DEPARTMENT OF PERIODONTICS

SEMINAR ON

ROOT BIOMODIFICATION
Introduction
 The removal of bacterial deposits, arrest
of periodontal disease and regeneration
of periodontal tissues that are lost due
to the disease process constitute the
ideal and main goal in periodontal
therapy.
 Thus, biocompatibility of root surface is
of extreme importance for achieving
success of periodontal therapy.
 Root
Biomodification
Defination :

 Root biomodification is a periodontal

regenerative procedure which
involves chemical modification of
root surface.
Rationale :
 Root debriment generates a smear layer
which contains micro-organisms &
toxins, that interfere in periodontal
healing.
 Blood element adhesion to the
demineralized roots and clot
stabilization by collagen fibers are
important for the success of therapy.
 Thus, the use of an agent to remove this

smear layer and to expose the collagen

fibers is an important factor to obtain
biologically acceptable tooth surfaces.
 Various Chemical Agents Used
For Root Biomodification :
 Citric Acid
 Tetracycline

 Fibronectin

 EDTA-(Ethylene Diamine Tetra Acetic

Acid.)
 Sodium Deoxycholate

 Human Plasma Fraction (COHN IV)

 Enzyme Lysosome

 PGDF-Platelet Derieved Growth Factor

 Miscellaneous -
* Aqueous Ethyl Ether
* Lithium Aluminum Hydride
* Bile Salts
* Calcium Chealators
I-Citric Acid
 Most common chemical agent used for
root biomodification.
 Citric Acid conditioning is based on the

premise that-
Demineralizies the root surface

Expose the collogen fibers

Forms a barrier against epithelial migration

Removal of smear layer formed by

Instrumentation
 REGISTER & BURDICK (1976)
 Performed series of studies that
showed-
Citric Acid at 1 PH, when applied for 2-3
minutes on root surface causes:-
1) Surface demineralization
2)Induces cementogenesis & attachment
of collagen fibers.
Action of Citric Acid :
(i) Accelerated healing & new cementum
formation.
(ii)After root planning only-
Produces a 4µ demineralized zone
with collagen fibers.
(iii)* Removes the smear layer
* Exposes the dentinal tubules
* Makes the tubules appear wider with
funnel shaped orifices.
(iv) Eliminates endotoxins & bacteria
(v) Prevents apical migration of epithelium.
Recommended Technique :
-By Register & Burdick (1975)
(i) Raise a mucoperiosteal flap
(ii)Throughly instrument the root surface
-removing calculus & underling cementum.
(iii)Apply cotten pledgets soaked in
saturated solution of citric acid.
* 20-30% concentration PH1
* Leave for 2-3 minutes
(iv) Remove pledgets
* Irrigate root surface profusely with
water.
(v) Replace the flap & suture it.
Technique of Register & Burdick:
- Modified by Miller (1983)
(i) Burnishing application (Versus
rubbing)
(ii) 5 minutes application
(iii) Use of high concentration 50%
and PH 2
Strerret et al (1989) :
 Found that- use of miller's technique on

native dentin removed the smear layer

and opened the dentinal tubules.
But did not expose collagen fibers.
Han's (1985)
 Have reported increase in new
attachment.
Daly (1982)
 Immersed periodontally involved roots in
citric acid at PH1 followed rinsing in 0.85%
Nacl for 1 minute. Found significant
reduction in the microfloura in former.
 REFERENCES

 Journal of clinical periodontology

-1995 : 22 : 550-557
 Text book of clinical periodontology

-Carranza & Newman

 Textbook of clinical periodontology and

implantology-Jan Lindhe
II-Tetracyclines
 Broad spectrum antibiotics & effective
against periodontal pathogens.
 Have low PH in concentrated solution

Act as calcium chelator resulting in

deminerilazation.
 Action

(i) Enhances binding of matrix proteins

(ii)Stimulate the fibroblast attachment &
growth.
Narrowed dentinal Widening of Dentinal
tubules tubules after tetracycline
application
(iii)Suppress epithelial attachment &
migration.
(iv) Removes amorphous layer & exposes
dentinal tubules.
(v) Maintains anti-microbial activity for
14 days.
References:
 Journal of clinical periodontology
1998 25 : 404 - 412
 Text book of clinical periodontology
Carranza and newman
 Text book of clinical periodontology and
implantology-Jan Lindhe
III-Fibronectin
 High glycoprotein found on the surface
of the cells, in plasma, extracellular
matrix and in basement membrane.
 It is a glycoprotein required by
fibroblasts to attach to the root
surfaces.
 Plays an important role in -

