Bone Regeneration And Grafting

Reconstructive Osseous Surgery

Write short note on root surface conditioner.
Answer. Several substances have been used to condition the root surface, for attachment of new connective tissue fiber.

Various agents used as root surface conditioner are:

• Chemical treatment of root surfaces
  • Acid etching, i.e. citric acid and tetracycline
  • Detergents, i.e. cetylpyridinium chloride and sodium N-lauroylsarcosine
  • Chelating agent, i.e. EDTA
  • Enzymes
  • Attachment proteins, i.e. fibronectin and growth factors
• Mechanical
• Laser

Read And Learn More: Periodontics Question And Answers

Citric Acid

• It is used at pH of 1 for 2-3 minutes on root surface, after surgical debridement it produces a surface demineralization, which in turn induces cementogenesis and attachment of collagen fibers.
• It removes the smear layer, and may open dentinal tubules, thus allowing cementum to form within these tubules and produces cementum pins. This could be associated with accelerated cementogenesis.
• Epithelium does not migrate apically because of the accelerated healing either by connective tissue attachment or a collagen adhesion may occur before epithelium migrates.
• Citric acid may demineralize small bits of residual calculus, disinfect the root surface and aid in removing endotoxins.

EDTA

• It is used at concentration of 24% and at pH 7.
• EDTA exposes collagen fibers of dentine matrix, which leads to the adhesion of blood clot to the root surface and favors migration of fibroblasts.
• It improves clot organization, retard epithelium down growth and enhances clinical attachment gain.
• It has advantage over citric acid as it acts at neutral pH while citric acid acts at acidic pH and necrotizes surrounding periodontal tissue.

Fibronectin

• It acts as adhesive for attachment of fibroblast on root surfaces.
• It promotes connective tissue attachment and regeneration of bone.
• It prevents separation of flap and favor hemostasis.
• Prevents migration and proliferation of epithelial cells.

Tetracycline

• Remove smear layer and exposes dentinal tubules.
• Enhances attachment and spreading of fibroblasts on root surfaces.
• Decreases epithelial cell attachment.
• Reduces gingival collagenolytic activity by inhibiting neutrophil collagenases.

Growth Factors

• Various growth factors used are platelet derived growth factor, insulin like growth factor, fibroblast growth factor.
• These are the naturally occurring polypeptide molecules which are secreted by macrophages, endothelial cells, fibroblasts and platelets which regulate events in periodontal wound healing.
• They undergo regulation of connective tissue cell migration as well as proliferation of periodontal ligament cells, differentiation of osteoblasts and cementoblasts and production of extracellular matrix proteins for periodontal regeneration.