Pilot clinical studies on the effect of topical citric acid application on healing after replaced periodontal flap surgery

The effect of citric acid conditioning of the root surfaces during periodontal surgery was studied in 12 patients with residual pockets ≥ 5 mm two months following oral hygiene instruction and initial root planing. Full thickness, replaced flap procedure (“modified Widman”) was performed with or without topical citric acid application using a split mouth approach. Six months post‐operatively, improvement of the periodontal conditions was observed as evidenced from reduction of probing pocket depth, gain of probing attachment level and gingival recession. A mean probing attachment level gain for pooled acid treated surfaces of 2.1 mm was obtained as compared to 1.5 mm for the non‐acid treated control surfaces. Our previous dog and human studies have demonstrated new connective attachment after acid conditioning of root surfaces as contrasted to readaplation of a junctional epithelium in the non‐acid treated controls. However, the results of the present study indicate that from a clinical standpoint, the use of citric acid application might only provide a small improvement in probing attachment levels.