Periodontal Disease and Regeneration - Pt 2 Flashcards
What is compartmentalization?
- 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
What three things are involved in peridontal regeneration?
- wound stability
- space provision
- primary intention healing
What are three grafting materials used?
- barrier membrane
- bone substitute
- biologic agents
What 7 things are involved in an ideal membrane?
- biocompatible
- cell occlusive
- tissue integration
- space making for progenitor cells
- facilitate migration and proliferation of progenitor cells
- clinical manageability
- resistant to bacterial infection
What are the 4 types of non-resorbable membranes used?
- cellulose acetate (millipore)
- e-PTFE (gore-tex)
- d-PTFE (cytoplast)
- rubber dam
What are the two advantages of non-resorbable membranes?
- greater space maintenance
- technique sensitive
What are the 3 disadvantages of nonresorbable membranes?
- requires second sx to remove
- increased risk of exposure
- possible infection if exposed (d-PFTE is an exception)
What are the resorbable membranes?
- synthetic polymers (i.e., PLA, PGA)
- collagen (cross-linked)
- collagen (non-cross linked)
- connective tissue: (acellular dermal matrix)
- pericardium (bovine and human)
- amniotic and chorion membranes
- calcium sulfate
- alginate
What are the advantages AND disadvantages of resorbable membranes?
- tissue friendly, tissue integration
- easy to use
- semi-permeable: allows passage of nutrients
- allow BV penetration
- chemotactic
- retention of growth factors
- reduce risk of exposure and infection
- some can be left exposed
What is an autograft?
*same individual to same individual
intra-oral
- tuberosity
- chin
- ramus
extra-oral
- tibia
- calvarium (back of head)
- iliac crest
What is an allograft?
*same species different individual
- comes in cortical, cancellous, or combinations
What is mineralized Freeze-Dried Bone Allograft (FDBA)?
solvent preserved, mineralised allograft
What is a demineralized freeze-drized bone allograft (DFDBA)?
demineralization removes bone mineral, exposes collagen and growth factors (i.e., BMPs)
What is a xenograft?
graft taken from a different species
- anorganic bovine (cow) bone matrix
- anorganic equine (horse) bone matrix
- anorganic porcine (pig) bone matrix
What are alloplasts?
synthetic graft or inert foreign body implanted into the tissues
calcium phosphate ceramics
- perioglas
- hydroxyapatite
- calcium phosphosiliciate
- biphasic calcium phosphate
- beta TCP
What are the 3 main growth factors used?
- enamel matrix derivatives (EMD - emdogain, osteogain, straumann)
- recombinant human platelet derived growth factor (GEM 21)
3 recombinant human bone morphogenetic protein 2
What are the 4 types of laser tissue interactions?
What happens when a microflap is created and a laser is used?
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
Describe accelerated healing using lasers.
- biostimulation of fibroblasts and osteoblasts
- increased growth factor release
- anti-inflammatory
- acceleration of granulation tissue formation
- increased collagen synthesis
- increased new bone formation
Is regeneration obtained (metanalysis study)?
- all materials give similar results
- exception: alloplastic materials and biological factors
- non-exclusion tx can produce new CT attachment
- different healing outcomes
- same defect can show both regeneration and repair
- how meaningful is it if other teeth treated by the same protocol show LJE?
- strong proof of principle evidence for partially successful regenerative outcomes
Is regeneration effective?
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
What are the regeneration failures from local factors?
- plaque and inflammation
- tooth mobility and occlusion
- endodontic status
- defect characteristics
- technical aspects –> excessive tissue manipulation during treatment, blood supply
- foreign bodies
- repetitive treatment procedures that disrupt orderly cellular activity during healing
What are the regeneration failures from systemic factors?
- smoking
- diabetes
- stress
- age
- nutrition
- systemic disorders and medications interfering with healing
What does current evidence about peridontal regeneration suggest?
can only restore a fraction of original tissue volume
True or false: complete regeneration may still be an illusion
True
What is more important, wound management or materials used?
wound management
What 2 things do regenerative procedures have the potential to do?
- produce an environment/situation conducive to health
- improve the long and short term prognosis of a tooth
