Perio Regeneration-Martinez Flashcards
1
Q
Define Infrabony Pocket
A
- a pocket whose base is apical to alveolar crest
2
Q
What are the different types of infrabony defects?
A
- 1 wall defect
- 2-wall (interdental crater)
- 3-wall defect
3
Q
Infrabony Pockets: Treatment Modalities
A
- Non-regenerative therapy
- Open Flap Debridement (OFD)
- Apically positioned flap + osseous surgery
- Regenerative therapy:
- Bioactive agents/Biologics
- EMD
- PDGF-BB
- Guided Tissue Regeneration (GTR)
- Bioactive agents/Biologics
4
Q
Laurell 1997: Which treatment of Infrabony Pockets had the best CAL Gain & Bone Fill?
A
- GTR
- CAL Gain
- 4.2
- Bone Fill
- 3.2
- CAL Gain
5
Q
Tonetti & Cortellini 2000: Which treatment of Infrabony Pockets had the best CAL Gain?
A
- Emdogain (EMD)=biologic
- 3.5
- GTR
- 3.8
6
Q
Treatment of infrabony pockets Conclusion
A
- graft, biologic, or barrier produced more favorable CAL Gain & PD reduction vs OFD
- GTR=most effective
7
Q
Define Guided Tissue Regeneration (GTR):
A
- 2000
- surgical procedure to regenerate loss periodontal structures through different tissue responses
- 1976
- cells that repopulate the root surface after therapy will determine nature of attachment (compartmentalization concept)
8
Q
Compartmentalization concept
A
- the cells that repopulate the root surface after therapy will determine the type of attachment
9
Q
Periodontal repair vs regeneration
A
- Repair:
- restore gingival sulcus to the same level of the base of previous pocket
- (lowers pocket
- Regeneration:
- Completely restore the lost part (Bone) to original architecture and function.
- at same level as healthy
10
Q
What is the biologic rational behind GTR?
A
- exclude the tissue we dont want (epithelium & CT)
- allows regeneration of root cementum w/inserting periodontal fibers
- eventual regeneration of alveolar bone
11
Q
Who had the first successful application of GTR in humans?
A
Sture Nyman
12
Q
Overview Wound Healing Events after Periodontal Surgery
A
13
Q
Overview Wound Healing Events after Periodontal Surgery
A
14
Q
Soft Tissue Wound Healing
A
- Epithelial cell migration
- few days after surgery
- migration rate: 0.5 mm/day
- Epithelial cells=Epithelium
- Fibroblasts= Connective Tissue
15
Q
Hard Tissue Wound Healing
A
- Woven Bone Formation:
- Bone requires more time
- SLOW
- migration rate: 0.05 mm/day
- low healing rate
- Osseous Cells=Bone
- PDL Cells=Cementum & Bone
- SLOW
- Bone requires more time
16
Q
GTR: Concept of combination therapy
A
- membrane→ Barrier
- Graft→ Scaffold & Space maintenance
17
Q
GTR: PASS Principle
A
- Primary Closure
- Angiogenesis
- Stability
- Space Maintenance
18
Q
GTR: Indications
A
- 2 & 3- wall intrabony defect
- class 2 furcation defects
- Dehisence defects
- Implant-associated defects
- Root coverage procedures
19
Q
How to predict bone fill?
A
Most coronal adjacent bone level
20
Q
Therapeutic Process: Steps
A
21
Q
What factors affect clinical outcomes of GTR?
A
- Patient
- behavioral (plaque, smoking)
- psychological
- Enviromental
- Defect
- severity of attachment loss (>3mm)
- angle of defect (≤ 25%)
- Technique:
- primary closure
- space maintenance
- Healing
- plaque control
- membrane exposure
22
Q
What types of bone grafts are available?
A
- Autograaft
- Allograft
- Xenograft
- Alloplast
23
Q
Autograft
A
- Bone transferred from one place to another in same individual
- chin, ramps, iliac crest
24
Q
Allograft
A
- b/w genetically similar members of the same species
- DFDBA, FDBA, cadaver bone
25
Xenograft
* from another species
* Bio-Oss (Bovine)
* Equimatrix (Horses)
* Z-core (porcine)
26
Alloplast
* synthetic graft or inert foreign body
* bone ceramic, PerioGlass
27
Autograft: Advantages vs Disadvantages
* Advantages:
* all bone properties
* better resistance to infection
* no immune response
* Disadvantages:
* second surgical site
* rapid resorption rate
28
Allograft: FDBA vs DFDBA
* FDBA
* Mineralized freeze-dried bone allograft
* loses cell viability through manufacturing process
* Mineralized:
* better space maintenace
* slower resorption rate
* osteoconductive
* More radiopaque
* breakdown by foreign body reaction
* DFDBA
* demineralized freeze-dried bone allograft
* enhance osteogenic potential by releasing BMPs
* bone morphogenetic proteins
* Demineralized:
* BMPs expression
* possible osteoinduction
* osteoconductive
* more radiolucent
29
Allograft: Indications
* implant defects
* GTR
* GBR
* sinus augmentation
30
Examples of Allograft
* MinerOss
* Symbios
* LifeNet Health
* Puros
31
What is the importance of processing in Allografts?
* Freeze Dried: 4hrs
* FDBA
* tutoplast: 39 days
* Puros
* Tutoplast Process
* removes all antigenicity
* inactivates pathogens
* preserves bone and collagen structure
* graft healing comparable to autogenous graft
32
Xenograft Properties:
* Biocompatible
* Bovine=most popular
* Equine and porcine
33
What are the different types of Membranes?
* Non-resorbable
* PTFEe, PTFEd
* Millipore (cellulose acetate)
* Resorbable
* collagen
* synthetic
* PLA, PGA, PLGA
* Acellular dermal matrix
34
What are some NEW membranes?
* Alginate
* New degradable copolymers
* Hybrid or nanofibrotic membranes
* Amniotic membranes
35
Membranes Technical Considerations:
* Flap Design:
* Papilla preservation technique=PPT
* Simplified (SPPT)
* \< 2mm
* Modified (MPPT)
* ≥ 2 mm
* Suture:
* External Vertical Mattress
36
Biologic Agents: Main use
* implant site development
* reconstruction of lost periodontium
37
What are the principle objectives of biologic agents?
* Proliferation
* Migration
* Differentiation
38
What types of bone grafts are osteoconductive?
* Autograft
* Allograft
* Xenograft
* Alloplast
39
What types of bone grafts are osteoinductive?
* Autograft
* Allograft
40
What type of bone grafts are osteogenic?
* Autograft
