In vitro comparison of different 24% EDTA gel formulations efficacy on root surface conditioning
Comparação in vitro da eficácia de diferentes formulações do gel de EDTA 24% no condicionamento da superfície radicular
Sousa, Cliciane Portela; Frizzera, Fausto; Batista, Luiz Henrique Carvalho; Dantas, Andrea Abi Rached; Zandim-Barcelos, Daniela Leal; Sampaio, José Eduardo Cezar
http://dx.doi.org/10.1590/S1807-25772013000100002
Rev. odontol. UNESP, vol.42, n1, p.7-12, 2013
Abstract
The main goal of root biomodification is to modify the root surface in order to improve the repair of periodontal tissues destroyed by periodontal disease. Objective: To evaluate the conditioning efficacy of 24% EDTA gel of different trademarks, considering the variables time and application method, by scanning electron microscopy. Material and method: 225 samples were randomly assigned to five groups: sterile saline solution (control); 24% EDTA (Santa Paula Pharmacy); 24% EDTA-T (Santa Paula Pharmacy); 24% EDTA (PrefGel – Straumann); 24% EDTA (Biodinâmica). For each experimental group the gels were applied for 1, 2 or 3 minutes by topical application; vigorous or smooth friction. The Kruskal-Wallis and Dunn tests (p ≤ 0,05) were used and individually applied to the variables commercial brand, time and type of application. Result: The statistical analysis showed that 24% EDTA Biodinâmica gel promoted less smear layer removal compared to the other groups. No significant differences could be detected among the different times of application. The smooth friction resulted in lower amount of residual smear layer. Conclusion: All 24% EDTA gels tested were able to remove smear layer and to expose dentinal tubules irrespective of application time; however, the application method by smooth friction was more effective than the other ones. The comparative analysis demonstrated that the Biodinâmica gel was the least effective product, promoting less smear layer removal and exposure of collagen fibers than the other EDTA gels.
Keywords
EDTA, collagen, microscopy electron scanning, tooth root.
Resumo
A biomodificação radicular visa a alterar a superfície radicular para auxiliar no reparo das estruturas periodontais de suporte destruídas pela doença periodontal. Objetivo: Avaliar por meio de microscopia eletrônica de varredura a eficácia do condicionamento químico com gel de EDTA 24% na remoção de smear layer e na exposição de fibras colágenas, verificando-se diferentes marcas comerciais, modos e tempos de aplicação. Material e método: Um total de 225 amostras foram obtidas e distribuídas aleatoriamente em cinco grupos: soro fisiológico (controle); EDTA 24% (Farmácia Santa Paula); EDTA-T 24% (Farmácia Santa Paula); EDTA 24% (PrefGel; Straumann); EDTA 24% (Biodinâmica). As amostras de cada grupo foram redistribuídas aleatoriamente em subgrupos (n = 5) e condicionadas com os diferentes géis de EDTA nos tempos de 1, 2 e 3 minutos, e nos modos de aplicação tópica, fricção vigorosa e fricção suave. Os testes de Kruskal-Wallis e Dunn (p ≤ 0,05) foram utilizados e aplicados separadamente para os fatores: marca comercial, tempo e modo de aplicação. Resultado: A análise estatística revelou que o gel de EDTA 24% da Biodinâmica promoveu a menor remoção de smear layer. Não foram detectadas diferenças estatísticas para os tempos de aplicação. O modo de aplicação fricção suave resultou em menor quantidade de smear layer residual. Conclusão: Todos os géis de EDTA 24% utilizados foram eficazes na remoção de smear layer e na exposição de fibras colágenas, independentemente do tempo de aplicação; no entanto, o modo de fricção suave foi mais efetivo. Na análise comparativa entre os produtos, o EDTA da Biodinâmica foi menos efetivo, já que promoveu menor remoção de smear layer e exposição de fibras colágenas.
Palavras-chave
EDTA, colágeno, microscopia eletrônica de varredura, raiz dentária.
