Connective tissue regeneration to periodontally diseased teeth. A histological study.

A study was made to investigate the biological principle of new attachment of connective tissue to periodontally diseased root surfaces utilizing the previous finding that topical application of citric acid to the affected area may stimulate periodontal regeneration. Reconstructive surgery was performed on ten surfaces of nine teeth involved in advanced chronic periodontal disease. A muco-periosteal flap was raised and the apical extent of existing subgingival calculus was demarcated by a notch made through the calculus and into the root. Following thorough instrumentation, a saturated solution of citric acid was applied to the root surface for five minutes and the flap repositioned and sutured. Four months later the teeth with attached periodontal tissues were removed and processed for histological analysis. Connective tissue regeneration characterized by deposition of new cementum, and more coronally, by tightly apposed soft connective tissue had occurred in all specimens. The junctional epithelium ended 1.2–2.6 mm coronal to the apical border of the notch in the various specimens. The results demonstrate that regeneration of periodontal tissues to a root surface that has become denuded as a result of chronic, destructive periodontal disease and that has been covered by calculus is, in fact, a biological possibility. This study does not establish whether or not acid conditioning of the root surface is a prerequisite for new attachment.