periodontal wound healing

• eliminate the infection or inflammation

• arrest disease progression

• restore function and aesthetics

• establish long term maintenance

• restore periodontal health

• reduce periodontal pocket depths

GOALS OF PERIODONTAL THERAPY

• resolution of inflammation

• reduction in gum volume

• pocket depth reduction

• formation of long je

• bone response

• connective tissue response

TISSUE RESPONSE FOLLOWING PERIO THERAPY

gingival recession, gain in cal, or both

periodontal reduction occurs in 3 ways:

periodontal reduction

due to tissue shrinkage and reattachment and not due to tru regeneration

formation of long JE

most common outcome following conventional therapy

normal JE

a short epithelial attachment

normal JE

forms a physiologic seal between the gingiva and the tooth

normal JE

located at the cervical tooth area

long JE

characterized by the apical migration of epithelial cells along the root surface

long JE

provides a stable epithelial attachment and contributes to pocket depth reduction

long JE

there is no formation of new cementum, pdl, nor alveolar bone

reattachment

reunion of periodontal tissues

that were previously detached from

the tooth root but remain viable

reattachment

occurs when inflammation is resolved

after procedures such as scaling and

root planing

reattachment

allowing the tissues to readhere to the

root surface without the formation of

new attachment structures

reattachment

after procedures such as scaling and

root planing

new attachment

formation of a new connective

tissue attachment on a previously

diseased root surface

new attachment

characterized by the development of

new cementum with newly inserting

periodontal ligament fibers

new attachment

occurs following

periodontal surgical or regenerative

procedures

new attachment

represents true

periodontal regeneration

new attachment

has more ideal outcome in periodontal therapy

regeneration

process where some tissue are able to replace

the damaged components and essentially return to a

normal state

regeneration

process where some tissue are able to replace

the damaged components and essentially return to a

normal state

repair

does not involve the restitution of tissue

components

repair

occurs by replacement of the injured cells with

connective tissue,

repair

leading to the formation of a scar,

or by a combination of regeneration of some residual

cells and scar formation

scar

used to describe the replacement of

parenchymal cells in any tissue by collagen,

Healing by primary intention (primary

union)

Clinical examples: surgical incisions,

paper cuts, superficial lacerations

Healing by primary intention (primary

union)

refers to epithelial regeneration with

minimal scarring

Healing by secondary intention (secondary

union)

refers to larger wounds that heal by a

combination of regeneration and

scarring

Healing by secondary intention (secondary union)

clinical examples: pressure ulcers, bedsores, burns, etc

scaling and root planing

regenerative procedures

scaling and root planing

a non-surgical periodontal procedure that involves

the mechanical removal of bacterial deposits,

calculus, and endotoxins from the tooth and root

surface

john w. riggs

first specialist to limit his practice to periodontics

1728

when did pierre fauchard described scaling

• establish gingival health

• pocket depth reduction

• biofilm disruption

• root detoxification

PRIMARY GOALS OF SCALING AND ROOT PLAINING

visual examination and tactile examination

ways to detect calculus

visual examination

is not difficult with good lighting and a clean

field

Tactile exploration

much more difficult and requires the

skilled use of a fine-pointed explorer or probe

grafting procedures

any surgical interventions designed to stimuolate the regrowth of alveolar bone

grafting procedures

required for severe cases involving infrabony defects or furcations

autographs

bone are obtained from the same indiv but diff location

allograph

bone from diff individual but same species

xenograph

bone from diff species

osteogenesis

refers to the formation or

development of new bone by cells contained

in the graft

osteoinduction

a chemical process by

which molecules contained in the graft (e.g.,

bone morphogenetic proteins) convert the

neighboring cells into osteoblasts

osteoconduction

physical effect by which

the matrix of the graft forms a scaffold that

favors outside cells to penetrate the graft and

form new bone

robinson

described the osseous coagulum

osseous coagulum

mixing of bone dust and blood

osseous coagulum

provides additional space for the interaction of vascular and cellular elements

bone blend

used for autoclave plasticcapsule or pestle

cancellous bone

pede siya makita sa maxillary tuberosity, edentulous areas and healing sockets

bone swaging

requires an edentulous area adjacent to the defect

freeze dried bone allograph

a type of bone allograph that function through osteoconduction, serving as a physical scaffold for the formatio nof new bone

demineralized free dried bone allograph

a type of bone allograph that aims for osteoinduction

bone morphogenic proteins

induces host cells to differentiate into osteoblasts

xenograph

derived from cow or natural coral skeleton

root surface conditioning

also known as root surface biomodifiction

root surface conditioning

includes removal of bacteria, endotoxins, and other antigens on the cementum

root surface conditioning

such as citric acid, tetracycline, osteophosphoric acid and edta

growth factors

class of polypeptide hormones that stimulate

essential cellular events, including proliferation,

chemotaxis, and differentiation.

growth factors

used to encourage the migration of periodontal

ligament (PDL) cells, the synthesis of extracellular

matrix, and the differentiation of cementoblasts and

osteoblas

Insulin like growth factor (IGF)

enhances the proliferation of gingival

fibroblasts and PDL cells

bone morphogenic proteins

osteoinductive factors that

stimulate mesenchymal cells to

differentiate into bone-forming cells

Enamel matrix derivatives

(EMD/Emdogain)

mimics the biologic events of tooth developemt

• platelet derived groowth facotr

• insuline like growth factor

• bone morphogenic protein

• enamel matri derivatives

PRIMARY GROWTH FACTORS USED IN REGENERATION