment to root surfaces.Materials and Methods:Thirty-two specimens of human teeth with advanced periodontal disease were used. The surfaces were root planed until smooth. Half of the specimens were treated with 0.9% saline and the other samples with Biopure MTAD. As a negative control group, five further samples were left unscaled with surface calculus. Human gingival fibroblast cells HGF1-PI1 were cultured and poured over the tooth specimens and incubated. After fixation, the samples were sputter-coated with gold and examined with a SEM. The morphology and number of attached, fixed viable cells were examined. The data was analysed using the Mann-Whitney-U statistical test.Results:There was no significant difference between the numbers of attached cells in the experimental group treated with MTAD and the control group treated with saline. Little or no attached cells were seen in the negative control group.Conclusion:RSD created an environment suitable for cell growth and attachment in a laboratory setting. The use of MTAD did not promote the attachment and growth of cells on the surface of human roots following RSD.

Wound healing of dehiscence defects following different root conditioning modalities: an experimental study in dogs

The purpose of this study was to investigate the periodontal healing pattern of dehiscence-type defects following different chemical root conditioning modalities. Buccal osseous dehiscence defects were created on six teeth of seven dogs. After dental plaque accumulation, defects were treated with sterile saline solution (control group) or one chemical conditioning modality: citric acid (CA group), ethylenediaminetetraacetic acid (EDTA group), tetracycline (TTC group), citric acid + tetracycline (CA + TTC group), or tetracycline + citric acid (TTC + CA group). After 3 months of healing, clinical parameters were evaluated, and the animals were killed. Histological sections were processed, and a computer-assisted histometric analysis was used to evaluate the formation of new cementum, new bone, and epithelial apical migration. All treatments yielded significant improvements in terms of probing depth decrease and clinical attachment level gain compared to baseline values; however, without significant differences among the groups (p > 0.05; one-way ANOVA). The highest amount of new cementum was noted in the EDTA group (3.72 ± 0.83 mm, 77.6 %), while the lowest amount of new bone was observed in the TTC group (0.7 ± 0.94 mm, 14.3 %). However, no statistically significant differences could be observed among the groups regarding epithelial apical migration, new cementum, and alveolar bone formation (p > 0.05). Chemical root surface conditioning did not promote any significant improvement in periodontal healing pattern of dehiscence-type defects in dogs. Chemical root surface conditioning after surgical debridement did not promote positive or negative effects on periodontal healing pattern of dehiscence-type defects.

Influence of dental exposure to oral environment on smear layer removal and collagen exhibition after using different conditioning agents

Although in vitro studies have shown encouraging results for root surface conditioning with demineralizing agents, in vivo studies have failed to show its benefits in periodontal healing. This can be attributed to several factors, among which, the hypermineralization of dental surface. Therefore, this in vitro study compared, using scanning electron microscopy (SEM), the effect of root surface conditioning with different conditioners (1% and 25% citric acid, 24% EDTA and 50 mg/mL tetracycline hydrochloride) in impacted teeth and in teeth that had their roots exposed to the oral environment. One trained examiner assessed the SEM micrographs using a root surface modification index. There was a tendency of more root surface modification in the group of impacted teeth, suggesting that the degree of root mineralization influences its chemical demineralization.

Root surface conditioning with bone morphogenetic protein-2 facilitates cementum-like tissue deposition in beagle dogs

