Guided tissue regeneration of intrabony defects with perforated barrier membranes, simvastatin, and EDTA root surface modification: A clinical and biochemical study.

BACKGROUND: Perforated barrier membranes (PBM) were suggested to enhance periodontal regeneration by allowing positive charity of wanted elements from the gingival tissue side. The present study was designed to evaluate clinically and biochemically the use of PBM combined with simvastatin (SMV) gel with and without an associated EDTA gel root surface etching as a suggested option that could improve SMV availability and clinical outcomes of PBM. METHODS: Forty patients having moderate-to-severe chronic periodontitis with 40 intrabony defects were randomly divided into four treatment groups (10 sites each). Patients in group 1 received 1.2% SMV gel and covering the defect with occlusive membrane (OM). Patients in group 2 received 1.2% SMV gel and covering the defect with PBM. Group 3 received 24% EDTA root surface etching, 1.2% SMV gel, and defect coverage with OM (eOM). Patients in group 4 were treated as in group 3 but the defect was covered with PBM (ePBM). Clinical parameters were recorded at baseline before surgical procedures and were reassessed at 6 and 9 months after therapy. The mean concentration of SMV in gingival crevicular fluid (GCF) was estimated by reverse-phase high-performance liquid chromatography at days 1, 7, 14, 21, and 30. RESULTS: At 6- and 9-month observation periods, groups 3 and 4 showed a statistically significant improvement in PD reduction and CAL gain compared with groups 1 and 2. Group 4 showed a statistically significant more defect fill compared with groups 1, 2, and 3 (P ≤ .05). Group 2 showed statistically significant higher defect fill compared with group 1 and group 3 (P < .05). Bone density was significantly increased with no significant difference between the four groups at 6- and 9-month observation periods. SMV-GCF concentration in group 4 showed the highest mean concentration with no significant difference than that of group 3. CONCLUSION: The use of perforated barrier membranes in association with SMV enhances the clinical hard tissue parameters compared with occlusive ones in treating intrabony periodontal defects. Moreover, EDTA root surface treatment could enhance SMV availability in the defect area.

Dimensional evaluation of blood clot gap distances within intrabony defects following grafting and EDTA root surface treatment-experimental study in dogs.

BACKGROUND: Because it is important to establish and maintain a firm blood clot to the surrounding tissues within the intrabony lesion; we have to investigate the potentials of different materials in resisting clot retraction that disrupt clot adhesion to the root surface. This study was designed to measure the gap distance created by clot retraction within the defect following intrabony defects grafting with and without root surface EDTA etching. METHODS: Eight mongrel dogs with surgically created acute-chronic bilateral mandibular interproximal intrabony defects in the premolar-molar areas were enrolled in this study (total 8 defects per dog). Intrabony defects were divided into four groups, the first group (OFD): control open flap debridement, the second group, (EDTA treated defects) in which debridement of the defects was followed by two minute root surface etching with a neutral 24% EDTA gel followed by two minute copious saline irrigation, the third group (only grafted defects): defects received closely packed ß-TCP of a particle size ranged from 150 to 500 mm, and the fourth group, (Graft + EDTA treated defects): defects were etched for 2 minutes with a neutral 24% EDTA gel and saline irrigation followed by intrabony defect fill of ß-TCP. Twenty four hours post treatment, animal euthanasia was carried out for histomorphometric analysis of the tooth and root side gap distances. RESULTS: EDTA treated group and EDTA + graft group showed statistically significant lower degree of clot shrinkage compared to both the control and only grafted group. Clot shrinkage in EDTA treated group showed no significant difference from that of the EDTA + graft group (p = 0.197). OFD and only grafted groups were found to show statistically higher clot retraction percnetage compared to both EDTA and EDTA+graft groups. CONCLUSION: following intrabony defect debridement, blood clot undergoes clot retraction creating a micro gap with the root surface. EDTA root surface etching before graft application into the defect area significantly reduced the amount of gap distance.

Mixed nano/micro-sized calcium phosphate composite and EDTA root surface etching improve availability of graft material in intrabony defects: an in vivo scanning electron microscopy evaluation.

