Root conditioning agents

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Root conditioning agents

  1. 1. By, T.MYTHREYEE ROOT CONDITIONING AGENTS
  2. 2. <ul><li>Periodontium-Gingiva,Alveolar bone,Periodontal ligament,Cementum. </li></ul><ul><li>Periodontal diseases-main etiological agent-’’BACTERIA’’. </li></ul><ul><li>On the root surface bacteria are mostly gram –ve bacteria. </li></ul>
  3. 4. <ul><li>These bacteria in the cementum of teeth with untreated periodontal disease </li></ul><ul><li>Endotoxins(have potent inflammatory agents) </li></ul><ul><li>Prevent the growth of FIBROBLASTS and are CYTOTOXIC. </li></ul>
  4. 5. <ul><li>These changes create obstacle to new ATTACHMENT. </li></ul><ul><li>So the root must be cleaned of cementum bound endotoxins. </li></ul><ul><li>In vitro mechanical removal of cementum is possible and showed new growth of cells(Aleo,et al 1975;Cogen et al 1983,1984) </li></ul>
  5. 6. ATTACHMENT LOSS
  6. 7. <ul><li>Root planing removes diseased cementum but it produces a ‘’smear layer’’. </li></ul><ul><li>In vivo total removal of cementum is not possible and trace amounts of endotoxins are left behind(JONES and O’HEARY,1978). </li></ul>
  7. 8. <ul><li>TOPICAL CHEMOTHERAPUTIC AGENTS:for detoxification and enhancement of new attachment in: </li></ul><ul><li>Cosmetic gingival reconstruction(Miller,1985) </li></ul><ul><li>Bone augmentation(Yukna,1980) </li></ul><ul><li>Overcome rapid rate of epithelial proliferation down along the root. </li></ul>
  8. 9. <ul><li>Use of acids-1 st reported in NEWYORK DENTAL RECORD in 1846,later YOUNGER(1893) </li></ul><ul><li>Several substances have been used for ROOT CONDITIONING- </li></ul><ul><li>These include Citric acid,Fibronectin,Tetracycline. </li></ul>
  9. 10. CITRIC ACID <ul><li>Studies by Urist showed formation of new bone or cementum on partially or totally demineralised dentin matrix or allogenic bone. </li></ul><ul><li>pH-1.0-1.4 </li></ul><ul><li>Application time-2or 3 min. </li></ul>
  10. 12. MODE OF ACTION <ul><li>Removal of smear layer formed after root planing </li></ul><ul><li>This creates a mat like collagen surface with exposed dentinal tubules </li></ul><ul><li>PDL cells and gingival FIBROBLASTS adhere better to demineralized root surface. </li></ul>
  11. 13. CITRIC ACID MECHANISM FOR GAINING ROOT COVERAGE <ul><li>EXPOSED ROOT SURFACE </li></ul><ul><li>CITRIC ACID Ph 1.0 </li></ul><ul><li>4microns DEMINERALIZED SURFACE EXPOSED COLLAGEN FIBRILS +EXPOSED COLLAGEN FIBRILS OF FLAP OR GRAFT. </li></ul><ul><li>PLASMA FIBRONECTIN FACTOR,FACTOR 13 </li></ul><ul><li>FIBRIN COVALENT LINKAGE </li></ul>
  12. 14. <ul><li>COLLAGEN FIBRILS OF ROOT </li></ul><ul><li>NEWLY SYNTHESIZED COLLAGEN FIBERS </li></ul><ul><li>COLLAGEN FIBRILS OF GRAFT </li></ul>
  13. 15. ACTIONS <ul><li>Accelerated healing and new cementum formation. </li></ul><ul><li>No significant action on non-root planed roots,after root planing-4mm deep demineralized zone is created. </li></ul><ul><li>Antibacterial effect.(Daly,1982) </li></ul><ul><li>Root detoxification(Aleo et al,1975) </li></ul><ul><li>Prevents migration of epithelium . </li></ul><ul><li>Enhanced fibroblast growth and stability(Boyko et al ,1980) </li></ul><ul><li>Attachment by direct linkage. </li></ul>
  14. 16. TECHNIQUE OF APPLICATION
  15. 17. TETRACYCLINE HCL <ul><li>Actions- </li></ul><ul><li>Antibacterial,exposure of root collagen and opening of the dentinal tubules </li></ul><ul><li>Demineralization </li></ul><ul><li>Detoxification </li></ul><ul><li>Attachment by direct linkage </li></ul>
  16. 18. Other advantages
  17. 19. DISADVANTAGES <ul><li>Requires high concentrations(>0-5%) </li></ul><ul><li>Longer application times(>5min) </li></ul><ul><li>Not so effective as CA in root demineralization and removal of smear layer. </li></ul><ul><li>No human histologic or clinical studies show +ve results as CA. </li></ul>
  18. 20. FIBRONECTIN <ul><li>It is a glycoprotein that fibroblasts require to attach to root surfaces. </li></ul><ul><li>Addition of fibronectin-promotes new attachment. </li></ul><ul><li>Fibronectin-fibrin sealing system helps in healing of PERIODONTAL SURGICAL WOUNDS </li></ul><ul><li>Commercially available in Europe as ‘’TISSUCOL’’. </li></ul>
  19. 22. ACTIONS <ul><li>Enhances the effect of demineralization with regard to new attachment </li></ul><ul><li>Enhances cell proliferation from PDL and SUPRACRESTAL area </li></ul><ul><li>Conc-0.38/ml saline,has also been used as a substitute for sutures </li></ul><ul><li>Chemotactic effect on fibroblasts and mesenchymal cells. </li></ul>
  20. 25. APPLICATIONS <ul><li>COSMETIC GINGIVAL RECONSTRUCTION </li></ul><ul><li>PRIOR TO PLACEMENT OF BONE IMPLANTS </li></ul><ul><li>INFRABONY DEFECTS </li></ul><ul><li>IMPLANT ADDITIVE(TTC) </li></ul><ul><li>PRIMARY TREATMENT FOR CL2 FURCATIONS. </li></ul>
  21. 26. CONCLUSION <ul><li>Although not yet fully supported by research on humans,CA and TTC have significant benefits that cannot be achieved by scaling and root planing alone. </li></ul><ul><li>In future they may provide a surface substrate for use of’’ PROTEIN MODIFIERS’’. </li></ul><ul><li>Note:’’SYNTHETIC BIOLOGIC PROTEIN MODIFIERS’’-artificially stimulate tissue regeneration. </li></ul>
  22. 27. Hope u liked it…THANK YOU!

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