Modification of the root surface may play an important role in regenerating the periodontal attachment between the root and periodontal connective tissue. We speculated that bone morphogenetic protein (BMP) application to the root surface constructed a novel attachment by cementum-like hard tissue, although gingival connective tissue proliferated to the root surface. The aim of this study was to examine whether BMP-2 guided cementum-like tissue deposition on a BMP-conditioned root surface. Root dentin on the buccal side of 24 teeth in four beagle dogs was surgically exposed. The denuded root dentin surfaces were demineralized with EDTA and washed with saline. Subsequently, 15 microL of BMP-2 solution (loading dose, 0.4 and 1.0 microg/microL) was applied to the root dentin surface. In the control roots, phosphate-buffered saline was applied to the root surface. Specimens were analyzed histologically 16 wk after surgery. Formation of cementum-like tissue was frequently observed on the BMP-2-conditioned root at the coronal portion. Cellular cementum-like tissue was separated from the original cementum and encapsulated with gingival connective tissue. Cementum-like tissue formation with BMP-2 at 1.0 microg/microL was significantly greater than that in the control roots and those with BMP-2 at 0.4 microg/microL. Downgrowth of the junctional epithelium in the 1.0 microg/microL BMP-2 group was significantly less than that in the control roots. Root dentin surface conditioning with BMP-2 stimulated cementum-like tissue formation and inhibited epithelial downgrowth.

Root Surface Biomodification with an Er:YAG Laser for the Treatment of Gingival Recession with Subepithelial Connective Tissue Grafts

Root surface biomodification has been used to treat gingival recession and periodontitis. The principle for this procedure is that removing the smear layer from the root surfaces exposes collagen fibers, which leads to improved healing. Clinical studies generally have failed to find any improvement in clinical parameters when using such agents. The aim of this study was to evaluate and compare the outcome of gingival recession therapy using the subepithelial connective tissue graft (SCTG) with or without Er:YAG laser application for root surface biomodification. Twenty-four teeth in 12 patients with Miller class I and II recession were treated with SCTG with (test group) or without (control group) the application of an Er:YAG laser (2 Hz, 60 mJ/pulse, 40 s, with air spray). Clinical attachment level (CAL), recession depth (RD), recession width (RW), and probing depth (PD) were measured at baseline and 6 months postsurgery. There were no significant differences between test and control groups (p > 0.05). Postoperatively, significant root coverage, gains in CAL, and highly significant increases in the RW were observed in both groups. For test and control groups, the average root coverage was 80% and 86%, respectively (p > 0.05), and complete root coverage was 75% and 67%, respectively. The present study showed that root surface conditioning with an Er:YAG laser does not enhance the results achieved when SCTG was performed alone.

Biological effects of a root conditioning agent for dentin surface modificationin vitro

PurposeConnective tissue reattachment to periodontally damaged root surfaces is one of the most important goals of periodontal therapy. The aim of this study was to develop a root conditioning agent that can demineralize and detoxify the infected root surface.MethodsDentin slices obtained from human teeth were treated with a novel root planing agent for 2 minutes and then washed with phosphate-buffered saline. Smear layer removal and type I collagen exposure were observed by scanning electron microscopy (SEM) and type I collagen immunostaining, respectively. Cell attachment and lipopolysaccharides (LPS) removal demonstrated the efficiency of the root conditioning agent.ResultsSEM revealed that the smear layer was entirely removed and the dentinal tubules were opened by the experimental gel. Type I collagen was exposed on the surfaces of the dentin slices treated by the experimental gel, which were compared with dentin treated with other root planing agents. Dentin slices treated with the experimental gel showed the highest number of attached fibroblasts and flattened cell morphology. The agar diffusion assay demonstrated that the experimental gel also has effective antimicrobial activity. Escherichia coli LPS were effectively removed from well plates by the experimental gel.ConclusionsThese results demonstrated that this experimental gel is a useful tool for root conditioning of infected root surfaces and can also be applied for detoxification of ailing implant surface threads.

Root surface conditioning in closed apex avulsed teeth: a clinical concept and case report

In an avulsed tooth with an open apex, a recommended procedure is to coat the root surface with topical doxycycline before reimplantation. Doxycycline, a derivative of the tetracycline family, has an antibacterial effect and anti-inflammatory qualities, and is effective in reducing inflammatory and replacement resorption following dental trauma. Treating the root surface of an avulsed closed apex tooth is a rational and recommended procedure. A case is presented in which an avulsed closed apex tooth, conditioned with topical doxycycline, was reimplanted in the socket. At follow-up, 16 months later, no clinical signs and symptoms were present and radiographic evaluation showed only superficial root surface resorption and an intact PDL.

