Human suprabony healing responses following root demineralization and coronal flap anchorage. Histologic responses in 7 sites.

6 suprabony pockets in 2 adult patients were treated with debridement and citric acid root demineralization. Following these procedures, coronal positioning of the marginal flaps was performed at 2 sites. At 4 sites, the marginal flaps were sutured coronally using orthodontic brackets as anchors. At 1 additional site, root debridement only was performed and the margin was placed at about crestal level. Prior to root planing, all roots were notched both at the level of the gingival margin and the most apically positioned calculus. Blocks were harvested 7 and 18 weeks postsurgery and prepared for histologic analysis. Clinical results showed a gain in probing attachment in both coronally positioned sites (average = 1.8 mm) and coronally anchored sites (average = 4.5 mm). The additional debrided-only site showed a gain in probing attachment of 0.1 mm. Histologically, new cementum with functionally inserted fibers was seen within the calculus notch in all coronally anchored sites. This new attachment was associated with crestal osteogenesis. In the 2 coronally positioned and root demineralized sites, new attachment was seen within the calculus notch in 1 out of the 2 specimens evaluated. Within the limits of the evidence presented, coronal anchorage of flaps enhanced probing attachment and new attachment when used in conjunction with root demineralization.