A Histometric Evaluation of the Effect of Citric Acid Preparation Upon Healing of Coronally Positioned Flaps in Nonhuman Primates

Abstract

Facial recession defects were created on maxillary canine teeth of six Macaca irus monkeys and left untreated and exposed to oral fluids for 6 to 12 weeks. Notches were placed in the exposed root surfaces at the level of the free gingival margins. Following root planing with the addition of topical citric acid application on experimental surfaces, pedicle flaps were coronally positioned over the previously exposed roots. After euthanasia, block sections representing postsurgical time periods of 0, 3, 7, 14, 21, 28 and 42 days were secured and tissues were processed for histologic evaluation. All citric acid-treated surfaces exhibited new connective tissue attachment of pedicle flaps to previously exposed areas by 14 days with transmission electron micrographs confirming beginning cementum deposition. In contrast, controls demonstrated epithelial migration to, or apical to, reference notches. Although the total number of samples available for statistical comparison was small, a two-tailed t test for correlated samples showed citric acid application did not result in enhanced clinical root coverage, but did result in significantly greater amounts of new connective tissue attachment (P less than 0.05, df = 3). Pedicle flap healing against teeth with devital pulps was identical to that seen in teeth with vital pulps, while citric acid application to root-planed surfaces of vital teeth had no observable effect upon pulpal tissues.

A Multicenter Comparative Study of Two Root Coverage Procedures: Coronally Advanced Flap With Addition of Enamel Matrix Proteins and Subpedicle Connective Tissue Graft

“…While a minimal degree of periodontal regeneration has been reported in some studies, 19,27,38,46 others showed new connective tissue attachment and a larger degree of periodontal regeneration. 22,47 EMD is effective in inducing periodontal regeneration in dehiscence type defects 42,43 and following treatment of gingival recession with subepithelial connective tissue graft with the addition of EMD.…”

Alterations in Location of the Mucogingival Junction 5 Years After Coronally Repositioned Flap Surgery

“…20 Although proven effective as a root coverage procedure, 5,8,21 CRF results in limited or no periodontal regeneration in gingival recession defects. 20,22 The possibility of obtaining a new connective tissue attachment may be considerably better in narrow recession defects than in wider ones, most likely because the periodontal ligament cells at the lateral parts of the defect serve as a source of granulation tissue from which a new attachment can develop. 20 Based on changes in PD and CAL measurements, most of the sites in our study showed no changes during 60-month follow-up period ( Table 6).…”

Periodontal wound healing responses to varying oxygen concentrations and atmospheric pressures

“…Traditionally, it has been accepted that connective tissue attachment would physically resist inflammation more effectively than a long epithelial attachment (Armitage et al, 1977, Moskow et al, 1979, Woodyard et al, 1984. However, Magnusson et al (1983) surgically created a long junctional epithelial attachment in Lftaum MO continued in all groups, indicating probable bone resorption over the twelve weeks (see Table 5).…”

“…Equivocal observations exist regarding the beneficial effects of citric acid in promoting connective tissue attachment (Stahl and Froum, 1977, Colo et al, 1980, Froum et al, 1983, Woodyard et al, 1984. Cafesse et al (1985) enhanced connective tissue attachment with citric acid conditioning of root surfaces followed by fibronectin application, although all animals were sacrificed at six weeks which may not be indicative of the long term effect.…”