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

Abstract

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.

Biological Effects of a Root Conditioning Treatment on Periodontally Affected Teeth - An In Vitro Analysis

“…However, as a result of mechanical therapy, is produced a thick smear layer of microcrystalline debris (14,20) which is intimately associated with the root surface, as confirmed by the present study in control group. Therefore, acid conditioning have been used to decontaminate and to demineralize the root surface, remove the smear layer, exposing some components of the extracellular matrix of dentin and cementum, such as type I collagen, and facilitating attachment between the root surface and the healing connective tissue (10,13,25).…”

“…For this purpose, substances largely studied by current literature, with broad access and low cost were chosen: tetracycline (1,5-7,11-19), EDTA (5,7,11,12,20) and citric acid (2,3,11,12,14). Despite the large number of research involving such chemical agents (1)(2)(3)(5)(6)(7)(11)(12)(13)(14)21), to date, no study has compared their effects on initial biological events related to the success of regenerative periodontal therapy.…”

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

“…Nevertheless, this has not been observed in vivo (14,15). This unexpected result may be explained by the fact that root conditioning is influenced by the type of conditioner, the method of SRP (manual or ultrasonic) (16), the duration of the conditioning procedure (17), the mode of application of the conditioner (18), the concentration and pH of the conditioner (11), and probably the degree of root surface mineralization. This last factor is influenced by the length of time that the root surface is exposed to the oral environment.…”

Endodontic drug delivery for root surface disinfection: a laboratory feasibility evaluation

“…In this in-vitro study, because our focus was not the removal of the smear layer, only a tap water rinse was used after scaling. A complete and efficacious removal of the smear layer with the treatment used is not given [38]. For root conditioning and smear layer removal EDTA [39], citric acid [40] and tetracycline hydrochloride [41] is recommended but these root conditioning procedures are normally used in regenerative periodontal therapy or recession treatment [42].…”