BACKGROUND: The use of nanoparticles of graft materials may lead to breakthrough applications for periodontal regeneration. However, due to their small particle size, nanoparticles may be eliminated from periodontal defects by phagocytosis. In an attempt to improve nanoparticle retention in periodontal defects, the present in vivo study uses scanning electron microscopy (SEM) to evaluate the potential of micrograft particles of ß-tricalcium phosphate (ß-TCP) to enhance the binding and retention of nanoparticles of hydroxyapatite (nHA) on EDTA-treated and non-treated root surfaces in periodontal defects after 14 days of healing. METHODS: Sixty patients having at least two hopeless periodontally affected teeth designated for extraction were randomly divided into four treatment groups (15 patients per group). Patients in group 1 had selected periodontal intrabony defects grafted with nHA of particle size 10 to 100 nm. Patients in group 2 were treated in a similar manner but had the affected roots etched for 2 minutes with a neutral 24% EDTA gel before grafting of the associated vertical defects with nHA. Patients in group 3 had the selected intrabony defects grafted with a composite graft consisting of equal volumes of nHA and ß-TCP (particle size 63 to 150 nm). Patients in group 4 were treated as in group 3 but the affected roots were etched with neutral 24% EDTA as in group 2. For each of the four groups, one tooth was extracted immediately, and the second tooth was extracted after 14 days of healing for SEM evaluation. RESULTS: Fourteen days after surgery, all group 1 samples were devoid of any nanoparticles adherent to the root surfaces. Group 2 showed root surface areas 44.7% covered by a single layer of clot-blended grafted particles 14 days following graft application. After 14 days, group 3 samples appeared to retain fibrin strands devoid of grafted particles. Immediately extracted root samples of group 4 had adherent graft particles that covered a considerable area of the root surfaces (88.6%). Grafted particles appeared to cover all samples in a multilayered pattern. After 14 days, the group 4 extracted samples showed multilayered fibrin-covered nano/micro-sized graft particles adherent to the root surfaces (78.5%). CONCLUSION: The use of a composite graft consisting of nHA and microsized ß-TCP after root surface treatment with 24% EDTA may be a suitable method to improve nHA retention in periodontal defects with subsequent graft bioreactivity.

Doxycycline-loaded ß-tricalcium phosphate release following EDTA root surface etching improved the clinical outcomes in chronic periodontitis: an in vivo study.

BACKGROUND: The main objective of the present study is to quantify doxycycline (DOX) release from ß-tricalcium phosphate (ß-TCP) after EDTA root surface treatment. METHODS: Thirty systemically healthy patients with ≥1 paired contralateral interproximal intrabony defect ≥4 mm deep along with an interproximal probing depth ≥6 mm and clinical attachment level ≥4 mm were randomized into two groups. Group 1 (G1) consisted of sites treated with open flap debridement followed by placement of DOX blended with ß-TCP (DOX-ß-TCP), whereas group 2 (G2) sites were treated with flap surgery followed by the placement of DOX blended with ß-TCP after EDTA etching of the exposed root surfaces (DOX-ß-TCP + EDTA). Samples of gingival crevicular fluid (GCF) were obtained 1, 3, 7, 14, and 21 days after surgery. Quantitative measurements of DOX were taken with high-performance liquid chromatography. Clinical evaluation and follow-up for 6 months were performed. RESULTS: At 21 days, the DOX-ß-TCP + EDTA-treated group showed a 194.7 µg/mL value. The DOX-ß-TCP + EDTA-treated group retained more DOX during the periods of 3, 7, 10, 14, and 21 days than the DOX-ß-TCP-treated group. Six months after therapy, DOX-ß-TCP + EDTA-treated sites showed more significant clinical improvements compared to DOX-ß-TCP-treated sites (P ≤ 0.05). CONCLUSIONS: EDTA root surface etching enhances DOX availability in the GCF following its release from ß-TCP as a drug carrier.

A novel approach to the use of doxycycline-loaded biodegradable membrane and EDTA root surface etching in chronic periodontitis: a randomized clinical trial.

BACKGROUND: The release profile of 25% doxycycline (DOX) gel loaded on a biodegradable collagen membrane (COL) after 24% EDTA root surface etching was evaluated. METHODS: Thirty systemically healthy patients, each with at least one pair of contralateral interproximal intrabony defects ≥4 mm deep, along with an interproximal probing depth ≥6 mm and clinical attachment loss ≥4 mm, were randomized into two groups. Group 1 consisted of sites treated with open-flap debridement followed by placement of DOX gel-loaded COL (DOX-COL), whereas group 2 sites were treated with flap surgery followed by the placement of DOX-COL after EDTA etching of the exposed root surfaces (DOX-COL + EDTA). Samples of gingival crevicular fluid were obtained 1, 3, 7, 14, and 21 days after surgery. Separation was performed, and quantitative measurements of DOX were taken with a high-performance liquid chromatography. Clinical evaluation and follow-up for 6 months were performed. RESULTS: At 21 days, DOX-COL + EDTA group showed 5.3 µg/mL value. However, no DOX was detected in samples of the DOX-COL group. DOX-COL + EDTA-treated group retained more DOX during the periods of 3, 7, 10, and 14 days than did the DOX-COL group. CONCLUSION: EDTA root surface etching could enhance DOX availability in the gingival crevicular fluid after its release from the collagen membrane.

