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Effects of acid conditioning in root surface decontamination and in root coverage: analysis by SEM and randomized clinical trial

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João Paulo Corrêa Barros
Total Authors: 1
Document type: Master's Dissertation
Press: Bauru.
Institution: Universidade de São Paulo (USP). Faculdade de Odontologia de Bauru (FOB/SDB)
Defense date:
Examining board members:
Adriana Campos Passanezi Sant'Ana; Sebastiao Luiz Aguiar Greghi; José Eduardo Cezar Sampaio
Advisor: Adriana Campos Passanezi Sant'Ana

The aim of this study was to investigate the effects of root conditioning in different periods of time in decontamination of root surfaces in vitro and to evaluate the effects in root coverage in humans. For the in vitro study, 132 root fragments were separated in 11 groups, according to treatment: PA180 scaling and root planing (SRP) + phosphoric acid (PA) application for 180 seconds; PA90 SRP + PA application for 90 seconds; EDTA180 SRP + EDTA application for 180 seconds; EDTA90 SRP + EDTA application for 90 seconds; ACT180 SRP + citric acid associated to tetracycline (ACT) for 180 seconds; ACT90 SRP + ACT for 90 seconds; AC180 SRP + citric acid (CA) for 180 seconds; AC90 SRP + CA for 90 seconds; T180 SRP + acid tetracycline (T) for 180 seconds, T90 SRP + T for 90 seconds; Control SRP. Fragments were analysed by scanning electron microscopy to determine the degree of root surface decontamination, according to surface rugosity index (SRI), residual calculus index (RCI), loss of tooth substance index (LTSI), presence of tissue remnants index (PTRI) and removal of smear layer index (RSLI). The results obtained were statistically analysed according to Kruskal Wallis method. At the randomized clinical trial, 27 patients aged 23-60 years (39,9 ± 13,22 years), both genders, presenting Millers class I or II recessions, were randomly allocated into one of the following groups to investigate the effects of acid conditioning in root coverage: G180- application of citric acid associated to tetracycline (ACT) for 3 minutes after SRP(n= 20 sites); G90- application of ACT for 90 seconds after SRP (n= 20 sites); G0- RAR (n= 20 sites).All sites were treated by subepithelial connective tissue graft. Probing depth (PD), clinical attachment level (CAL), recession heigth (RH), width of keratinized gingiva (KGW), sulcular bleeding index and plaque index were investigated at baseline and at 1, 3, 6 and 12 months postoperative. Patients have answered a questionnaire to determine the intensity of hypersensitivity according to a pain scale varying from 0 (absent) to 10 (highest pain) at baseline and 7 and 14 days, 1, 3, 6 and 12 months postoperative. Control group showed the highest RSI (2.0 ± 1.02) and RSLI (3.83 ± 1.19), while EDTA180 showed the lowest RCI (1.33 ± 0.63), LTSI (1.0 ± 0.0), PTRI (1.08 ± 0.28) and RSLI (1.08 ± 0.28). No significant differences (p> 0.05) were observed among EDTA180, EDTA90, AC90, AC180, ACT90 and ACT180 at all investigated indexes. At randomized clinical trial, a significant (p< 0.0001) gain of attachment level, reduction of recession height and increase in keratinized gingiva width in all groups, along with no significant alteration in PD (p> 0.05).The mean percentage of root coverage was greater at G180 (59.58% ± 34.76%), but with no significant differences (p= 0.31) when compared to G90 (52.12% ± 30.98%) and G0 (40.87% ± 36.96%). A higher mean reduction of recession height was observed at G90 (1.95 ± 1.27) than at control group (0.95 ± 1.05), but with no significant differences (p> 0.05) when compared to G180 (1.20 ± 0.69). A wider keratinized gingiva was observed at G90 (3.50 ± 1.90) and G180 (4.05 ± 0.44) after 12 months, with significant differences (p=0.0018) when compared to G0 (2.0 ± 1.41). A significant reduction of hypersensitivity was observed at all groups (p< 0.0001), with no differences among groups (p> 0.05). These findings suggest that root conditioning favors an increase in keratinized gingiva width and reduction of recession height, along with reduction of hypersensitivity. Among the different types of conditioning agents, the best results were observed with 24% EDTA, CA pH 1.0 and ACT applied for 90 seconds or 3 minutes. (AU)

FAPESP's process: 11/03161-0 - Evaluation of the effects of different conditioning agents on the radicular surface decontamination: in vitro and in vivo study
Grantee:João Paulo Corrêa Barros
Support type: Scholarships in Brazil - Master