Blood clot stabilization on root dentin conditioned by the combination of tetracycline and EDTA

Effect of EDTA Activation on Blood Clot Structure in Regenerative Endodontics: A Scanning Electron Microscopy Study

INTRODUCTION

EDTA plays a crucial role in regenerative endodontic therapy (RET) because of its significant biological effects. However, EDTA is also recognized as the preferred anticoagulant for hematologic tests. Thus, this study aimed to assess the influence of different EDTA activation techniques on the morphology of blood clots after conditioning the root canal dentin.

METHODS

Forty extracted human teeth were prepared to simulate immature teeth and divided into the following 5 groups: (1) saline solution (negative control), (2) EDTA 17% + saline solution (CNI), (3) CNI + ultrasonic activation, (4) CNI + Easy clean activation, and (5) CNI + XP-endo Finisher activation. After irrigation, the roots were cleaved, and the root canals were filled with human blood to clot formation. The morphology and density of erythrocytes, platelets, and the fibrin network were observed using a scanning electron microscope. The fibrin network density was classified using a 4-point scale. Data were analyzed using the Friedman test and the Kruskal-Wallis test with Bonferroni adjustment (α = 5%).

RESULTS

All groups exhibited consistent blood clot morphology characterized by a high density of erythrocytes, platelets, and white blood cells throughout the entire length of the root canal. The negative control group showed statistically significant high scores of fibrin density compared with the CNI group in all root thirds (P < .05). However, there was no statistical difference in the scores for the fibrin network density between the groups irrigated with EDTA with and without activation (P > .05).

CONCLUSIONS

EDTA may impair the fibrin network formation compared with the saline group. However, EDTA activation did not significantly change the effects on the blood clot in contact with the conditioned intraradicular dentin.

A Scanning Electron Microscope Evaluation of the Adhesion of Fibrin Clot to the Periodontally Compromised Teeth after Exposed to Different Root-conditioning Agents: An In Vitro Study

AIM

The aim of this research was to assess the binding of fibrin clot to the teeth affected by periodontal disease following exposure to different root conditioning agents.

MATERIALS AND METHODS

A total of 60 human teeth with a solitary root that were subjected to extraction following severe periodontal disease were used as study samples in this research. Two analogous grooves were prepared on the proximal radicular surface of every sample employing a diamond-tapered fissure bur using an aerator handpiece beneath abundant irrigation. Every sample was assigned to one of the following groups: • Group I: Tetracycline hydrochloride solution • Group II: Ethylenediaminetetraacetic acid (EDTA) gel • Group III: Biopure MTAD™ Subsequent to conditioning, the samples were rinsed for 3 minutes with phosphate-buffered saline (PBS) and permitted to air-dry for 20 minutes. A drop of fresh human whole blood procured from a hale and hearty volunteer was coated onto the dentin blocks in all three groups. A scanning electron microscope under 5000× magnification at 15 kV was used to examine the samples. Kruskal-Wallis test and Mann-Whitney U test were performed to procure the inter- and intragroup assessments Results: The greatest fibrin clot union was noted in the EDTA gel group at 2.86 ± 0.14 in pursuit by Biopure MTAD™ group at 2.39 ± 0.08 as well as tetracycline hydrochloride solution group at 1.82 ± 0.10. A statistically significant difference was noted between the investigational groups (p < 0.001).

CONCLUSION

This research arrived at a conclusion that the dentinal surfaces subjected to conditioning with EDTA gel group as well as coated with human whole blood resulted in appreciably superior fibrin clot bonding to dentin vs Biopure MTAD™ as well as the tetracycline hydrochloride solution group.

CLINICAL SIGNIFICANCE

Connective tissue attachment subsequent to surgical procedures causing the adhesion of a fibrin clot to the radicular surface as a result of initial wound healing processes is directly related to periodontal regeneration. It depends on biocompatibility for the fibrin clot and the periodontal pathosis-affected radicular surface to stick together, which can be procured with the aid of a variety of root conditioning measures in course of periodontal treatment.

Blood clot stabilization after different mechanical and chemical root treatments: a morphological evaluation using SEM

Purpose

This in vitro study was conducted to evaluate the effects of different debridement techniques and conditioning procedures on root surface morphology and blood clot stabilization.

Methods

Two debridement techniques (curette [CU] vs. high-speed ultrasound [US]) and 2 conditioning procedures (ethylenediaminetetraacetic acid [EDTA] and phosphoric acid [PA]) were used for the study. Seven experimental groups were tested on root surfaces: 1) no treatment (C); 2) CU; 3) US; 4) CU+EDTA; 5) US+EDTA; 6) CU+PA; and 7) US+PA. Three specimens per group were observed under scanning electron microscopy (SEM) for surface characterization. Additional root slices received a blood drop, and clot formation was graded according to the blood element adhesion index by a single operator. Data were statistically analyzed, using a threshold of P<0.05 for statistical significance.

Results

The C group displayed the most irregular surface among the tested groups with the complete absence of blood traces. The highest frequency of blood component adhesion was shown in the CU+EDTA group (P<0.05), while no differences were detected between the CU, US+EDTA, and CU+PA groups (P<0.05), which performed better than the US and US+PA groups (P<0.05).

Conclusions

In this SEM analysis, EDTA and conventional manual scaling were the most efficient procedures for enhancing smear layer removal, collagen fiber exposure, and clot stabilization on the root surface. This technique is imperative in periodontal healing and regenerative procedures.