Comparitive effects of tetracyclines and citric acid on dentin root surface of periodontally involved human teeth: A scanning electron microscope study

Periodontal diseases produce physical and chemical alterations in the root cementum. Various topical applications as root conditioning agents have been recommended as an adjunct to mechanical root surface debridement to remove smear layer, endotoxins and to expose collagen fibers on dentin surface. The objectives were to compare dentin surface changes following applications of tetracyclines and citric acid to the instrumented root surface of periodontally involved human teeth under scanning electron microscope.The study group comprised of 80 dentin samples, which were prepared from periodontally-compromised teeth, planned for extraction. Diseased surfaces were root planed. The teeth were sectioned and solutions of tetracycline HCl, minocycline, doxycycline and citric acid were applied to the surfaces with cotton pellets for 5minutes.The root surface samples were then examined by scanning electron microscope.Removal of smear layer in all the four groups was near total except a few areas. All four groups showed slight difference in mean number of total dentinal tubules. Minocycline and doxycycline showed no significant difference. The proportion of patent dentinal tubules was (74%) in tetracycline HCl group compared to minocycline (48.3%), doxycycline 42%), citric acid (52%), showing the differences statistically significant. Tetracycline group showed higher number of patent tubules when compared to minocycline, doxycycline and the difference was statistically significant.Results of this study suggest that tetracycline is the best current tetracycline form for root surface conditioning as measured by its ability to affect both dentin smear layer removal and tubule exposure.

Is coronally positioned flap procedure adjunct with enamel matrix derivative or root conditioning a relevant predictor for achieving root coverage? A systemic review.

This study is a systemic review of coronally positioned flap, coronally positioned flap+chemical root surface conditioning, or coronally positioned flap+enamel matrix derivative (EMD) for the treatment of Miller class I and II gingival recession. All studies available through the Medline database by the end of October 2005 were used. Each study provided mean clinical attachment level, keratinized tissue, probing pocket depth, gingival recession depth and root coverage percentage before and after treatment with coronally positioned flap alone, coronally positioned flap+chemical root surface conditioning, or coronally positioned flap+EMD. Effectiveness was evaluated by comparing the weighted mean average in gingival recession depth, probing pocket depth, clinical attachment level, keratinized tissue and root coverage percentage achieved with the three treatments. Seven studies for the coronally positioned flap+EMD group, four studies for the coronally positioned flap+chemical root surface conditioning group, and seven studies for the coronally positioned flap group were retrieved for this weighted mean analysis. The results of clinical attachment level, gingival recession depth, and root coverage percentage in the coronally positioned flap+EMD group were statistically significantly better than the changes in the coronally positioned flap and coronally positioned flap+chemical root surface conditioning group at 6 and 12 mo (p<0.001). There was no significant difference at the 6-mo comparison among clinical attachment level, keratinized tissue, probing pocket depth, and gingival recession depth, except in the root coverage percentage for coronally positioned flap and coronally positioned flap+chemical root surface conditioning groups. The results suggest that root coverage by the coronally positioned flap and coronally positioned flap+chemical root surface conditioning procedures were unpredictable but became more predictable when the coronally positioned flap procedure was improved by the modification of adding EMD.

Surgical Treatment of Infrabony Defects With Autologous Platelet Concentrate or Bioabsorbable Barrier Membrane: A Prospective Case Series

