Periodontal Healing

Question 1

What is new attachment?

Answer 1

Describes the union of connective tissue with previously pathogenically altered root surface

Question 2

What is the effect of mechanical plaque control on the microflora?

Answer 2

• marked decrease in total number of organisms
• proportion of gram negative anaerobic organisms is greatly reduced
• residual flora is gram positive aerobic
• these changes are partly due to a reduction in plaque thickness

Question 3

Following debridement, how do the periodontal tissues heal in the first week?

Answer 3

• an initial acute inflammatory response as a result of trauma, subsides over 24-48 hours
  Over following week:
• decrease in vasodilation
• decreased gingival crevicular fluid
• decreased PMN’s
• decreased ulceration of pocket

Question 4

Which cells are at the healing site following debridement?

Answer 4

• fibroblasts migrate to the site and collagen fibres are laid down
• pocket epithelium begins to attach to root surface via formation of a basement membrane and hemidesmosome attachment
• these hold keratinocytes to the cementum
• this is epithelial new attachment (long junctional epithelium)

Question 5

What is the purpose of the long junctional epithelium?

Answer 5

• results in gradual closure of the pocket
• may continue for months after treatment
• acts as a zip and zips up the pocket from the base

Question 6

Clinically how does healing of the periodontal tissues present?

Answer 6

• a reduction in redness/swelling as inflammation subsides
• BOP is reduced as inflammation reduces
• ulcers in pocket epithelium heal
• gingivae becomes more pink and firm as connective tissue matures
• as inflammation subsides, there is shrinkage of the tissues due to tightening of the gingival cuff

Question 7

How is healing regulated?

Answer 7

Elimination of inflammation and specific factors which promotes healing include:
- cytokines are released which in turn attracts fibroblasts forming connective tissue