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

Abstract

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.

In vitro evaluation of gingival fibroblasts proliferation and smear layer formation in pre-conditioned root surfaces

“…Over the years, scaling and root planning has been proposed to promote a biocompatible root surface for the adjacent periodontal tissues 10,[21][22] . However, this conventional approach produces a fine smear layer over the root surface, which may compromise tissue healing 5,8,10 .…”

“…Its progression is associated to subgingival bacterial colonization 2 , whose toxins are absorbed and fixed to the cement surface 3 , acting as a barrier to the attachment of periodontal tissues [2][3][4][5][6] , consequently promoting irritation, collagen fiber degradation 3 , progressive alveolar bone, cement and periodontal ligament destruction 7 . Root surface conditioning of a tooth affected by periodontal disease aims to remove dental calculus, bacterial biofims and their toxins 2,[8][9] , which consequently contributes to a reduced inflammatory process, periodontal tissue repair [10][11][12] including formation of new supporting tissues [12][13][14] . However, mechanical debridement procedures are known to create a layer of organic, mineralized waste, also known as smear layer, which covers the prepared root surface and obstructs the dentinal tubules [14][15] , serving as substrate for bacterial growth and making periodontal attachment to the root surface more difficult 11 .…”

“…However, mechanical debridement procedures are known to create a layer of organic, mineralized waste, also known as smear layer, which covers the prepared root surface and obstructs the dentinal tubules [14][15] , serving as substrate for bacterial growth and making periodontal attachment to the root surface more difficult 11 . Therefore, an alternative method to remove the smear layer is the combination of debridment and chemical root conditioning, which may be capable of decontaminating, detoxifying and demineralizing the root surface, thus opening the dentinal tubules and exposing the collagen matrix 2,[11][12][13][14]16 , which is fundamental for recolonization of cells involved in periodontal repair 2,[10][11][12]14 , promoting a urface that is biologically compatible with both epithelial and connective issues 2,12,14,[17][18] . Many substances have been used with this objective in mind, mainly in solution form, including citric acid, tetracycline and ethylenediaminetetraacetate acid (EDTA) 13 .…”

“…Citric acid was the first chelating agent to be used 19 . It features antimicrobial action 10,[19][20] , promotes superior fibrin interlinking 20 and intensifies mesenchymal cell adhesion via biochemical mechanisms 11 , accelerating cementogenesis 12,14 . However, high concentrations of this chemical conditioner must be avoided 5 , since an extremely acidic pH results in necrosis, denatured collagen and unfavorable periodontal repair on adjacent tissues 18 .…”

Efeitos do condicionamento ácido na descontaminação da superfície radicular e no recobrimento radicular: análise em MEV e estudo clínico randomizado

“…Esses efeitos benéficos foram descritos inicialmente para o ácido cítrico, mas podem também ser observados com outros agentes condicionadores, como solução de EDTA a 24% LINDSKOG, 1995 a,b,c ;BLOMLOF, 1996;BLOMLOF et al, 1996 a,b ;MAYFELD et al, 1998;BLOMLOF et al, 2000 a,b ;SCELZA et al, 2004) e tetraciclina hidroclorídrica (BAKER, 1983;GOLUB et al, 1984;CIARLONE et al, 1989;WIKESJO et al, 1986;TERRANOVA et al, 1986;WIKESJO, 1988;LAFFERTY et al, 1993;STERRET, 1997;ISIK et al, 2000;SHETTY et al, 2008).…”