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Regeneration > Periodontal Disease and Regeneration - Pt 2 > Flashcards

Periodontal Disease and Regeneration - Pt 2 Flashcards

1
Q

What is compartmentalization?

A
  • new CT attachment can be predicted if cells from the PDL settle on the root surface during healing
  • gingival epithelial cells migrate faster than bone and PDL cells
  • physical barrier placement
  • migration of bone and PDL cells into defect while preventing soft tissue migration
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2
Q

What three things are involved in peridontal regeneration?

A
  1. wound stability
  2. space provision
  3. primary intention healing
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3
Q

What are three grafting materials used?

A
  1. barrier membrane
  2. bone substitute
  3. biologic agents
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4
Q

What 7 things are involved in an ideal membrane?

A
  1. biocompatible
  2. cell occlusive
  3. tissue integration
  4. space making for progenitor cells
  5. facilitate migration and proliferation of progenitor cells
  6. clinical manageability
  7. resistant to bacterial infection
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5
Q

What are the 4 types of non-resorbable membranes used?

A
  1. cellulose acetate (millipore)
  2. e-PTFE (gore-tex)
  3. d-PTFE (cytoplast)
  4. rubber dam
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6
Q

What are the two advantages of non-resorbable membranes?

A
  1. greater space maintenance
  2. technique sensitive
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7
Q

What are the 3 disadvantages of nonresorbable membranes?

A
  1. requires second sx to remove
  2. increased risk of exposure
  3. possible infection if exposed (d-PFTE is an exception)
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8
Q

What are the resorbable membranes?

A
  1. synthetic polymers (i.e., PLA, PGA)
  2. collagen (cross-linked)
  3. collagen (non-cross linked)
  4. connective tissue: (acellular dermal matrix)
  5. pericardium (bovine and human)
  6. amniotic and chorion membranes
  7. calcium sulfate
  8. alginate
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9
Q

What are the advantages AND disadvantages of resorbable membranes?

A
  1. tissue friendly, tissue integration
  2. easy to use
  3. semi-permeable: allows passage of nutrients
  4. allow BV penetration
  5. chemotactic
  6. retention of growth factors
  7. reduce risk of exposure and infection
  8. some can be left exposed
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10
Q

What is an autograft?

A

*same individual to same individual

intra-oral
- tuberosity
- chin
- ramus

extra-oral
- tibia
- calvarium (back of head)
- iliac crest

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11
Q

What is an allograft?

A

*same species different individual

  • comes in cortical, cancellous, or combinations
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12
Q

What is mineralized Freeze-Dried Bone Allograft (FDBA)?

A

solvent preserved, mineralised allograft

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13
Q

What is a demineralized freeze-drized bone allograft (DFDBA)?

A

demineralization removes bone mineral, exposes collagen and growth factors (i.e., BMPs)

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14
Q

What is a xenograft?

A

graft taken from a different species
- anorganic bovine (cow) bone matrix
- anorganic equine (horse) bone matrix
- anorganic porcine (pig) bone matrix

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15
Q

What are alloplasts?

A

synthetic graft or inert foreign body implanted into the tissues

calcium phosphate ceramics
- perioglas
- hydroxyapatite
- calcium phosphosiliciate
- biphasic calcium phosphate
- beta TCP

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16
Q

What are the 3 main growth factors used?

A
  1. enamel matrix derivatives (EMD - emdogain, osteogain, straumann)
  2. recombinant human platelet derived growth factor (GEM 21)
    3 recombinant human bone morphogenetic protein 2
17
Q

What are the 4 types of laser tissue interactions?

A
18
Q

What happens when a microflap is created and a laser is used?

A

immediate microbiological effects
- 85% laser patients culture negative for perio pathogens
- 100% of ultrasonic root debridement patients remained culture positive

potential to reduce risk of bacteremia

19
Q

Describe accelerated healing using lasers.

A
  1. biostimulation of fibroblasts and osteoblasts
  2. increased growth factor release
  3. anti-inflammatory
  4. acceleration of granulation tissue formation
  5. increased collagen synthesis
  6. increased new bone formation
20
Q

Is regeneration obtained (metanalysis study)?

A
  1. all materials give similar results
  2. exception: alloplastic materials and biological factors
  3. non-exclusion tx can produce new CT attachment
  4. different healing outcomes
  5. same defect can show both regeneration and repair
  6. how meaningful is it if other teeth treated by the same protocol show LJE?
  7. strong proof of principle evidence for partially successful regenerative outcomes
21
Q

Is regeneration effective?

A

OFD (open flap debridement) vs GTR (guided tissue regeneration)
- 20 year follow up
- 3 month maintenance cleaning

Found:
- access flap left deeper residual PD with increased risk of progression
- regeneration results in higher tooth retention and less periodontitis progression
- assume positive clinical findings = periodontal regeneration

*flap group had 2.6-3.6 OR of needing re-intervention compared to regenerative groups

22
Q

What are the regeneration failures from local factors?

A
  1. plaque and inflammation
  2. tooth mobility and occlusion
  3. endodontic status
  4. defect characteristics
  5. technical aspects –> excessive tissue manipulation during treatment, blood supply
  6. foreign bodies
  7. repetitive treatment procedures that disrupt orderly cellular activity during healing
23
Q

What are the regeneration failures from systemic factors?

A
  1. smoking
  2. diabetes
  3. stress
  4. age
  5. nutrition
  6. systemic disorders and medications interfering with healing
24
Q

What does current evidence about peridontal regeneration suggest?

A

can only restore a fraction of original tissue volume

25
Q

True or false: complete regeneration may still be an illusion

A

True

26
Q

What is more important, wound management or materials used?

A

wound management

27
Q

What 2 things do regenerative procedures have the potential to do?

A
  1. produce an environment/situation conducive to health
  2. improve the long and short term prognosis of a tooth

Regeneration (5 decks)

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