References
1. Kassab M, Cohen RE. The effect of root modification and biomodification on periodontal therapy. Compend Contin Educ Dent. 2003;24:31-44. PMid:12619258.
2. Wirthlin MR, Hancock EB. Biological preparation of disease surfaces. J Periodontol. 1980;51:291-7. http://dx.doi.org/10.1902/jop.1980.51.5.291
3. Brännström M, Nordevall KJ, Glantz PO. The effect of EDTA containing surface active solutions on the morphology of prepared dentin. An in vivo study. J Dent Res. 1980;59:1127-31. PMid:6769983. http://dx.doi.org/10.1177/00220345800590070501
4. Chaves E, Cox C, Morrison E, Caffesse R. The effect of citric acid application on periodontally involved root surfaces. II. An in vivo light microscopic study. Int J Periodontics Restorative Dent. 1993;13:189-96.
5. Wikesjö UME, Nilvéus RE, Selvig KA. Significance of early healing events on periodontal repair: a review. J Periodontol. 1992;63:158-65. PMid:1593409. http://dx.doi.org/10.1902/jop.1992.63.3.158
6. Pitaru S, Hekmati M, Soldinger M, Savion N. Growth and migration of gingival epithelial cells on mineralized and partially demineralized root surfaces in an in vitro system. J Periodontol. 1988;59:531-4. PMid:3050020. http://dx.doi.org/10.1902/jop.1988.59.8.531
7. Zaman KU, Sugaya T, Hongo O, Kato H. A study of attached and oriented human periodontal ligament cells to periodontally diseased cementum and dentin after demineralizing with neutral and low pH etching solution. J Periodontol. 2000;71:1094-9. PMid:10960015. http://dx.doi.org/10.1902/jop.2000.71.7.1094
8. Heritier M. Effects of phosphoric acid on root dentin surface. A scanning and transmission electron microscopic study. J Periodontal Res. 1984;19:168-76. PMid:6231367.
9. Register AA, Burdick FA. Accelerated reattachment with cementogenesis to dentin, demineralized in situ. II. Defect repair. J Periodontol. 1976;47:497-505. PMid:1067403. http://dx.doi.org/10.1902/jop.1976.47.9.497
10. Blomlöf J, Lindskog S. Periodontal tissue-vitality after different etching modalities. J Clin Periodontol. 1995;22:464-8. http://dx.doi.org/10.1111/j.1600-051X.1995.tb00178.x
11. Blomlöf J, Lindskog S. Root surface texture and early cell and tissue colonization after different etching modalities. Eur J Oral Sci. 1995;103:17-24. http://dx.doi.org/10.1111/j.1600-0722.1995.tb00005.x
12. Trombelli L, Scabbia A, Zangari F, Griselli A, Wikesjö UM, Calura G. Effect of tetracycline HCL on periodontally-affected human root surfaces. J Periodontol. 1995;66:685-91. PMid:7473011. http://dx.doi.org/10.1902/jop.1995.66.8.685
13. Blomlöf J, Jansson L, Blomlöf L, Lindskog S. Root surface etching at neutral promotes healing. J Clin Periodontol. 1996;23:50-5. PMid:8636457. http://dx.doi.org/10.1111/j.1600-051X.1996.tb00504.x
14. Blomlöf J. Root cementum appearance in healthy monkeys and periontitis-prone patients after different etching modalities. J Clin Periodontol. 1996;23:12-8. PMid:8636451. http://dx.doi.org/10.1111/j.1600-051X.1996.tb00498.x
15. Blomlöf J, Blomlöf L, Lindskog SF. Smear layer formed by different root planing modalities and its removal by an ethylenediaminetetraacetic acid gel preparation. Int J Periodontics Restorative Dent. 1997;17:243-9.
