Introduction
The primary etiological factor in periodontal disease is bacterial plaque. This results in an inflammatory lesion in the gingival tissues leading to progressive destruction of the supporting periodontal tissues. Periodontitis-affected root surfaces are hypermineralized and contaminated with cytotoxic and other biologically active substances. The ultimate goal of periodontal therapy is to obtained periodontal regeneration of the periodontium in the area of previously affected root surface. Scaling and root planing are the main treatment for decontaminate the root surface. However potential limitation of scaling and root planing is it does not remove endotoxins completely. Chemical root conditioner are playing important role in decontaminating root surface as well as enlarge dentinal tubules into which healing connective tissue can enter. The various root conditioning agents used are citric acid, tetracycline, doxycycline, phosphoric acid, ethylene diamine tetra acetic acid, fibronectin, laminin etc.
Aims and Objective
The present study was aimed to compare the efficacy of citric acid as root conditioner with scaling and root planing scaling and root planing alone by observing the change in root surface under SEM.
Review of literature
It is one of the earliest chemical agents that has been used for root conditioning (Labahn et al 1992).1 Citric acid demineralization enhances new attachment or reattachment and regeneration by one or more of the following mechanisms: antibacterial effect, exposure of root collagen, opening of dentinal tubules and removal of smear layer (Polson et al 1987),2 demineralization prior to cementogenesis (Register et al 1975),3 no adverse effect to pulp or periodontal tissues, enhanced fibroblast growth (Boyko et al 1980).4
Materials and Methods
For the present study 20 single rooted anterior teeth indicated for extraction having hopeless prognosis due to advanced periodontitis were collected from OPD. The obtained teeth are scaled and root planed properly then tooth root are divided in two parts and 40 samples were obtained. One part of each root sample were treated with saline and other with citric acid. Scanning photomicrographs of the root surfaces were taken at 3000X. The specimen were examined for total number of patented tubules and percentage of patented tubules. Results were statistically analyzed.
Results
Table 1
Comparison of no. of smear free dentinal tubule in per 100µm2 SEM Photo micrographs score in I SRP only and Group II SRP with citric acid treatment
|
Groups |
N |
Mean score |
Standard deviation |
Standard Error |
Mean differences |
t value |
p value |
|
Group I |
20 |
0.832 |
0.48046 |
.10743 |
0.874 |
t= -5.6 |
<0.0001 |
|
Group II |
20 |
1.706 |
0.50289 |
.11245 |
|
|
|
A highly significant differences (p value <0.0001) is observed in between the scores of SEM photomicrographs of Group SRP only and Group SRP with citric acid treatment.
The mean of group I SRP alone is 0.832 and group II SRP with root conditioning with citric acid is 1.706 which signifies that less number of patented dentinal tubule in group I while more number of patented dentinal tubules are seen in group II. The difference is highly significant
Discussion
Plaque is the main etiological factor periodontal disease, presence of bacterial plaque on the root surface affects periodontal regeneration by providing poor base for attachment and proliferation of fibroblasts. Various acids and chelating agents were tried for root surface bio modifications for effective periodontal regenerations. Citric acid as root conditioner has been used since many years, since its acidic pH it removes smear layer from partially demineralized scaled and root planed surfaces. It also does widening and opening of dental tubule as well as exposing various components of cementum extracellular matrix and dentin extracellular matrix. The study sample included twenty freshly extracted teeth. For the present study 40 sample from 20 single rooted anterior teeth indicated for extraction due to advanced chronic periodontitis have hopeless prognosis were selected that satisfied the inclusion and exclusion criteria of the study Following extraction, the teeth were thoroughly washed with distilled water and transported in the same. Meticulous root planing was then done with a Gracey Curette to obtain a smooth, shiny and hard surface. Specimens were obtained from the cervical 2/3rd of the roots. It contains less cementum as compared to the apical third (Borghetti et al 1987)5 so it is easy to remove the cementum and obtain a glass like dentin surface for root conditioning. Instrumentation prior to application of root conditioning agents was done to remove the hypermineralized surface layer present on the periodontitis-affected roots (Trombelli et al 1995) 6 and also to remove as much cementum as possible because root conditioning done on hypermineralized cemental surfaces does not induce collagen fiber attachment (Polson AM and Hanes PJ 1989);7 In the present study we used a supersaturated solution of citric acid (Shetty B 2008). 8 Photomicrography analysis of SEM samples revealed that removal of smear layer and opening of dentinal tubules was more in samples treated by citric acid with SRP than the SRP alone.
Conclusion
Observation made from present study shows that citric acid is effective against removal of smear layer from root surface as well as uncovering and widening of dentinal tubule orifices. Hence use of citric acid with SRP on root surface might have a significant role in periodontal regeneration and new attachment.
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