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perio > perio wound healing > Flashcards

perio wound healing Flashcards

1
Q

definition of WOUND

A

an injury to living tissue, a forcible interruption of the continuity of any tissue

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2
Q

definition of WOUND HEALING

A

process involving cascade of cellular and molecular changes that occurred after tissue injury, resulting in either tissue repair or regen

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3
Q

defn of FIRST INTENTION HEALING

A

primary union of a wound in which the incised tissue edges are held in close approximation until union occurS

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4
Q

characteristics of healing by first intention

A

1) Wound completely close by approximating wound edges
2) Reduction of healing time by minimising the new tissue formation within wound
3) Reduction of bleeding and post op discomfort
4) Minimum scar formation and tissue loss
5) Suitable for regeneration/ grafting procedures, well repaired lacerations and clean wounds

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5
Q

defn of healing by second intention

A

wound closure wherein the edges remain separated and the wound heals from the base and sides via formation of granulation tissue

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6
Q

characteristics of healing by second intention

A

1) Wound is left open and allowed to close on its own
2) Slower healing, more discomfort and scar formation compared to healing by primary intention
3) Suitable mode as wound is kept open for drainage from infection or debri remeoval
4) Seen in extractions and ordinary flap operation

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7
Q

defn of healing by third intention

A

delayed primary closure or tertiary wound healing

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8
Q

characteristics of healing by third intention

A

1) Manage heavily infected or contaminated wounds
2) Primary closure is achieved when reduction of inflammation and bacterialcount is observed

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9
Q

defn of REPAIR

A

healing of a wound by tissue that does not fully restore the architecture or function of the original part, includes reattachment and new attachment

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10
Q

defn of REATTACHMENT

A

to attach again. The reunion of epithelial and CT with a root surface following separation by incision or physical injury

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11
Q

defn of NEW ATTACHMENT

A

union of CT or epithelium with a root surface that has been deprived of its original attachment apparatus. This new attachment may be epithelial adhesion

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12
Q

defn of REGENERATION

A

union of CT or epithelium with a root surface that has been deprived of its original attachment apparatus. This new attachment may be epithelial adhesion

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13
Q

in edentulous spaces, what does regeneration refer to

A

refers to surgical augmentation of a resorbed ridge
honestly wtf does this mean

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14
Q

what happens after scrd?
- microbial biofilm disruption leads to ____, which halts the ____, resulting in improvement of clinical signs of the disease

A

reduction of host response cascade*, halting periodontal destruction

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15
Q

in wound healing, cell to cell interactions are orchestrated by what?

A

growth factors, cytokines, ECM components

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16
Q

which phase is the most important phase in wound healing? why?

A

hemostasis phase because the clot needs to form to protect what is left behind (otherwise will bleed to death), and is also the start so that granulation tissue can move to the site (cell migration)

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17
Q

what process starts immediately after initial injury and lasts 3-6 hours

A

blood clot formation
- a fibrin clot that comprises of activated platelets, neutrophils, RBCs embedded in a matrix of fibrin fills the site and initiates recruitment of inflammatory cells

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18
Q

functions of the blood clot

A
  • ensure that primary hemostasis is achieved
  • protects denuded (covering stripped) tissues at this first phase
  • serves a provisional scaffold for cell migration
  • degranulating platelets release pro inflammatory cytokines and growth factors that have inductive and conductive properties
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19
Q

what are some examples of pro inflammatory cytokines and growth factors released by degranulating platelets

A

TGF-b, PDGF, FGF, EGF

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20
Q

what does PDGF and TGF-b do?

A

induce chemotactic attraction of neutrophils and activate differentiation of monocytes into mature macrophages after infiltration of the injury

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21
Q

what does EGF and VEGF do

A

enhance vascular permeability and chemotaxis

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22
Q

what do keratinocytes do

A

produce IL1 that is involved in chemotaxis of neutrophils

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23
Q

what produces IL1 that is involved in chemotaxis of neutrophils

A

keratinocytes

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24
Q

what molecules enhance vascular permeability and chemotaxis

A

EGF and VEGF

25
Q

what molecules activate differentiation of monocytes into mature macrophages after infiltration of the injury

A

PDGF and TGF-b

26
Q

which day after injury does wound contraction form

A

day 3

27
Q

which process starts within minutes of injury and lasts 4-6 days

A

inflammatory phase
- starts concomitantly with hemostasis

28
Q

what are the key cells of inflammatory phase

A

neutrophils and macrophages

29
Q

what is the aim of inflammatory phase

A

to phagocytose and remove damaged tissue components, bacteria and foreign material

30
Q

how do inflammatory cells migrate into the wound

A

via chemotaxis

31
Q

after inflammatory cells migrate into the wound via chemotaxis, what happens after?