Chlorhexidine controlled-release profile after EDTA root surface etching: an in vivo study.

BACKGROUND: The main objective of the present study was to quantify chlorhexidine (CHX) release after the use of CHX-EDTA root surface treatment as a local-delivery antimicrobial vehicle. METHODS: Twenty non-smoking patients clinically diagnosed as having moderate-to-severe chronic periodontitis were selected to participate in this study. After cause-related therapy, one site in every patient received defect overfill with CHX gel 2% (20 sites). In addition, twenty contralateral sites received defect fill of CHX gel after 3 minutes of 24% EDTA gel root surface etching (20 sites). Gingival crevicular fluid samples were collected at 1, 3, 7, and 14 days post-therapy. RESULTS: The CHX-EDTA group showed statistically significantly higher levels of CHX than those of the control group at 1, 3, and 7 days. At 14 days, the CHX-EDTA group showed 0.8 mg/mL values. CONCLUSION: The use of CHX-EDTA root surface treatment as a local-delivery antimicrobial improves CHX substantivity.

The effects of EDTA gel conditioning exposure time on periodontitis-affected human root surfaces: surface topography and PDL cell adhesion.

OBJECTIVE: The purpose of this investigation was to study the surface topography of periodontally-affected human roots following EDTA gel application at different time periods with and without scaling and root planing. In addition, to assess any correlations between root surface changes following EDTA gel conditioning and periodontal ligament fibroblast adhesion. METHODS: Forty-eight teeth that had a labial probing depth and clinical attachment loss of more than 7mm were used in this study. Periodontally-affected teeth were randomly divided into 4 groups of 12 teeth in each. Furthermore, a sample group of 6 teeth, which had a healthy periodontium, were used to serve as the healthy control (G1). The second group (G2) served as a diseased treated control in which sample teeth were only scaled and root planed prior to immediate extraction. Teeth in the third group (G3) were conditioned with a pH neutral, 24% Ethylenediaminetetraacetic acid (EDTA gel), for 2 minutes without any scaling or root planing and immediately extracted. The teeth in the fourth group (G4) were scaled, root planed, and then conditioned with the EDTA gel preparation for 2 minutes before immediate extraction. Finally the teeth in the fifth group (G5) were conditioned with EDTA gel for 4 minutes following scaling and root planing and immediately extracted. Half the samples in each group were randomly selected and processed for SEM evaluation of the surface topography. The other half were prepared to assess PDL cell adhesion with PDL fibroblasts being cultured and seeded on the root surface for 24 hours then processed for SEM evaluation of the adherent cells. RESULTS: SEM evaluation of the root planed surfaces in G2 revealed the typical appearance of a smear layer. The root surfaces of all samples in G3 exhibited a uniform coating of calculus that was covered by a considerable amount of loosely attached material including residual plaque and debris. In G4 EDTA gel exposure for 2-minutes following scaling and root planing resulted in removal of the smear layer and a marked exposure of round to oval dentinal tubule orifices. Areas of bacterial accumulation were observed in 4 out of the 6 samples examined in this group. The root surfaces after the 4-minute EDTA gel application (G5) had a fibrillar texture associated with a marked decrease in the number and an increased diameter of the exposed dentinal tubule openings. With regard to PDL cell adhesion, the majority of the 2-minute EDTA gel conditioning on the non-instrumented samples in G3, showed a failure of cells to adhere to the diseased root surface. The examined samples in G4 showed a significant increase in the number of flat and round adherent cells when compared to the diseased control samples (G2) (P > or = 0.01). The G5 samples showed a significant increase in the number of flat cells when compared to G4 (P > or = 0.01). CONCLUSION: The present study confirms the capability of EDTA gel to remove a root surface associated smear layer and to expose a collagen matrix when it was applied after scaling and root planing. In addition, a positive correlation was found between time of EDTA gel conditioning and the degree of PDL cell adhesion. It appears from the present investigation that EDTA gel conditioning for 4 minutes provides the most desirable root surface to which maximum PDL cells can adhere and on which they can grow.