Citric acid treatment of periodontitis‐affected cementum

Philip Hanes, Alan Poison, Tom Frederick

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22 Scopus citations


Abstract Previous studies have described an inconsistent histological occurrence of a zone of surface demineralization on periodontitis‐affected cementum following treatment with citric acid, and a lack of connective tissue attachment to the latter surfaces. In view of these findings, the purpose of the present study was to use scanning electron microscopy to examine the surface morphology of cementum from normal and periodontitis‐affected root surfaces following citric acid treatment for differences in the effects of the demineralizing solution on these surfaces. Cementum surfaces were derived from the roots of extracted human teeth from areas beneath attached periodontal ligament fibers (normal) and calculus deposits (periodontitis‐affected). 5 specimens were evaluated in both groups. Periodontal ligament fibers were removed from normal root surfaces with a curette, and calculus deposits were removed from periodontitis‐affected root surfaces using an ultrasonic sealer. The resultant 5 specimens in each group were then sectioned in half, one‐half serving as the untreated control and the other as the experimental, citric acid treated specimen. Experimental specimens were immersed in a saturated solution of citric acid, pH 1 for 3 min and then rinsed in tap water. Both control and experimental specimens were dehydrated in ethanol, critical‐point dried, sputter‐coated with gold and examined in the scanning electron microscope for morphological characteristics. Citric acid treatment of cementum from normal root surfaces produced an undulating, markedly fibrillar surface morphology which is consistent with the exposure of a fibrillar, collagen substrate. Periodontitis‐affected cementum, however, was not appreciably altered in appearance by the citric acid treatment, having only a faint mat‐like surface texture. These findings suggest that cementum from beneath calculus covered areas of periodontitis‐affected roots had undergone changes which reduced the effects of the demineralizing solution. This limited demineralizing effect of citric acid on periodontitis‐affected cementum may partially explain the lack of connective tissue attachment reported in several animal studies and clinical trials utilizing citric acid conditioning of the root surface in efforts to obtain new attachment.

Original languageEnglish (US)
Pages (from-to)567-575
Number of pages9
JournalJournal of Clinical Periodontology
Issue number7
StatePublished - Aug 1991
Externally publishedYes


  • cementum
  • citric acid
  • periodontitis‐affected cementum

ASJC Scopus subject areas

  • Periodontics


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