Attachment/regeneration Flashcards
what is reattachment?
Does it occur in periodontal disease?
the reunion of the root and the connective tissue that have been separated by incision/injury.
no
what is new attachment?
union of the connective tissue with the previously pathogenically altered root surface
What is regeneration?
attachment of pdl cells and fibres to new cementum formation and coronal regrowth of alveolar bone
what are the effects of mechanical plaque control have on the microflora?
what are these changes partly due to?
reduction in total no. of organisms
reduced proportion of gram negative
residual flora is gram positive and aerobic
- reduction in plaque thickness
following debridement, what happens initially?
what happens over following week?
initial - acute inflammation reaction because of trauma, subsides in 24-48 hour
week - reduced vasodilation/GCF/PMN’s/ulceration
what is new epithelial attachment due to? (3)
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.
when does new attachment occur?
after non surgical periodontal therapy because of long junctional epithelium
what does a long junctional epithelium result in?
gradual closure of a pocket, continuous for months after treatment
acts like a zip
clinically what happens after debridment? (5)
- 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
what happens to cause tissue shrinkage?
tightening of gingival cuff - orientation of healthy gingival collagen fibres and formation of long JE attachment
is the long JE fragile?
yes
how does healing occur?
due to elimination of inflammation and and due to specific factors which promote healing
following treatment what is released during healing to have a regulatory function?
cytokines
what do cytokines stimulate?
proliferation and healing of the ulcerated pocket - attracts fibroblasts
regeneration is healing by formation of what?
long JE - effective at preventing tooth loss
regeneration means attachment of pdl cells and fibres to what?
attachment of pdl cells and fibres to new cementum formation and coronal regrowth of alveolar bone
regeneration of what is rarely seen?
where can it be occasionally seen?
bone
occasionally seen in depths of infrabony pockets
for regeneration to occur hat needs to happen? (3)
- epithelium and GCT must be excluded from the wound area
- adequate debridement of root surface
- repopulation by appropriate progenitor cells to form PDL
if the epithelium is allowed to grow into the wound space what will happen?
will proliferate quickly
prevent fibroblasts becoming attached to cementum and forming new attachment
what is RSD important in providing?
a suitable surface for cells to attach to
what are the main techniques to promote new attachment?
bone grafting
conditioning root surfaces
use of membranes - GTR
what is GTR?
use of mechanical barrier to eliminate epithelium from wound to determine which cells repopulate the wound
GTR promotes repopulation by?
cells derived from PDL and bone useful for furcation defects and infrabony pockets
