Attachment/regeneration

Question 1

what is reattachment?

Does it occur in periodontal disease?

Answer 1

the reunion of the root and the connective tissue that have been separated by incision/injury.
no

Question 2

what is new attachment?

Answer 2

union of the connective tissue with the previously pathogenically altered root surface

Question 3

What is regeneration?

Answer 3

attachment of pdl cells and fibres to new cementum formation and coronal regrowth of alveolar bone

Question 4

what are the effects of mechanical plaque control have on the microflora?
what are these changes partly due to?

Answer 4

reduction in total no. of organisms
reduced proportion of gram negative
residual flora is gram positive and aerobic
- reduction in plaque thickness

Question 5

following debridement, what happens initially?

what happens over following week?

Answer 5

initial - acute inflammation reaction because of trauma, subsides in 24-48 hour
week - reduced vasodilation/GCF/PMN’s/ulceration

Question 6

what is new epithelial attachment due to? (3)

Answer 6

fibroblasts - migrate in lay down collagen
limited re-modelling of alveolar crest
pocket epithelium attaches to root surface via formation of a long epithelial attachment.

Question 7

when does new attachment occur?

Answer 7

after non surgical periodontal therapy because of long junctional epithelium

Question 8

what does a long junctional epithelium result in?

Answer 8

gradual closure of a pocket, continuous for months after treatment
acts like a zip

Question 9

clinically what happens after debridment? (5)

Answer 9

• reduction in redness and swelling as inflammation subsides
• reduced bop as inflammation subsides
• ulcers heal
• gingivae become more pink and firm as CT heals
• shrinkage because of reduced inflammation

Question 10

what happens to cause tissue shrinkage?

Answer 10

tightening of gingival cuff - orientation of healthy gingival collagen fibres and formation of long JE attachment

Question 11

is the long JE fragile?

Answer 11

yes

Question 12

how does healing occur?

Answer 12

due to elimination of inflammation and and due to specific factors which promote healing

Question 13

following treatment what is released during healing to have a regulatory function?

Answer 13

cytokines

Question 14

what do cytokines stimulate?

Answer 14

proliferation and healing of the ulcerated pocket - attracts fibroblasts

Question 15

regeneration is healing by formation of what?

Answer 15

long JE - effective at preventing tooth loss

Question 16

regeneration means attachment of pdl cells and fibres to what?

Answer 16

attachment of pdl cells and fibres to new cementum formation and coronal regrowth of alveolar bone

Question 17

regeneration of what is rarely seen?

where can it be occasionally seen?

Answer 17

bone

occasionally seen in depths of infrabony pockets

Question 18

for regeneration to occur hat needs to happen? (3)

Answer 18

• epithelium and GCT must be excluded from the wound area
• adequate debridement of root surface
• repopulation by appropriate progenitor cells to form PDL

Question 19

if the epithelium is allowed to grow into the wound space what will happen?

Answer 19

will proliferate quickly

prevent fibroblasts becoming attached to cementum and forming new attachment

Question 20

what is RSD important in providing?

Answer 20

a suitable surface for cells to attach to

Question 21

what are the main techniques to promote new attachment?

Answer 21

bone grafting
conditioning root surfaces
use of membranes - GTR

Question 22

what is GTR?

Answer 22

use of mechanical barrier to eliminate epithelium from wound to determine which cells repopulate the wound

Question 23

GTR promotes repopulation by?

Answer 23

cells derived from PDL and bone useful for furcation defects and infrabony pockets