Efficacy of Chemical Root Surface Modifiers in the Treatment of Periodontal Disease. A Systematic Review

Background: Periodontal regeneration has been a relentless goal of the periodontist. Perhaps the oldest and most frequently attempted type of regeneration has involved chemical modification of the root surface. Varying results from histological and clinical studies have created controversy about the clinical effectiveness of root surface decalcification.

Rationale: This systematic review assesses the efficacy of root surface biomodification through the use of citric acid, tetracycline, or ethylenediaminetetraacetic acid (EDTA) in patients with chronic periodontitis. Focused Question: Does the use of chemical root decalcification result in effective periodontal regeneration and improved clinical outcomes in patients with chronic periodontitis?

Search Protocol: The Cochrane Database of Systematic Reviews; Database of Abstracts of Reviews of Effectiveness; Cochrane Central Register of Controlled Trials; American College of Physicians Journal Club, evidence-based MEDLINE journals; and National Center for Biotechnology Information PubMed Journals, as well as Dogpile, Google, and Copernic search engines were screened. Hand searches were performed on the Journal of Clinical Periodontology, Journal of Periodontology, Journal of Periodontal Research, and Periodontology 2000. Searches were performed for relevant clinical trials published through September 25, 2002.

Selection Criteria

Inclusion criteria: Histological and clinical studies evaluating the effects of citric acid, tetracycline, or EDTA on root surfaces of patients with chronic periodontitis were considered for inclusion.

Exclusion criteria: Studies evaluating extracellular matrix proteins (e.g., fibronectin), enamel matrix proteins (e.g., amelogenins), or other proteins or growth factors applied to the root surface were not included.

Data Collection and Analysis: Primary outcome measures included changes in connective tissue attachment, cementogenesis, clinical attachment levels, probing depths, and gingival recession. Secondary outcome measures included changes in bone level, gingival inflammation, and plaque levels. Results for continuous outcome measures for primary variables (clinical attachment levels, probing depths, and recession) were expressed as mean differences or standardized mean differences. Clinical attachment levels and reduction in probing depth were evaluated using meta-analysis. All papers were rated according to methodological strength of evidence.

Ann Periodontol 2003;8:205-226.