Attachment And Regeneration Flashcards
What is meant by the term reattachment
Reunion of root and connective tissue separated by incision or injury- does not occur in perio disease
What is meant by new attachment?
Union of connective tissue with previously pathogenically altered root surface- occurs in perio
What is meant by the term regeneration?
Reattachment of PDL cells and fibre to new cementum formation and coronal regrowth of alveolar bone- not commonly seen in perio
What are the effects of mechanical plaque control on the micro flora?
Marked decrease in total number of organisms
Proportion of gram -ve anaerobic organisms reduced
Residual flora is gram +ve
Describe initial healing post RSD
Initial inflammatory reaction subsides after 24-48 hours Over next week: Decreased vasodilation Decreased GCF Decreased PMNs Decreased ulceration of the pocket
Describe further healing
Fibroblasts migrate to site and collagen fibres are laid down
Limited remodelling of alveolar crest
Pocket epithelium begins to attach to Roth surface- long JE
Describe new attachment by means of long JE
Formation of basement membrane and Hemidesmosome attachment
Hemidesmosomes hold keratinocytes to the cementum
Long JE results in gradual closure of the pocket
May continue for months post tx
What can be seen clinically in healing tissues
Reduction in redness and swelling
Reduced BOP
ulcers in pocket epithelium heal
Gingivae becomes pink and firm as connective tissue mature
Shrinkage of tissues as inflammation subsides
What causes shrinkage?
Tightening of the gingival cuff due to-
Orientation of healthy gingival collagen fibres
Formation of new JE attachement
What regulates healing?
Elimination of inflammation
Specific factors promote healing
Cytokines released during healing attract fibroblasts
Does regeneration of perio tissues normally occur through non surgical perio tx?
No
Healing by formation of long JE is effective in preventing tooth loss
What is meant by the term regeneration?
Attachment of PDL fibres to new cementum and coronal regrowth of alveolar bone- rarely seen
What is required for regeneration?
Epithelium and connective tissue must be excluded from wound area
Root surface must be compatible with healing- instrumented adequately
Repopulation by appropriate progenitor cells to form PDL
What technique are used to promote new attachment?
Bone grafting
Conditioning root surfaces
Use of membranes- guided tissue regeneration
What is guided tissue regeneration?
Placement of membrane to prevent epithelial and gingival cells forming tissue in wound site in order to allow time for PDL and bone cells to regenerate
Useful for furcation defects and infra only pockets
