The effect of citric acid treatment on periodontal healing after replantation of permanent teeth

Abstract

The aim of this study was to evaluate the effect of surface demineralization on the healing of 120 replanted teeth in fifteen 8- to 16-month-old dogs. Replanted teeth were divided into two groups (A and B). In group A, teeth were replanted following planing of the entire root surface. In group B, teeth were replanted following planing and surface demineralization with citric acid. Replanted teeth were splinted for 7 days, and observation periods were 3, 14 and 56 days. A total of 95 teeth and their surrounding tissues were examined histologically under a light microscope. Histological examination of specimens 3 days after replantation revealed that initial reunion between the root and the alveolar periodontal ligament fibres was via a fibrin-like network in both groups. Fourteen days after replantation histological observations showed superior healing in group B with regard to epithelial condition, periodontal ligament fibre reattachment to the root surface, resorption and functional arrangement of the periodontal ligament fibres. By 56 days after replantation, healing was superior in group A; group B was characterized by severe inflammatory and replacement resorption. These results indicated that surface demineralization had an initial positive effect, but later led to impaired healing.

An experimental model for studies on delayed tooth replantation and ankylosis in rabbits

“…However, it is not known whether this necrotic tissue should be removed or not before replantation and how this should be performed. There have been suggestions for various substances for topical application on the root surface or in the root canal prior to replantation of teeth with long extra-oral periods (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). However, current recommendations for clinical management of teeth with long extra-oral storage are still mainly based on best practice experience (16).…”

Delayed tooth replantation after treatment of necrotic periodontal ligament with citric acid

“…Most studies referring to the use of acidic substances (hydrochloric, citric, phosphoric and ascorbic acids) in cases of delayed tooth replantation have investigated the repair process after complete PDL removal by mechanical or chemical means and/or the treatment of root surface with the abovementioned acid solutions [7][8][9][10][11][12]. However, the biocompatibility of the necrotic periodontal ligament treated with citric acid is unknown.…”

“…Acidic solutions, such as citric acid, phosphoric acid, hydrochloric acid and ascorbic acid have been employed for root surface treatment after removal of periodontal ligament [7][8][9][10][11][12]. The goals of using acidic solutions include pH neutralization (if sodium hypochlorite is used for chemical removal of periodontal ligament), reattachment of collagen fibers to cementum surface [7][8][9][10][11][12][13] and elimination of bacterial endotoxin [14].…”

Treatment of root surface in delayed tooth replantation: a review of literature

“…It has been demonstrated that the application of acid alone for root surface treatment does not yield good results (25,51). Likewise, the use of alkaline solutions alone, such as sodium hypochlorite, particularly at high concentrations, may possibly lead to the formation of a connective tissue that does not reattach to the tooth surface (22,34).…”

“…This can be performed either mechanically by scraping with curettes (20,(23)(24)(25)(26)(27), scalpel blade (17,28,29), rubber cup polishing with pumice/water slurry (30), diamond bur and sandpaper disk (31,32) or chemically with sodium hypochlorite (21,22,(33)(34)(35). This can be performed either mechanically by scraping with curettes (20,(23)(24)(25)(26)(27), scalpel blade (17,28,29), rubber cup polishing with pumice/water slurry (30), diamond bur and sandpaper disk (31,32) or chemically with sodium hypochlorite (21,22,(33)(34)(35).…”