Clinical Correlates Flashcards by Austin Mahlik

When does the second phase (late phase) of wound healing start

Day 2-3

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Late phase involves what cells (4)

Monocytes
Macrophages
Fibroblasts
Mesenchymal SC’s

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Bone vs tissue in wound repair

Last phase can last long in bone- woven bone to mineralized

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Most variable phase?

Matrix formation (the last one) 10-100+days

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Granulation/tissue formation/proliferation stage involves (2)

T-cells and endothelium

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Cells in early phase(1)

PMNs

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Hemostasis components involved(3)

RBC
Fibrin
platelets

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Pure Mucogingival
Defect 2nd Premolar

Cause?

tooth erupted too buccal/bone was absent to begin with….. Then gingiva was brushed away (from chronic trauma)

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How to treat Pure Mucogingival

Defect 2nd Premolar (Graft and donor sites)

Marginal Free Gingival Graft – 1° intention

Donor Site – 2°
intention

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Primary intention healing

close the wound

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Secondary intention healing

Explain and used in what (2)

leave an ulcerated area (no tissue covering) i.e. extraction socket

ulcerations and gingivectomy

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Miller class recession for Pure Mucogingival
Defect 2nd Premolar

Class II/III

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Treating the Recipient Site Prep for Marginal Free Gingival Graft

Procedure/Prep (3 steps)

Where do you do excision? leave what intact?

Primary Incisions
Split-thickness flap
– Sharp dissection
Excision of flap at
base leaving bleeding connective tissue bed with periosteum layer intact

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Donor site split flap will heal via what method?

secondary intention

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Take tissue from where (labial or near palate?)

split flap is taken off what?

Labial-by cheek

taken off the periosteum

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Grafts are mobile or not after surgery?

Immobile-don’t move it

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Epithelial (Epi) will start migrating in the repaired area of a graft in how long? What about blood vessels?

12 hours for Epi

24-48 hours for vessels

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What is important after surgery (think hemostasis)

Direct pressure to form a thin clot which will seal the wound

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Angiogenesis will occur how long after gingival graft in the repaired area?

24-48 hours

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Antiseptic mouth rinse post gingival graft?

Some people say yeah (he does), some say no-but…. DO NOT BRUSH (has to be immobile)

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Why can you not brush after gingival graft?

It has to be immobile!!!

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Who wrote the first paper on gingival grafting and healing? When was it written?

Atkins in 1966…

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First 24 hours of healing you only get what

diffusion of oxygen-aka plasmatic circulation?

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Red good after grafting?

Yes-means blood vessels are moving in

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7 Day Normal Healing Migration? How much if so? Sutures?

Incision lines closed – Epithelial cell migration – 0.5 mm/day Remove sutures – Could slow healing

8 weeks FGG Tissue attached to what? What happens the next 3 months?

Tissue attached to root Remodeling of wound edges over the next 3 months

how long will it take for tissue from graft to heal to the point that they will not know (secondary healing)

~1 week

How long does it take a clot to form in the secondary intention healing? Thus you are past early inflammation phase

~24 hours

Epi (epithelium) migration between clot and CT in secondary intention healing takes how long

48-72 hours

Osteoclast and osteoclast activity takes how long to begin after a large wound is opened in secondary intention healing

Osteoclastic activity – Maxes out in 2-10 days Osteoblastic activity takes over... – Maxes out in 10-28 days

When does CT begin to organize in secondary intention healing at graft site

~7 DAYS, clot will convert to granulation tissue by 8 wks bone loss has regenerated

Grafting in diabetic patients

Simply a much slower process

Age and healing in grafts

As one ages, wound healing slows

Is the effectiveness of wound healing between healthy and diabetic diff in the long run or just the rate?

Just rate-they will heal equally as well just diabetics will heal much slower

Clinical Consequences of extraction (4)

* Alveolar bone resorption-horizontal & vertical * Increase functional demands on remaining dentition (more stress) • Need for restorative dentistry • Unesthetic appearance – Loss of papillae – Shadows

Modernly..Extraction: Clinical Considerations What are we doing differently? Why?

