“Root Conditioning- to do or not to do”- Guest lecture as a part of Dr NTRUHS Zonal CDE programme at SVS Institute of Dental Sciences, Mahabubnagar, India on 15/7/2014 and at Paneenya Mahavidyalaya Institute of Dental Sciences, Hyderabad, India on 27/09/2014.

2. kənˈdɪʃ(ə)n/
Verb
1. have a significant influence on or
determine the manner or outcome of
something.
2. Bring something into the desired
state for use.

3. “Presumable Clinical Reattachment”
with Aromatic H2SO4
"loss of Cemental Vitality”
“Cemental Cuticle”
“Cemental Pins”
“Fibrin Linkage”

4. A known situation is that the complex
inflammatory, enzymatic, and molecular
biological influences which accompany
periodontal disease may produce
physical or chemical changes which are

5. Goes P, Melo IM, Dutra CS, Lima AP, Lima V.
Effect of alendronate on bone-specific alkaline phosphatase on periodontal bone
loss in rats. Arch Oral Biol. 2012 Nov;57(11):1537-44.

6. A zone of partial destruction of the
connective tissue fibers
A zone of intact connective tissue
fiber attachment to cementum
A zone of complete destruction
A space of 0.1 to 0.2 µ containing
some granular material but no
recognizable fibrils, can be seen.
This is the “Cemental Cuticle”

7. Loss of collagen cross banding,
Breakdown of dentogingival fibers
Dissolution of mineral components
Atypical development and
orientation of large apatite crystals
characterize the surface structure
of hypermineralized cementum in
periodontitis
Cervical root resorption or
idiopathic root resorption, and
its nature has not been adequately
elucidated

8. The root surface is covered with a
“cementum cuticle” formed
because of fiber destruction and
hypermineralization.
Cementum which has undergone
longer exposure shows a complete
covering of the normal projections
with what appears to be flat sheet-
like plaque and calculus
formations.

9. Plaque bacterial products have been
detected in the deep
surface layer
Bacterial lipopolysaccharide can be
identified at a distance of from
the surface of the periodontally
diseased roots
Invasion of bacteria, enzymes and
noxious products into cemental
matrix has been demonstrated in
periodontitis

13. The composition of the smear layer has
not yet been well defined*, but it
presumably reflects the composition of
the underlying cementum from which it is
produced.
The Ca/P ratio is 1.69 in normal cementum
vs 1.13** in smear layer over cementum.
*Ruggeri A Jr, Prati C, Mazzoni A, Nucci C, Di Lenarda R, Mazzotti G, Breschi L. Arch Oral Biol.
2007 Jan;52(1):1-8.
**Eliades G, Palaghias G,Vougiouklakis G. J Dent Res 1991; 70:383,Abstract 940.

14. Poor clot
stabilization on
root surface
Impaired
attachment of
periodontal fibers
Poor migration
and proliferation
of fibroblasts
Almost zero
expression of root
surface collagen
*Endodontics, Volume 1
edited by John Ide Ingle, Leif K. Bakland
Prevents
hypersensitivity**
Prevents
further bacterial
ingress**
**Rusin RP, Agee K, Suchko M, Pashley DH.
Dent Mater. 2010 Jun;26(6):600-7.

15. Although meticulous root
Instrumentation has been advocated,
root surface will inevitably
for
connective tissue attachment to the root
surface.
Thus, for regeneration to occur,
in order to
restore its biocompatibility becomes the
necessity.

17. Kassab M, Cohen RE. Compend Contin Educ Dent. 2003 Jan;24(1):31-4

20. Rough smear
layer covering
root surface
“Old-carpet/Shag carpet”
appearance
Partial opening of
dentinal tubules
with traces of
smear layer
Complete smear
layer removal with
dentin collagen
fiber exposure.
Leite FR, Sampaio JE, Zandim DL, Dantas AA, Leite ER, Leite AA.
Quintessence Int. 2010 Apr;41(4):341-9.

21. Absence of Fibrin
Network
Dense Cellular and Fibrin
Network
Scarce Fibrin Network
Moderate Cellular and
Fibrin Network
Dantas AA et al. J Contemp Dent Pract. 2012 May 1;13(3):332-8.

23. Fibroblast showing numerous
oval shaped blebs, microridges,
and foldings
“Fried Egg” appearance
Smooth margin devoid of
lamellopodia
Multiple lamellopodia

24. Feature Current Status Reference
Root dentin surface conditioning
with BMP-2 stimulated cementum-
like tissue formation
Miyaji H , 2011
Presence of fibrin after CA
conditioning inhibits epithelial
proliferation.
Cavassim R, 2012
No evidence of new bone
formation
Zandim DL, 2013
Root conditioning with EDTA
and/or EMD enhanced cell
adhesion more than SRP alone.
Belal MH (2012)
Does not affect bone graft
maturation
Saini A (2013)
Citric acid and EDTA were able to
preserve the structural and
biochemical properties of the
exposed dentin matrix
Ruggeri A (2007)

26. In vivo animal and human histological
studies have shown
when decalcifying
agents are used to condition the root
surface.
Nevertheless, the
employed by clinicians and
researchers has prevented consistent
comparisons among them*.
*do Amaral. J Appl Oral Sci vol.19 no.5 Bauru Sept./Oct. 2011

31. There still is a
concerning to the
which justifies the search for
parameters that can support the
option for this procedure in periodontal
treatments.

32. Still, and perhaps because clinical and
histological data ,
many clinicians include root conditioning
as part of their combination procedures for
periodontal regeneration*.
There is stronger evidence for smoking,
plaque control and maintenance
compliance
.
*Saito A, Saito E. Oral Health Dent Manag. 2014 Jun;13(2):543-7.
**de Sanctis M, Clementini M. J Clin Periodontol. 2014 Apr;41 Suppl 15:S108-22