Citric acid burnishing of dentinal root surfaces. A scanning electron microscopy report

The integrity of formalin-fixed periodontally diseased root surfaces was assessed following root planing to dentin and citric acid application. Extracted human teeth (fixed in 10% formalin), with crowns removed, were vertically sectioned in half. A horizontal groove on each proximal surface marked the extent of attachment loss. The diseased root surface was vigorously root planed to expose dentin. Cotton pellets, soaked in a saturated solution of citric acid, were either "placed" (control) or "burnished" (vigorously rubbed using root planing pressure) (experimental) on the prepared root surface for 5 min. Pellets were changed 2 times/min. The teeth were fixed and prepared for scanning electron microscope viewing and photography. A representative print was selected for each specimen. To confirm differences between test and control groups, untrained raters were asked to perform 2 sorting exercises. First, they were asked to sort the representative photographs of each specimen into 2 piles based on surface characteristics. Second, they were asked to choose from pairs of photographs, representing matched specimens, the one photograph which appeared to have the greatest collagen surface area. The surfaces of experimental specimens revealed patent dentinal tubules and an intertubular area with a very distinct "shag carpet" appearance of deeply tufted collagen fibrils. Control samples also exhibited open dentinal tubules, yet the intertubular surface displayed a "matted collagen" surface. Results of the 2 sorting exercises confirm that burnishing of formalin-fixed dentin root surfaces for 5 min with cotton pellets soaked in a saturated solution of citric acid consistently produces a distinct tufted collagen fibril surface.