The use of EDTA root conditioning in regenerative procedures of periodontal tissues

Abstract

Periodontitis is a chronic destructive inflammatory disease caused by bacteria present in dental plaque. This condition induces the breakdown of tooth supporting apparatus, and the ultimate result of the untreated disease is tooth loss. The primary goal of periodontal therapy consists not only to arrest the tissue destruction caused by periodontal disease but also to regenerate the tooth supporting tissues, including alveolar bone, periodontal ligament and cementum. Several procedures have been proposed to enhance regeneration of periodontal tissues, including chemical root surface conditioning. The concept of root conditioning has been based on the perceived need for decontamination of the root surface devoid of attachment apparatus and for exposure of collagen fibers. Periodontitis-affected root surfaces are hypermineralized and contaminated with bacteria and inflammation-inducing bacterial components, such as endotoxin. In addition, the smear layer formed during mechanical root instrumentation has been suggested to act as a physical barrier, inhibiting new connective tissue attachment to the root surface. Therefore, a number of varying pH agents have been used to eliminate the factors that render the root surface bioincompatible for periodontal tissues regeneration. Root conditioning with a neutral pH agent such as EDTA appeared to produce in a short-term perspective a more biocompatible surface compared to conditioning at low pH. Etching at low pH may induce an immediate necrosis while etching at neutral pH preserves the integrity of exposed collagen fibers and the vitality of the adjacent tissues. EDTA root conditioning removes the root surface-associated smear layer, widening dentinal tubule orifices, and exposing collagen matrix when it is applied after scaling and root planing. The aim of this article is to present an overview of the biological effects of EDTA conditioning for root surface modification and to discuss the use of this chemical agent in regenerative procedures of periodontal tissues. © 2013 by Nova Science Publishers, Inc. All rights reserved.