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Week 85 > Perio Regeneration-Martinez > Flashcards

Perio Regeneration-Martinez Flashcards

1
Q

Define Infrabony Pocket

A
  • a pocket whose base is apical to alveolar crest
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2
Q

What are the different types of infrabony defects?

A
  • 1 wall defect
  • 2-wall (interdental crater)
  • 3-wall defect
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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)
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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
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5
Q

Tonetti & Cortellini 2000: Which treatment of Infrabony Pockets had the best CAL Gain?

A
  • Emdogain (EMD)=biologic
    • 3.5
  • GTR
    • 3.8
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6
Q

Treatment of infrabony pockets Conclusion

A
  • graft, biologic, or barrier produced more favorable CAL Gain & PD reduction vs OFD
  • GTR=most effective
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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)
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8
Q

Compartmentalization concept

A
  • the cells that repopulate the root surface after therapy will determine the type of attachment
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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
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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
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11
Q

Who had the first successful application of GTR in humans?

A

Sture Nyman

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12
Q

Overview Wound Healing Events after Periodontal Surgery

A
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13
Q

Overview Wound Healing Events after Periodontal Surgery

A
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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
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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
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16
Q

GTR: Concept of combination therapy

A
  • membrane→ Barrier
  • Graft→ Scaffold & Space maintenance
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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
Q

Xenograft

A
  • from another species
    • Bio-Oss (Bovine)
    • Equimatrix (Horses)
    • Z-core (porcine)
26
Q

Alloplast

A
  • synthetic graft or inert foreign body
  • bone ceramic, PerioGlass
27
Q

Autograft: Advantages vs Disadvantages

A
  • Advantages:
    • all bone properties
    • better resistance to infection
    • no immune response
  • Disadvantages:
    • second surgical site
    • rapid resorption rate
28
Q

Allograft: FDBA vs DFDBA

A
  • 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
Q

Allograft: Indications

A
  • implant defects
  • GTR
  • GBR
  • sinus augmentation
30
Q

Examples of Allograft

A
  • MinerOss
  • Symbios
  • LifeNet Health
  • Puros
31
Q

What is the importance of processing in Allografts?

A
  • 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
Q

Xenograft Properties:

A
  • Biocompatible
  • Bovine=most popular
  • Equine and porcine
33
Q

What are the different types of Membranes?

A
  • Non-resorbable
    • PTFEe, PTFEd
    • Millipore (cellulose acetate)
  • Resorbable
    • collagen
    • synthetic
      • PLA, PGA, PLGA
    • Acellular dermal matrix
34
Q

What are some NEW membranes?

A
  • Alginate
  • New degradable copolymers
  • Hybrid or nanofibrotic membranes
  • Amniotic membranes
35
Q

Membranes Technical Considerations:

A
  • Flap Design:
    • Papilla preservation technique=PPT
      • Simplified (SPPT)
        • < 2mm
      • Modified (MPPT)
        • ≥ 2 mm
  • Suture:
    • External Vertical Mattress
36
Q

Biologic Agents: Main use

A
  • implant site development
  • reconstruction of lost periodontium
37
Q

What are the principle objectives of biologic agents?

A
  • Proliferation
  • Migration
  • Differentiation
38
Q

What types of bone grafts are osteoconductive?

A
  • Autograft
  • Allograft
  • Xenograft
  • Alloplast
39
Q

What types of bone grafts are osteoinductive?

A
  • Autograft
  • Allograft
40
Q

What type of bone grafts are osteogenic?

A
  • Autograft

Week 85 (8 decks)

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