ROOT SURFACE BIO MODIFICATION USING NATURAL FRUIT JUICE EXTRACTS: AN IN VITRO SCANNING ELECTRON MICROSCOPIC STUDY

Background: Scaling and root planning is cornerstone of periodontal therapy; however, it produces smear layer that may limit biological interaction between periodontal tissue and treated root surface. Root surface biomodification has been advocated to remove smear layer, expose collagen matrix and create a favorable surface for periodontal healing. Natural fruit extract rich in organic acid have recently gained attention as potential alternative to conventional chemical root conditioning agents. 
Objective: To explore and assess the efficacy of freshly prepared citrus fruit extracts as a root surface conditioning agent over the conventional agents. 
Methods: Single rooted teeth indicated for extraction due to periodontal diseases, were sectioned, instrumented with curettes and treated with test and control agents. Treated samples were observed and studied under scanning electron microscope.
Results: SEM evaluation demonstrated that all three root conditioning agent effectively modified instrumented root surface. The 10% citric acid group exhibited smear layer removal with complete dentinal exposure. Both fresh lemon and fresh carambola fruit juice extract immediately removed smear layer. Comparatively greater dentinal tubule exposure was observed in carambola group than in the lemon group, although complete tubule exposure was only achieved with citric acid.
Conclusion: Within the limitation of this exploratory in vitro study,10% Citric acid demonstrated most effective root surface bio modification. Fresh carambola fruit juice showed root conditioning potential with greater dentinal tubule exposure than fresh lemon juice, suggesting its application as a natural root conditioning agent. However, further quantitative laboratory investigations and clinical studies are required to validate these preliminary finding.