An ultrastructural study comparing new gingival tissue attachment on chemically exposed fibrils and retained periodontal ligament.

Successful periodontal healing has been demonstrated in animals following application of citric acid to exposed root surface. However, we have been unable to achieve comparable results on clinical patients. Accordingly, the present study, using monkeys, was designed to re-evaluate the degree of interdigitation of newly-formed gingival fibrils with ones exposed to citric acid compared to normal attachment tissues of the retained periodontal ligament. We found that superficial collagen fibrils in both cases suffer degradation following normal inflammation and healing secondary to flap surgery. On retained periodontal ligament tissues, this change was limited to superficial levels and newly-formed collagen fibrils were linked immediately with old ones. In contrast, when exposed collagen fibrils were conditioned by exposure to citric acid, the degradative change occurred more deeply, and healing was delayed. Thus, the citric acid may not be the best choice of root treatments in terms of promoting better gingival tissue attachment. Furthermore, the results indicated that fibrils preserved on the root should not be curetted as possible during flap surgery as they offer an improved chance for optimal reattachment.