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.