16. Blomlöf J, Blomlöf L, Lindskog S. Effect of different concentrations of EDTA on smear removal and collagen exposure in periodontitis-affected root surfaces. J Clin Periodontol. 1997;24:534-7. PMid:9266339. http://dx.doi.org/10.1111/j.1600-051X.1997.tb00225.x
17. Lasho D, O'Leary T, Kafrawy A. A scanning electron microscope study of the effects of various agents on instrumented periodontally involved root surface. J Periodontol. 1983;54:210-20. PMid:6406665. http://dx.doi.org/10.1902/jop.1983.54.4.210
18. Blomlöf J, Blomlöf L, Lindskog S. Smear removal and collagen exposure after non-surgical root planing followed by etching with EDTA gel preparation. J Periodontol. 1996;67:841-5. PMid:8884639. http://dx.doi.org/10.1902/jop.1996.67.9.841
19. Blomlöf L, Jonsson B, Blomlöf J, Lindskog S. A clinical study of root surface conditioning with EDTA gel I. Non surgical periodontal treatment. Int J Periodontics Restorative Dent. 2000;20:561-5.
20. Blomlöf L, Jonsson B, Blomlöf J, Lindskog S. A clinical study of root surface conditioning with EDTA gel II. Surgical periodontal treatment. Int J Periodontics Restorative Dent. 2000;20:567-73.
21. Sampaio JEC, Theodoro LH, Correa MA, Mendes AJ. A comparative SEM study of smear layer removal by detergents and EDTA on the root surfaces. Int J Periodontics Restorative Dent. 2005;25:157-63. PMid:15839592.
22. Bergenholtz A, Babay N. Scanning electron microscopy of the root surface texture of extracted periodontally diseased teeth following various etching and chelating regimens. Int J Periodontics Restorative Dent. 1998;18:171-9. PMid:9663095.
23. Tay FR, Kwong SM, Itthagarun A, King NM, Yip HK, Moulding KM, et al. Bonding of self-etching primer to non-carious cervical sclerotic dentin: interfacial ultrastructure and microtensile bond strength evaluation. J Adhes Dent. 2000;2:9-28. PMid:11317411.
24. Batista LHC, Sampaio JEC, Pilatti GL, Shibli JA. Efficacy of EDTA-T gel for smear layer removal at root surfaces. Quintessence Int. 2005;38:531-8.
25. Pilatti GL. Sampaio, JEC. Estudo "in vitro" da eficácia de um gel de EDTA na remoção da "smear layer" da superfície radicular. Rev Pós Grad. 2005;12:111-7.
26. Sampaio JEC, Rached RS, Pilatti GL, Theodoro LH, Batista LH. Effectiveness of EDTA and EDTA-T brushing on the removal of root surface smear layer. Pesqui Odontol Bras. 2003;17:319-25. PMid:15107913. http://dx.doi.org/10.1590/S1517-74912003000400005
27. Leite FRM, Sampaio JEC, Zandim DL, Dantas AAR, Leite ERM, Leite AA. Influence of root-surface conditioning with acid and chelating agents on clot stabilization. Quintessence Int. 2010;41:257-63. PMid:20213027.
28. Leite FR, Moreira CS, Theodoro LH, Sampaio JEC. Blood cell attachment to root surfaces treat with EDTA gel. Pesqui Odontol Bras. 2005;19:88-92.
29. Sampaio JEC, Fontanari LA, Pinto SCS, Cavassim R. Biomodificação tecidual: uma revisão da literatura. Rev Periodontia. 2009;19:37-43.
30. Khatri PM, Jaiswal SG, Bhongade ML. The effectiveness of enamel matrix protein (Emdogain®) in combination with coronally advanced flap in the treatment of multiple marginal tissue recession: a clinical study. J Indian Soc Periodontol. 2012;16:224-30. PMid:23055589 PMCid:3459503. http://dx.doi.org/10.4103/0972-124X.99266
31. Koop R, Merheb J, Quirynen M. Periodontal regeneration with enamel matrix derivative in reconstructive periodontal therapy: a systematic review. J Periodontol. 2012;83:707-20. PMid:22050544. http://dx.doi.org/10.1902/jop.2011.110266