Autologous platelet concentrate (APC) contains concentrated platelet-derived growth factors that promote wound healing and tissue regeneration. The purpose of this prospective case series was to compare the treatment effects of an intralesional graft of APC to guided periodontal regeneration (GPR) using a bioabsorbable barrier membrane (MEM) over a 52-week period. Five patients were recruited for the study from two private periodontal practices. There were four females and one male having a mean age of 33 +/- 10.23 years. The five selected contralateral teeth had similar, but not identical, combinations of 1-, 2-, and 3-wall infrabony defects not involving furcations. Probing depths (PDs) of the defects were > or = 6 mm and had radiographic angular infrabony defects > or = 4 mm in depth. The patients had no local or systemic contraindications to minor oral surgical procedures and had not taken systemic antibiotics for > or = 6 months before the commencement of the study. All patients had completed cause-related periodontal therapy up to 6 months previously and had achieved a satisfactory level of oral hygiene. The selected teeth did not have purulent discharge from the pockets and responded normally to pulp sensibility testing. Patients were excluded if they smoked, were pregnant or lactating, or were allergic to any of the materials to be used in the treatment. At baseline and 8, 26, and 52 weeks after surgery, PDs, recession (REC), presence of plaque, and bleeding on probing were recorded, and standardized periapical radiographs were taken. At the time of surgery, the vertical distance to the deepest point of the infrabony defect was measured from the cemento-enamel junction (CEJ) to the buccal and lingual bone crests. The vertical distance to the base of the defect from the CEJ and defect angles were obtained from radiographs. The paired contralateral infrabony defects were treated with a graft APC or MEM after debridement and EDTA root surface conditioning. Surgical flaps were prepared and closed according to the papilla preservation method. Post-surgical care was provided at 1, 2, 8, 26, and 52 weeks after surgery. A mouthwash of 0.2% chlorhexidine gluconate was used twice daily for the first 3 weeks after surgery. Mean PD, REC, clinical attachment level (CAL), radiographic bone loss, and defect angle were computed and compared for each data collection point. From baseline to 52 weeks, a mean PD reduction of 3 +/- 1.41 mm (APC) and 3.6 +/- 1.67 mm (MEM), mean REC increase of 0.8 +/- 1.01 mm (APC) and 0.6 +/- 1.14 mm (MEM), mean CAL gain of 2.2 +/- 1.79 mm (APC) and 3 +/- 1 mm (MEM), mean radiographic bone fill of 3.24 +/- 2.85 mm (APC) and 2.7 +/- 1.9 mm (MEM), and mean defect-angle increase of 15.25 degrees +/- 18.21 degrees (APC) and 22.4 degrees +/- 27.3 degrees (MEM) were calculated. CAL gain was not related clearly to defect angle at baseline, although radiographic bone fill was slightly greater for defect angles <39.4 degrees +/- 7.88 degrees. This case series of five similar, but not identical, bilateral paired infrabony defects suggests that an APC graft achieves a similar CAL gain and PD reduction to GPR using an MEM over a 52-week period. A larger, controlled clinical trial is needed to evaluate further the efficacy of autologous platelet-rich plasma for the treatment of infrabony defects.

Effects of basic fibroblast growth factor on density and morphology of fibroblasts grown on root surfaces with or without conditioning with tetracycline or EDTA

A study was conducted to evaluate in vitro the effect of root surface conditioning with basic fibroblast growth factor (b-FGF) on morphology and proliferation of fibroblasts. Three experimental groups were used: non-treated, and treated with 50 microg or 125 microg b-FGF/ml. The dentin samples in each group were divided into subgroups according to the chemical treatment received before application of b-FGF: none, or conditioned with tetracycline-HCl or EDTA. After contact with b-FGF for 5 min, the samples were incubated for 24 h with 1 ml of culture medium containing 1 x 10(5) cells/ml plus 1 ml of culture medium alone. The samples were then subjected to routine preparation for SEM, and random fields were photographed. Three calibrated and blind examiners performed the assessment of morphology and density according to two index systems. Classification and regression trees indicated that the root surfaces treated with 125 microg b-FGF and previously conditioned with tetracycline-HCl or EDTA presented a morphology more suggestive of cellular adhesion and viability (P = 0.004). The density of fibroblasts on samples previously conditioned with EDTA, regardless of treatment with b-FGF, was significantly higher than in the other groups (P < 0.001). The present findings suggest that topical application of b-FGF has a positive influence on both the density and morphology of fibroblasts.