RSB BY RSB.pptx.........................

root surface biomofification

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2. DR R S ARAAJ B HUVAN R OOT S URFACE B IOMODIFICATION

3. Contents 3

4. Root surface wall of Periodontal pocket 4

5. Changes in the tooth surface wall of periodontal pockets ( e.g., degenerated remnants of Sharpey’s fibers, accumulation of bacteria and their products, disintegration of cementum and dentin) interfere with new attachment. 5

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8. INDICATION 8

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10. CITRIC ACID Accelerated healing and new cementum formation occur after surgical detachment of the gingival tissues and demineralization of the root surface by means of citric acid A fter root planing , the acid produces a 4-μm-deep demineralized zone with exposed collagen fiber. 10

11. 11 Root planed, non–citric acid treated roots are left with a surface smear layer of microcrystalline debris. Citric acid application not only removes the smear layer, exposing the dentinal tubules, but also makes the tubules appear wider and with funnel-shaped orifices Eliminate endotoxins and bacteria from the diseased tooth surface . An early fibrin linkage to collagen fibers exposed by the citric acid treatment prevents the epithelium from migrating over treated roots

12. Raise a mucoperiosteal flap and thoroughly instrument the root surface, removing calculus and underlying cementum. Apply cotton pledgets soaked in a saturated solution of citric acid (pH of 1.0) for 2–5 minutes. Remove pledgets and irrigate root surface profusely with water. Replace the flap and suture 12 Technique for application of citric acid

13. FIBRONECTIN Fibronectin is the glycoprotein that fibroblasts require to attach to root surfaces. The addition of fibronectin to the root surface may promote new attachment. 13

14. TETRACYCLINE T etracycline increases binding of fibronectin, which in turn stimulates fibroblast attachment and growth while suppressing epithelial cell attachment and migration . Tetracycline also removes an amorphous surface layer and exposes the dentin tubules. 14

15. EDTA Ethylene Diamine Tetra Acetic acid (EDTA) is an aminopolycarboxylic acid. EDTA is a supersaturated solution and exerts its demineralizing effect through chelating the divalent cations at neutral pH. Application of EDTA on the root surface Improves fibroblast attachment, Aids migration of cells on the root surface Aids in the orientation of the collagen fibers between the demineralized root surfaces. Etching at neutral pH also preserves the vitality of the adjacent tissue. 15

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17. GROWTH FACTORS Growth factors are group of naturally occurring polypeptide molecule in conjunction with certain matrix proteins acts as key regulators of the biological events. Growth factors like the fibroblast growth factors (FGFs), P latelet-derived growth factor (PDGF), I nsulin-like growth factors (IGFs), Transforming growth factors (TGFs), and C ertain attachment proteins like enamel matrix protein (Emdogain) play an important role in periodontal wound healing. 17

18. EMDOGAIN It is purified enamel matrix protein developed from porcine developing enamel. It is marketed under the trade name Emdogain Viscous gel consisting of enamel derived protein from tooth buds in a polypropylene liquid. 90% of protein in the mixture is amelogenin 18

19. 19 Ready-to-use syringe of Emdogain EMD (vial with green cap) and propylene glycol alginate liquid (vial with silver cap)

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21. PRE OP CBCT POST OP CBCT

22. Technique for application of emdogain Raise a flap Remove all granulation tissue exposing the underlying bone. The root surface should be thoroughly planed Completely control the bleeding within the defect Demineralize the root surface for 15 seconds Rinse the wound with saline and apply the gel to completely cover the exposed root surface Followed by complete closure of the wound 22

23. CASE DISCUSSION 23

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25. CONCLUSION 25 Clinically significant reconstruction of supporting periodontal tissue in selected sites and patients is possible with the use of proper regenerative materials like graft, membranes and their combination.

26. THANK YOU 26