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Perio--Surgical (Spring) > 3. Wound Healing > Flashcards

3. Wound Healing Flashcards

1
Q

What do perio therapy and perio disease have in common

A

they both damage the periodontal tissues

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2
Q

(Regeneration/repair) is the goal of perio therapy

A

regeneration

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3
Q

Which is more likely to occur after perio therapy (regeneration/repair)

A

repair

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4
Q

What is regneration

A
  • Lost tissues are completely restored
  • New cementum with inserting collagen fibers from PDL cells on a previously peridontally involved root surface with a regrowth of new alveolar bone
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5
Q

(T/F) Complete regeneration is uncommon

A

T

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6
Q

Define repair

A
  • Replacement of tissues do no replicate the tissues that were lost
  • May have an attachment with a long JE
  • No formation of new cementum, PDL and alveolar bone
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7
Q

What are the two types a ways wounds heal

A

primary and secondary intention

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8
Q

Describe primary intention

A
  • Clean incision
  • Edges are approximated with sutures, glue, etc.
  • Narrow incisional space filled with clotted blood
  • Minimal scaring
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9
Q

Describe day 1 of healing with primary intention

A
  • Neutrophils are the first cells to respond
  • PMNs migrate to the wound edge into a clot
  • Epitheloal cells begin to migrate beneath the surface scab to join at the midline
  • Angiogenesis begins with BM and extracellular matrix degradation with capillary sprout formation
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10
Q

Describe day 3 of healing with primary intention

A
  • Macrophages predominate over PMNs
  • Endothelial cell migration, proliferation and early organization and maturation
  • Granulation tissues starts to fill the incisional space
  • Collagen fibers are present but do not connect the incision
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11
Q

Describe day 5 of healing by primary intention

A
  • Granulation tissue fills the incisional space
  • Angiogenesis peaks with more organization and maturation
  • Collagen fibrils bridge the incision
  • Normal epithelium thickens
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12
Q

Describe week 2 of healing by primary intention

A

-Increased fibroblasts and collagen accumulation

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13
Q

Describe healing be primary intention after 1 month

A
  • Intact epithelium
  • Absence of inflammation
  • Tissue is still remodeling
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14
Q

Describe secondary intention healing

A
  • Wound edges are not approximated resulting in large tissue defect
  • Greater inflammation
  • More granulation tissue
  • More fibrin and necrotic debris must be removed
  • Scar formation with contraction
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15
Q

Scar formation with contraction (does/doesn’t) occur with the attached gingiva for what reason

A

Doesn’t because of its close approximation with the bone

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16
Q

Describe the damage that occurs to the perio tissues with SRP and curettage

A 
SRP= inadvertent tissue damage occurs 
Curettage= Intentional removal of pocket epithelium
17
Q

Describe the healing process after perio tissue damage from SRP/curettage

A
  • Formation of new epithelial lining along the sulcular wall with a resolution of inflammation
  • Epithelium migrates from the edge of the attached gingiva to enter the sulcus (generally covers the exposed gingival CT in about 10 days)
18
Q

Epithelium that migrates is derived from

A

the wound margins

19
Q

Purpose of gingival grafts

A

increase the width of keratinized gingiva (usually needed due to recession)

20
Q

Describe how gingival grafts heal

A
  • Vascular supply is completely severed from the donor tissue (must be nourished by diffusion from vessels in underlying tissue)
  • Surface degeneration occurs the first few days
  • Day 4= new capillaries form by ingrowth from recipient site or from vessels of the graft joining with capillaries in the bed
  • Epithelium continues to thicken
21
Q

Healing of a gingival graft is by (primary/secondary) intention

A

secondary

22
Q

Is there scaring with gingival grafts?

A

no (Location over bone limits wound contraction)

23
Q

Tissue will look normal after a gum graft after how long

A

~1 month

24
Q

A inverse (reverse) bevel incision can be,,,,

A

crevicular, marginal, or sub-marginal

25
Q

What is the difference between full thickness and split thickness flap

A 
Full= includes the periosteum 
Split= retains the periosteum on the bone
26
Q

Which contributes to greater bone resportion (full/split) thickness flap

A

full

27
Q

How does healing differ with full/split thickness flaps

A

healing is similar for both

28
Q

If bone is exposed the amount of bone resorption peaks when

A

at about 10 days

29
Q

Resorption as a result of a full thickness flap is (more/less) when the bone is thicker

A

less

30
Q

Describe the healing process after a flap is made

A
  • Clot forms between the bone and flap (resorbed after 1 week)
  • Gradual replacement with CT attachment between the bone and flap
  • Initial response of PMNs
  • Then macrophages, lymphocytes, plasma cells etc.
  • At 1 week soft tissues show wound healing and maturation with loosely arranged collagen fibers
  • 2 weeks- normal pattern of collagen fibers
  • 1 month- continued maturation and repair
  • 3 months= repair/regeneration is complete
  • Interproximal areas heal by secondary intention
31
Q

A barrier membrane is placed in guided tissue regeneration for what reason

A

Prevents Gingival CT, bone, and epithelium from growing along the root surface to allow new PDL cells to regenerate Sharpey’s fibers

32
Q

What type of healing occurs after perio therapy

A

depends on the tissue that enters the surgical site during healing

33
Q

Gingival CT in the surgical site during healing leads to what changes in bone

A

osseous resorption

34
Q

Bone in the surgical site during healing leads to

A

ankylosis and root resorption

35
Q

What are the different healing results you may see after perio therapy

A
  • No repair
  • Attachment via long JE
  • New bone not in contact with root
  • New bone with ankylosis and or root resoprtion
  • New attachment with a new PDL connecting the new bone to new cementum
36
Q

Complications of perio therapy are

A
  • Bleeding
  • Swelling, infection, abcsess
  • Lack of keratinized tissue
  • Failure to keratinize
  • Mobility
  • Recession
  • Root caries
  • Sensitivity

Perio--Surgical (Spring) (8 decks)

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