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Classic Lit Fall 2021 > Periodontal Wound Healing > Flashcards

Periodontal Wound Healing Flashcards

1
Q

What classical study looked at healing of Epi and CT?

A

Engler et al. 1966
Ramfjord et al. 1966

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2
Q

What happens in Epi and CT in the first 2 hrs?

A

Blood clot formation

PMN migrate to both sites

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3
Q

What happens in Epi and CT in the first 9hrs?

A

Continued PMN migration and formation of poly-band between blood clot and spinous layer

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4
Q

What happens in Epi and CT from 9-13hrs?

A

Epithelial cell migration and DNA Synthesis

CT continued PMN migration

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5
Q

When does angiogenesis occur in the CT?

A

12-24hrs (Ramfjord 1966) During this time there is also CT proliferation

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6
Q

What happens from days 1-2 in EPI and CT?

A

Epithelial DNA synthesis

CT Angiogenesis + proliferation continues

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7
Q

What happens from days 2-5 and 5-7?

A

Epithelial cell migration

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8
Q

When does the sulcus form?

A

5-7days healing

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9
Q

What happens from 7-14days?

A

New keratinized marginal gingiva (Epi)

New FGM formed due to CT proliferation

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10
Q

When is the peak of osteoclastic activity during periodontal surgical healing?

A

7-14 days

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11
Q

When does CT mature after periodontal surgery?

A

4-6weeks

Epithelialization of marginal gingiva and sulcus is complete - CT is organized

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12
Q

What are the phases of wound healing?

A

Hemostasis

Inflammation

Proliferation

Matrix Formation/Remodeling/Maturation

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13
Q

What happens during the Hemostasis phase?

A

Blood vessel injury > cellular leakage (leukocytes/erythrocytes/plasma cells) > vasoconstriction > platelet aggregation and coagulation

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14
Q

What is the role of a blood clot in healing?

A

Protects denuded tissues

serves as a provisional matrix for cell migration

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15
Q

What happens during the inflammation phase?

A

Wound Cleaning takes place

Neutrophils remove debris and bacteria > Monocytes convert to macrophages > Macrophages and Fibroblasts phagocytose remaining debris and bacteria

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16
Q

What happens during the proliferation phase of healing?

A

Granulation tissue formation

Macrophage release growth factors (induce granulation tissue formation, and fibroblast migration/proliferation) > keratinocytes migrate to form basal cells (epidermal migration begins) > Collagen formation starts > Endothelial cells create a vascular system

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17
Q

What happens during the matrix formation/remodeling/maturation phase?

A

New collagen rich matrix produced by fibroblasts > wound contraction > wound maturation

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18
Q

How long does wound maturation take?

A

6 weeks to 1 year

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19
Q

Which phase determines if regeneration or repair will occur?

A

Matrix formation/remodeling/maturation phase

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20
Q

What characteristics of the oral cavity complicate wound healing in comparison to the rest of the body?

A

Residual calculus

Rigid - nonvascular tooth surface attached to CT and Epi (vs 2 opposing vascular tissues)

PDL resources

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21
Q

How does healing of periodontium to tooth occur?

A

Wikesjo et al. 1991

attachment to dentin surfaces is mediated by adsorption of plasma proteins to the surface and subsequent development and maturation of a fibrin clot.

22
Q

What kind of animal was used for the Engler and Ramfjord 1966 study?

A

Rhesus Monkeys

23
Q

What kind of healing occurs after SRP? Citation?

A

Long Junctional Epithelium

Caton & Zander 1979

24
Q

Is LJE Better, Equal, or Less protective than JE?

A

Equal

Magnusson et al. 1983

25
Q

What kind of healing occurs after MWF? Citation?

A

LJE

Caton et al. 1980

26
Q

What are the phases of healing for osseous surger?

A

Inflammatory Phase

Reparative Phase

Remodeling Phase

27
Q

What happens during the Inflammatory phase of osseous healing?

How long is it?

A

2weeks long

Blood clot formation

Cytokines recruit inflammatory cells to the wound area

28
Q

What happens during the Reparative phase of osseous healing?