Promoting attachment of cell to one

another to extracellular matrix &
collagen
 Treating root surface with fibronectin
increases fibroblast attachment.
 Fibronectin - CHEMO ATTRACTANT

for fibroblast & periodontal ligament

cells.
 Possess therapeutic utility in promoting

connective tissue attachment for

periodontal regeneration.
 Biologic mediator that enhances the

tissue response in early phases of wound

healing prevents seperation of flap &
favours haemostasis & regeneration.
 Use of fibronectin as a supplement to
demineralization:
(i) Simulate coronal growth of cells from PDL -
Responsible for new attachment.
(ii)Favours growth & attachment of fibroblasts
and over cemental surface.
(iii)Speeds linkage process by being
chemoattractive for fibroblast.
(iv)Stabilizes clot between the exposed root
surface & new fibers.
References:
 Journal of clinical periodontology
1998 25 : 404 - 412
 Text book of clinical periodontology
Carranza and newman
 Text book of clinical periodontology and i-
implantology- Jan Lindhe
IV-EDTA
 Chealating agent
 Functions by forming a calcium chelate

solution with calcium ions.

 Softens Root surface.

 Removes smear layer.

 Effects partial demineralization to a

depth of 20-30µ in 5 minutes.

Organization of
Fibrin network
References:
 Brazilian oral research 2005 (Page-88-92)
 Text book of clinical periodontology
Carranza and newman
 Text book of clinical periodontology and
implantology-Jan Lindhe
PDGF
 Suggested to be a potent stimulator and
a strong mitogenic agent for human
periodontal ligament cells.
 It significantly stimulates human PDL
fibroblasts to attach and adhere to
periodontally involved root surfaces
when applied.
 It also regulates and modify the cell
activity.
 Presence of smear layer
on root surface.

 Shows attached
periodontal ligament
fibroblast cells.
 Smear layer removal and
opening of dentinal
tubules.

 In summary, PDGF
shows positive effect on.
adhesion and growth of
PDL fibroblasts to
diseased root surface
Thus, as it acts as a good modulating agent
and enhances regeneration-
PGDF HAVE PROMISING ROLE IN CLINICAL
PERIODONTICS.

REFRENCES
 Oral Diseases(2006) 12,543-552

hppt//www blackwell –synergy.com

 Journal of clinical periodontology-ISSN
0303-0979 (2000)
V- Sodium Deoxycholate &
Human Plasma Fraction
 These agents dissociate endotoxin into
subunits & detoxify the diseased root
surfaces.
 Human - Plasma fraction-

Increases connective tissue attachment.

Content - 69% α 1 & α 2 globulins
10% β globulin
20% λ globulin
References:
 Text book of clinical periodontology
Gururaja Rao
 Text book of clinical periodontology and
implantology-Jan Lindhe
VI- Miscellaneous
Aqueous Ethyl Ether
 Used to extract endotoxin

Lithium Aluminium Hydride

 Can cleave ester linkage in endotoxin.

Bile Salts
 Dislocate endotoxin into sub units which

reaggrate upon removal.

REFRENCES
Textbook of clinical periodontology-
GURURAJA RAO
Limitation of Chemical
Substances
 May give rise to secondary endodontic
involvement via dentinal tubules.
 Depth of action is not controlled.

 Increased size of dentinal tubules

More penetration of micro-organism

may cause root caries.
 Chemicals may infavourably alter the

morophology of collagen.
 REFRENCES

Textbook of clinical periodontology-

 COMPLICATION
 New attachment with regeneration is
the ideal outcome of the therapy.
 However, certain complication may be

seen-
(1) Healing with a long junctional epithelium.
(2) Ankylosis and resultant root resorption
(3) Recurrence of the pocket.
(4) Combination of above

REFRENCES
Journal Of Clinical Periodontology-
2000:41:30-47
 CONCLUSION
 Periodontal regeneration after therapy
has been a relentless goal of
periodontist.
 Oldest & most frequently attempted

type of regeneration has involved root

bio modification.
 Citric acid is most commonly used
chemical agent as compared to other
agents.
 Thus for a successful periodontal
therapy regenerative procedures like
root bio modification must be