Biomaterials for Periodontal & Soft tissue Regeneration

Question 1

What are the main goals of periodontal therapy?

Answer 1

1. Infection control
2. Pocket reduction/elimination
3. Regeneration (Restore architecture)
4. Long-term results (Improve prognosis & increase tooth survival)
5. Improved aesthetics

Question 2

What are some challenges for wound healing?

Answer 2

1. Open system (meaning it is connected to the oral cavity via the sulcus)
2. No blood supply on root surface

Question 3

What tissue types colonise the root surface?

(cell types)

Answer 3

1) Epithelial cells
2) Gingival Connective Tissue cells
3) Bone cells
4) Periodontal Ligament cells (most important)

Epethelial fastest to heal / PDL slowest

Question 4

What are the 3 Key Principles of Regeneration?

Answer 4

SITE PROTECTION (from mechanical damage)
Close site to seal membrane (e.g. sutures) which will Improved healing

SPACE (for PDL growth)
Barrier added between tooth & membrane to create space (ensure does not collapse)

BLOOD CLOT STABILITY

Question 5

What are the desired properties of a membrane?

Answer 5

• Biocompatible (often absorbable collagen membranes)
• Does not elicit inflammatory response
• Maintains barrier function
• Non-collapsible

Question 6

What flap design is this?

Answer 6

Simplified papillae preservation flap

Question 7

What flap design is this?

Answer 7

Modified papillae preservation flap

Question 8

What are the different bone grafting materials?

Answer 8

1. Autografts (yourself)
2. Allografts (another human)
3. Xenografts (animals)
4. Alloplastic (synthetic)

Question 9

What technique is illustrated here?

Answer 9

Guided tissue regeneration (GTR)

Question 10

What factors affect the outcomes of regerenative therapy?

Answer 10

Patient (OH & Smoking)
Defects (Morphology & Size/Radiographic Defect Angle)
Tooth (Endodontic condition & Mobility)

Question 11

What does EMD stand for?

Answer 11

Enamel matrix derivatives

Question 12

What are the combination therapies available for regeneration?

Answer 12

GTR + EMD
GTR + Graft
EMD + Graft
GTR + EMD + Graft

GTR = Guided tissue regerneration, EMD = Enamel matrix derivative

Question 13

What are the different stages of enamel matrix derivative?

Answer 13

1. EMD gel applied to tooth
2. Mesenchymal cells migrate into the lesion towards a root surface covered with EMD (attraction phase)
3. These cells attach and populate the surface (attachment phase)
4. Cell metabolism is increased and intra- cellular signal substances are activated(proliferation phase)
5. Growth factors - such as TGF-ß1 - are released and the cells organize to produce collagen & cementum (differentiation phase)
6. Condensation of collagen at a certain distance from the root surface, mineralization will start and alveolar bone forms

Question 14

Describe the steps of PRGF

Plasma rich in growth factors

Answer 14

1. Blood sample is taken from patient and put into centrifuge to get differnt fractions
2. Apply different fractions into pocket to aid regeneration

(fraction 1 = fibrin membrane)
(fraction 2 = rehydration of bone)