A

Immature new bone matrix and cartilage scaffolding occurs

Scaffold mineralizes over a period of 6-12 weeks forming immature woven bone

29
Q

What happens during the Remodeling phase of osseous healing?

A

Lamellar bone replaces woven bone

30
Q

How much bone loss can you expect after osseous surgery?

A

Wilderman et al. 1979

6 months: 1.2mm bone resorption

Following 12 months: 0.4mm bone apposition

Net bone loss: 0.8mm

31
Q

Selipsky 1976

A

The initial bone loss and later bone apposition after osseous surgery explains why there is initial increased mobility, followed by return to pre-surgical status/

32
Q

What is the average bone loss following osseous in the interradicular space?

A

0.23mm

Moghaddas and Stahl 1980

33
Q

What is the average bone loss following osseous in the Radicular area?

A

0.55mm

Moghaddas & Stahl 1980

34
Q

What is the average bone loss following osseous in the Furcation? Citation

A

0.88mm

Moghaddas & Stahl 1980

35
Q

What reasons are there for Crown Lengthening procedures?

A

Biologic Width invasion

Altered passive eruption

Subgingival caries

36
Q

How long should we wait after CL to place crowns?

(non-esthetic zone)

A

Lanning et al.
Heals to ~3mm above osseous crest after 3mo with minimal changes in vertical position of the FGM from 3-6mo

37
Q

How long should we wait after CL to place crowns?

(esthetic zone)

A

Brägger et al.

6mo after healing there is minimal change in the FGM

38
Q

Schropp et al. 2003

A

50% width reduction after the first 3mo following extraction

39
Q

Evian et al. 1982

A

Optimal time to harvest graft from socket

8-12weeks

peak in osteogenic activity

40
Q

What is the sequence of socket healing?

A

Amler & Salman 1960

  1. Blood clot fills socket
  2. Granulation tissue replaces (2-3days)
    1. Young CT replaces (by 20days)
  3. Uncalcified Bone Formation
  4. Filling in socket with primary bone
  5. Loss of Lamina Dura
  6. Bone density similar to surrounding alveolar bone
41
Q

What are the phases of FGG healing?

A

Oliver et al. 1968

3 phases

Initial (0-3 days)

Revascularization (4-11 days)

Tissue Maturation (11-42 days)

42
Q

What happens during the Initial phase of FGG healing?

A

(Oliver et al. 1968)

0-3 days

CT
Exudate accumulates between collagen fibers = Plasmatic Circulation providing cell nutrition

Epi
Degeneration with desquamation of outer layer

Blood supply
None

43
Q

What happens during the Revascularization phase of FGG healing?

A

(Oliver et al. 1968)
4-11 days

CT
Dense fibrous union btw graft/periostium
New FGM

Epi
Degeneration + Desquamation of entire graft epi
Epi proliferation from adjacent tissues

Blood supply
Capillary budding along base of graft

44
Q

What happens during the Tissue Maturation phase of FGG Healing?

A

(Oliver et al. 1968)
11-42 days

CT
Increased Density

Epi
Increased Thickness
Keratinization occurs at day 28

Blood supply
Reduction in vascularity

45
Q

When does keratinization of FGG occur?

A

28 days

Oliver et al. 1968

46
Q

How much creeping attachment can be expected form FGG?

A

0.89mm on average from 3-12mo
Matter & Simasoni

47
Q

How does CTG healing occur?

A

Guiha

7days - vascularization from periodontal plexus and supra-periosteal plexus

14days - complete graft vascularization

28 days - JE formed

28-60 days - Normal vascularization/oral epi

48
Q

How much CTG can be exposed?

A

Up to 30%

Guiha et al. 2001

49
Q

Bone loss after full vs partial thickness flap

A

Wood et al. 1972
Partial: 0.98mm
Full: 0.62mm

Fickl et al. 2011
Partial: 0.12mm
Full: 0.64mm

50
Q

Benefits of microsurgery for healing?

A

Higher vascular perfusion
less trauma and vessel injury
enhanced root coverage
enhanced wound healing

Burkhardt & Lang 2005

51
Q

What are the major systemic factors that can effect wound healing?

A

Smoking and uncontrolled Diabetes

Classic Lit Fall 2021 (29 decks)

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