3. Wound Healing

Question 1

What do perio therapy and perio disease have in common

Answer 1

they both damage the periodontal tissues

Question 2

(Regeneration/repair) is the goal of perio therapy

Answer 2

regeneration

Question 3

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

Answer 3

repair

Question 4

What is regneration

Answer 4

• 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

Question 5

(T/F) Complete regeneration is uncommon

Answer 5

T

Question 6

Define repair

Answer 6

• 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

Question 7

What are the two types a ways wounds heal

Answer 7

primary and secondary intention

Question 8

Describe primary intention

Answer 8

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

Question 9

Describe day 1 of healing with primary intention

Answer 9

• 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

Question 10

Describe day 3 of healing with primary intention

Answer 10

• 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

Question 11

Describe day 5 of healing by primary intention

Answer 11

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

Question 12

Describe week 2 of healing by primary intention

Answer 12

-Increased fibroblasts and collagen accumulation

Question 13

Describe healing be primary intention after 1 month

Answer 13

• Intact epithelium
• Absence of inflammation
• Tissue is still remodeling

Question 14

Describe secondary intention healing

Answer 14

• 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

Question 15

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

Answer 15

Doesn’t because of its close approximation with the bone

Question 16

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

Answer 16

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

Question 17

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

Answer 17

• 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)

Question 18

Epithelium that migrates is derived from

Answer 18

the wound margins

Question 19

Purpose of gingival grafts

Answer 19

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

Question 20

Describe how gingival grafts heal

Answer 20

• 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

Question 21

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

Answer 21

secondary

Question 22

Is there scaring with gingival grafts?

Answer 22

no (Location over bone limits wound contraction)

Question 23

Tissue will look normal after a gum graft after how long

Answer 23

~1 month

Question 24

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

Answer 24

crevicular, marginal, or sub-marginal

Question 25

What is the difference between full thickness and split thickness flap

Answer 25

``` Full= includes the periosteum Split= retains the periosteum on the bone ```

Question 26

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

Answer 26

full

Question 27

How does healing differ with full/split thickness flaps

Answer 27

healing is similar for both

Question 28

If bone is exposed the amount of bone resorption peaks when

Answer 28

at about 10 days

Question 29

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

Answer 29

less

Question 30

Describe the healing process after a flap is made

Answer 30

- 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

Question 31

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

Answer 31

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

Question 32

What type of healing occurs after perio therapy

Answer 32

depends on the tissue that enters the surgical site during healing

Question 33

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

Answer 33

osseous resorption

Question 34

Bone in the surgical site during healing leads to

Answer 34

ankylosis and root resorption

Question 35

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

Answer 35

- 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

Question 36

Complications of perio therapy are

Answer 36

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