A

sequential infiltration of neutrophils, macrophages and lymphocytes

32
Q

what cytokines promote recruitment and activation of T and B cells, and osteoclasts?

A

IL-1b, IL-6, TNF-a, TGF-b

33
Q

what do IL-1b, IL-6, TNF-a, TGF-b do

A

promote recruitment and activation of T and B cells, and osteoclasts
also initiates proliferation of keratinocytes and gingival fibroblasts

34
Q

in specifics, what does TGF-b do?

A
  • activates gingival fibroblasts to induce production of MMP2 and MMP9
  • stimulates proliferation of osteoclast precursor
  • stimulates differentiation and promotion of bone resorption
  • promotes macrophage activation
35
Q

what does collagenase do

A

degrades collagen and fibronectin in ECM

36
Q

what happens in the late inflammatory phase

A
  • lymphocytes infiltrate the wound and influence gingival fibroblast proliferation and collagen biosynthesis
  • reduction in inflammatory stimuli decreases the neutrophils and macrophages in the wound area and leads to switching of inflammatory macrophages to wound healing macrophages
37
Q

in which phase does lymphocytes infiltrate the wound ?

A

late inflammatory phase

38
Q

when do inflammatory macrophages switch to wound healing macrophages

A

late inflammatory phase

39
Q

defintion of granulation tissue

A

is healing tissue that forms in response to any injury or surgical insult of soft tissue

40
Q

what does granulation tissue consist of

A

fibroblasts, capillary buds, inflammatory cells, edema

41
Q

what phase follows the inflammatory phase and lasts 4-14 days

A

granulation tissue formation/ proliferative phase

42
Q

the proliferative phase is after which phase, and how long does it last

A

after inflammatory phase, lasts 4-14 days

43
Q

the proliferative phase is characterised by formation of ____

A

granulation tissue

44
Q

granulation tissue is _____ tissue rich in ____

A

highly vascularized, fibroblasts

45
Q

what does IGF do

A

induces chemotactic attraction and activates proliferation of PDL

46
Q

epithelial cells exhibiting the highest proliferative rate explains the development of

A

long junctional epithelium (apical migration of JE terminating at apical end of instrumentation)

47
Q

a proportion of fibroblasts converts to ____ which will draw ______ together, result in decrease in size

A

myofibroblasts, wound edges

48
Q

what is the remodelling phase characterised by

A

development of a new epithelium, elimination of grnulation tissue and ECM remodelling

49
Q

in the proliferative phase, macrophages release PDGF and TGFb to stimulate what

A

gingival fibroblast proliferation and synthesis

50
Q

in the proliferative phase, macrophages release what to stimulate gingival fibroblsat proliferation and synthesis?

A

PDGF and TGFb

51
Q

gingival fibroblsats and PDL play an important role in the re organization of what

A

of ECM through the synthesis of different types of collagen

52
Q

in the proliferative phase, PDGF and TGFb are also released during bone resorption leading to

A

stimulation of osteoblast migration during bone remod and differentiation

53
Q

in the remodelling phase, what factor that is released from extracellular bone matrix induces the migration of bone MSCs for bone remod?

A

IGF

54
Q

in the remod phase, IGF released from extracellular matrix induces what

A

induces migration of bone MSC for bone remod

55
Q

in remod phase, BMP4 released from extracellular bone matrix induces what

A

induces osteoblast differentiation and increase recruitment of MSC

56
Q

what are lipoxins

A

are metabolites of AA and are isolated from activated human leukocytes

57
Q

what are resolvins

A

derived from omega 3 fatty acid chains

58
Q

what is the role of lipoxins and resolvins

A

they block the pdtion of pro inflam mediators and promote the resolution of inflammation

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