Periodontal Tissue Response and Healing

Question 1

What’s the basic process of Periodontal Tissue Healing?

Answer 1

1. • Acute Inflammation 24-48hrs
2. • Decrease in vasodilation
   • Decrease in GCF
   • Decrease in inflammatory cells
   • Pocket ulceration heals

3.
- Formation of long junctional epithelium

3b. Bone remodelling
3c. Fibroblasts proliferate: Collagen fibres and Ground substance
3ci. Maturation of CT

Question 2

What happens to the bacterial flora during healing?

Answer 2

• Reduction in total numbers of microorganisms
• Shift from Gram -ve anaerobes to Gram +ve aerobes
• Shift to microbes associated with health

Question 3

What’s the immune response during an advanced lesion?

Answer 3

• Gingival recession with fibrosis in CT
• Continued extension of subgingival plaque
• Extension of inflammatory infiltrate
• Apical migration and ulceration of junctional epithelium
• Alveolar bone resorption and periodontal loss

Question 4

What’s the difference between an advance lesion and 1 week post-treatment in terms of immune response in the periodontium?

Answer 4

• There is a reduction in the number of neutrophils in the gingival crevice
• The CT infiltrate begins to diminish
• There’s a reduction in gingival swelling
• The ulcers in the pocket lining begin to heal
• Fibroblast proliferate

Question 5

How does the periodontium change 1 week to 1 month post treatment?

Answer 5

• Gingival recession is evident, associated with shrinkage of tissues
• New fibrous tissue formed and inflammatory infiltrate diminishes
• LONG EPITHELIAL ATTACHMENT BEGINS TO FORM
• Alevolar bone re-models but no regeneration occurs coronally

Question 6

How does the periodontium change 1 month to 3 months post-treatment?

Answer 6

• Gingival crevice contains small numbers of neutrophils
• Junctional epithelium re-established with the formation of a long epithelial attachment
• Gingival CT is mature with minimal inflammatory infiltrate

Question 7

What are the main tissue responses during tissue healing?

Answer 7

1. Shrinkage of tissue - following resolution of inflammation (gingival recession)
2. Formation of a long junctional epithelium
3. Tightening of gingival cuff - as gingival collagen fibres reform
4. Small gain in attachment - from base of pocket

Question 8

How is healing regulated?

Answer 8

• Stimulation and regulation of repair cytokines (TGF-Beta - promotes proliferation of gingival fibroblasts)
• Epithelial cell attachment is promoted by Laminin

Question 9

How do you know if tissue healing is failing?

Answer 9

• Bleeding on probing
• Redness
• Swelling
• Persisting deep pockets or increasing depths
• Suppuration
• Increasing mobility

Question 10

Why does tissue healing fail?

Answer 10

Inadequate patient plaque control:

• Lack of compliance
• Lack of dexterity

Residual subgingival calculus deposits harbouring subgingival plaque:

• Deep pockets
• Furcation lesions, concavities and root grooves
• Inexperienced operator