Healing of the periodontium

Question 1

Discuss local factors that affect healing

Answer 1

• Remaining plaque microorganisms
• Trauma to the tissues
• Presence of foreign bodies (popcorn husks, overhangs)
• Repetitive treatment that disrupt the orderly cellular activity in the healing process
• Inadequate blood supply leading to necrosis. Blood supply is needed for healing

Question 2

Discuss systemic factors that affect healing

Answer 2

• Infections and diabetes can delay healing
• Hormones affect healing. Glucocorticoids may depress the inflammatory reaction or by inhibiting the growth of fibroblasts, the production of collagen, and the formation of endothelial cells need for healing
• Systemic stress, thyroidectomy, testosterone, adrenocorticotropic hormone (ACTH), and large doses of estrogen suppress the formation of granulation tissue and impair healing.
• Progesterone increases the susceptibility of the gingiva to mechanical injury by causing dilation of the marginal vessels

Question 3

Explain the periodontal healing process following treatment after non surgical periodontal therapy

Answer 3

• After curettage, blood clots will the pocket area
• There is vasodilation and an increase presence of PMNs.
• Granulation tissue (extra growth of healing skin) is formed.
• Long junctional epithelium is formed rather than new connective tissue approximately one week after surgery.
• Eventually, there’ll be gradual reductions in inflammatory cells and GC fluid. Clinically, less inflammation is seen.

• This healing requires 4 or weeks, and full healing can take months

Question 4

Describe the clinical appearance of gingiva as it heals

Answer 4

• Immediately after scaling and curettage, the gingiva appears hemorrhagic and bright red
• After 1 week, the gingiva appears reduced in height because there is less inflammation
• The gingiva is also darker red than normal, but it is much less red than it will have been on previous days
• After 2 weeks and with proper oral hygiene, the normal color, consistency, surface texture, and contour of the gingiva are attained, and the gingival margin is well adapted to the tooth

Question 5

List the four types of healing responses and identify the healing responses OHT’s induce.

Answer 5

• Regeneration
• ** Repair
• ** New attachment
• Reattachment

Question 6

Describe regeneration

Answer 6

Regeneration occurs when new cells grow and differentiate in order to form the new tissues or parts. E.g. formation of new bone and cementum

• Bacteria and bacterial products and inflammatory exudate can inhibit regenerating cells and tissues

(it’s like when a lizard grows back a lost limb)

Question 7

Describe repair

Answer 7

Healing of periodontal tissues that do not replicate the original lost periodontium, like scar tissue. It helps re-establish a normal gingival sulcus at the base of the pocket.

It involves regeneration and mobilization of epithelial and connective tissue cells into the damaged area and increased mitosis to provide sufficient numbers of cells.

Question 8

Describe new attachment

Answer 8

When connective tissue or epithelium connect with a root surface where there was pocketting. Occurs AFTER disease.
Such as when the pocket depths decrease after scaling calculus

Question 9

Describe reattachment

Answer 9

Healing by the reunion of the periodontal connective tissue and tooth root where the two tissues have been separated by incision or injury, but NOT by disease.

For example if you have a surgical extraction, the tissues will reattach after they’ve been incised

Question 10

List the considerations that influence treatment planning and referral to dentist/periodontist

Answer 10

1. Extent of disease
2. Root length.Short roots are more seriously jeopardized by 5 mm of clinical attachment loss than long roots
3. Hypermobility
4. Difficulty of scaling - presence of deep pockets and furcations makes instrumentation much more difficult and results can often be improved with surgical access
5. Age of the patient
6. Lack of resolution of inflammation after scaling- further therapy may be required

Question 11

Why would surgical periodontal therapy be needed?

Answer 11

• Provide improved access for periodontal instrumentation of the root surfaces
• Reduce pocket depths
• Provide access to defects in the alveolar bone
• Regenerate the periodontium lost due to disease
• Enhance prosthetic dental care