Socket Grafting/Ridge Preservation Post- extraction ridges shrink over time – 2-3mm horizontal ridge reduction -1 mm vertical ridge reduction

Study by who and when on extraction socket anatomy

Januario 2011

From what to what is thin bone found (what tooth to what tooth)

Canine to canine, particularly on the facial

Two things supplying blood to the bone area

PDL and gingiva

What happens during– Hemostasis/Inflammation (2)

* Clotting | * PMN clean up

Proliferative phase of socket extraction healing (2)

Angiogenesis/Granulation and provisional matrix

Modeling and remodeling phases of socket extraction

Woven bone to lamellar bone

Most variable stage of healing after graft

The mineralization of bone

Overview: Socket healing by day Day 1,2-3,7,20,38 This is from what study?

Day1 – Clot forms / PMN’s clean up Day 2-3 – granulation tissue at base of socket Day 7 – early CT & bone formation at base Day 20 and bottom 1/3 of socket – complete clot organization & CT fills socket Day 38 – immature bone fills 2/3rd of socket From Amler 1999

Factors Influencing Resorption (7)

-Smoking -General systemic health -Condition of the socket pre and post op -Influence of the tissue biotype -Local differences in the sites of the mouth and the dental arches -Type and quality of the intermin prosthesis (flipper that does blanch the tissue)

Early socket healing between 2-4 weeks of granulation tissue was studied by who and when

Trombelli 2008

Early socket healing between of granulation tissue in one study was seen as fast as what?

2-4 weeks. This was that Trombelli guy. Granulation Tissue – Rapid angiogenesis – Seen in 4 of 10 samples – Other 6 samples had moved past this phase

Provisional matrix in early socket healing at 2-4 wks is made up of what 3 things?

– Densely packed mesenchymal cells – Highly vascular – Dense fibrous tissue

Immature woven bone makes up what % of intermediate socket healing from 6-8 wks? What is the makeup of the rest???

immature woven bone (~33%) Provisional matrix (~60%) – Cell & fiber rich Very little granulation tissue remains (<5%)

Early disruption dry socket clot formation research done when

1999

Early disruption dry socket clot formation research... Pus leaving after 20 days means?

bad.... Neutrophils should have left a long time ago

osteomyelitis and why?

infection of the bone, calculus was not removed in extraction

Tx for osteomyelitis

Placed on metronidazole & Chlorhexidine rinses

Why is healing on lower lingual bone hard

cortical bone-thick and does not heal well-little vasculature

What to know about extraction in esthetic zone

prep for healing ahead of time

Fractured ant tooth preferred Tx is what

placement Extraction #8 &9 • Socket Preservation • Delayed Implant Placement • FPD #7-10

used to remove coronal aspect of roots

Periostomes

Capset is made of

Calcium phosphate-artificial bone placement/holder

Purpose of capset/FBDA + Biomend in socket

holding place for gingival tissue

If you Flap it, you cause two things to happen... | 2

– Lose periosteal blood supply temporarily | – Lose PDL blood supply permanently

SIE stands for what?

• SIE | – Support immersion endoscopy

WOUND repair progression (4 main phases)

Hemostasis --> Inflammation --> Granulation tissue Formation/Proliferation --> Matrix formation/remodelling

Wound contraction starts in which stage and around what day in the phases of wound repair?

In early granulation formation stage which is around day 3

How long after a graft will the stage of re-vascularization take to begin?

~30 hours, before this it is just circulation (oxygen diffusion)

How long after a graft will the stage of vascular re-organization take to begin?

~9 days, goes through 28 days.

When is the stage of organic union?

Part of stage of revascularization and vascular re-organization... Not really sure what this is though.

Late socket healing (12-24 weeks) has components of what (4 things) What makes up the bulk of most samples?

Woven bone~33% Lamellar bone in deeper regions ~10% Adipocytes in marrow spaces Provisional matrix ~60% and makes up the bulk of most samples

Over time in socket healing, what is replaced by what?

Granulation tissue is essentially replaced by lamellar bone

Dry sockets are caused by a disruption in what

Fibrin clot-at about 2 days

By what day will you have a dry socket after fibrin clot disruption?

~4 days

20-30 days after clot disruption post socket surgery, what will be seen?

Dry sockets which have let to suppurative osteitis w/ boney sequestrum-The point is PMNs dominate the area and it is infected-Osteomyletis