Improving wound healing Flashcards
What is primary wound healing (SPT) in periodontal therapy?
Healing that occurs when wound edges are brought together by sutures after a surgical incision.
what is secondary healing
Healing that occurs when the wound is left open without primary closure, allowing natural tissue repair.
Occurs when the wound is left open to heal naturally.
Seen in non-surgical treatments like scaling and root planing where the gum tissue heals over time without sutures.
What is periodontal regeneration?
Complete restoration of lost tissue structure and function, including root cementum, PDL fibers, and new alveolar bone up to the original level (CEJ).
What is required for true periodontal regeneration?
Formation of new root cementum,
insertion of collagen fibers into the root,
functionally oriented PDL fibers attaching to new alveolar bone.
What is periodontal repair?
Partial restoration of lost tissue architecture and function, with incomplete regeneration of root cementum, collagen fibers, and alveolar bone.
What is long junctional epithelium (LJE) in periodontal repair?
Epithelial downgrowth covering the treated root surface instead of new connective tissue attachment.
What is connective tissue (CT) attachment in periodontal repair?
New cementum formation with collagen fibers inserting into the tooth surface but not connected to new bone.
What is connective tissue (CT) adhesion in periodontal repair?
Connective tissue contact with the root surface without new cementum formation.
What is osseous repair?
Bone formation without the presence of PDL, resulting in limited functional restoration.
Is regeneration possible?
EXTREMELY unlikely - we arent aiming for this, we are aiming for repair
What are some indications for Reparative approach?
Persisting deep pocket
Single deep 2- or 3-wall infra-bony defect / grade II furcation
Good plaque control (>20% PS)
(Non-smoker)
How do we do the reparative (periodontal repair) approach?
FIRST, that by using MINST
THEN, go onto the surgical approach - flap access, guided tissue “regeneration”, bone grafts, graft materials, “biologicals” (bioactive molecules)
Explain guided tissue regeneration
making a surgical incision into the gum flap and open it
fill up the hole with graft material (dark blue on image)
place a barrier membrane on top (green in image) to exclude gingival tissues from wound healing
Therefore, what we have done is created a space where the bone and PDL can migrate into this area.
Give examples of membrane materials used in periodontal regenerative surgery
Non-resorbable
Expanded PTFE fibers (Goretex™)
Require removal by re-entry after 6 weeks
Resorbable
Polylactic acid / Polyglycolic acid membranes
Bovine collagen
No re-entry surgery required
Give examples of graft materials used in periodontal regenerative surgery
Autogenous bone grafts – Bone or bone marrow harvested from the patient
Allografts – Human demineralized freeze-dried bone, etc.
Xenografts – Bovine deproteinized bone (e.g., BioOss)
Synthetic materials – Calcium phosphates, bioactive ceramics (e.g., Perioglass)
What do grafts do?
they help to regrow the bone - it is not known how
Give 3 examples of biological materials used in the regenrative approach?.
Enamel Matrix Proteins – Emdogain™ from pigs teeth
Growth Factors – FGF-2, PDGF-BB
Autologous Blood Particles – Platelet-Rich Plasma/Fibrin (PRP/PRF)
Explain how the enamel matrix proteins in the biological material EmdogainTM most likely works
Mostly amelogenin or splice variants
Also BMP2 and protein inhibitors *
Induces bone & cementum formation
Promotes growth and proliferation of PDL, endothelial, gingival cells
Immunomodulatory effect – M1 to M2
Explain what PRP and PRF is and explain what it is used for in perio regenerative therapy
Platelet-Rich Plasma (PRP) is an autologous concentration of growth factors derived from platelets following centrifugation to reach super-natural concentrations.
Platelet-Rich Fibrin (PRF) is an autologous blood concentrate derived from platelets following centrifugation without anticoagulant, bovine thrombin, or calcium chloride
This is used in regenerative periodontal therapy - can be mixed with BIOoss or used as a membrane
What is the main aim of perio therapy?
Periodontal regeneration remains an ultimate goal of periodontal therapy, even though unlikely
What are the best materials for perio regeneration?
Based on current evidence, barrier membranes or EMD (Enamel Matrix Proteins – Emdogain™) with or without the addition of bone-derived grafts are the biomaterials of choice for regeneration of intrabony defects and furcations
How is research into periodontal regeneration expecting to be successful?
In order to recapitulate development, approach must be:
Permissive: providing appropriate conditions for wound healing and for cells to migrate - “Conductive”
Stimulating: Actively stimulates regeneration by manipulation of molecular signals - “Inductive”
We do this by using tissue engineering - using cells, scaffolds and bioactive molecules (can be alone or together, but all 3 are better)
What is biotooth?
Transplantation of a bioengineered tooth germ OR a bio-engineered whole tooth:
What is a new idea of tooth regeneration which might be able to one day happen?
Gene editing to make people less susceptible to dental conditions.
