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week 87 > Wound Healing- Paquette > Flashcards

Wound Healing- Paquette Flashcards

1
Q

What are the goals of periodontal treatment?

A
  • Remove irritants from roots
  • eliminate exogenous bacterial infection from the periodontium
  • reduce or eliminate pocket depth
  • Reshape hard and soft tissue→regain harmonious topography
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2
Q

Repair vs Regeneration

A
  • Repair:
    • Architecture & Function are NOT completely restored
  • Regeneration:
    • the architecture & function are completely restored
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3
Q

What are the factors involved in Periodontal Tissue Repair & Regeneration?

A
  • Scaffolds
  • Cells
  • Growth Factors
  • Blood Supply
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4
Q

What are the periodontal procedures that involve wound healing?

A
  • SRP
  • Flap Surgery
  • Guided Tissue Regeneration
  • Guided Bone Regeneration
  • Tooth Extraction
  • Soft tissue Grafts
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5
Q

What is wound healing?

A
  • Dynamic, interactive process
  • involves:
    • soluble mediators
    • blood cells
    • extracellular matrix
    • parenchymal cells
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6
Q

What biological processes does wound healing involve?

A
  • Inflammation
  • Epithelialization
  • Granulation tissue formation
  • Neovascularization
  • Differentiation
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7
Q

What are the phases of wound healing?

A
  • Inflammation
  • Granulation Tissue Formation
  • Tissue Remodeling
    • Matrix formation/remodeling
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8
Q

Healing by primary vs secondary intension

A
  • Primary:
    • Little loss of tissue
    • wound margins are close together
      • unimpeded repair
      • blood clot quickly organized
  • Secondary:
    • A lot of tissue loss
      • Wound filled w/granulation tissue
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9
Q

Wound Healing: Molecular changing stages

A

Injury

  • Sealing Stage
    • Platelet Aggregation
    • Blood Clot
    • Edema
    • Fibrin forms
  • Growing Stage
    • Fibroblasts enter
    • Collagen Synthesis
  • Finishing (Remodeling) Stage
    • Fibrinolysis
    • Oxygenation & Ntr Perfusion
    • Epiphelialization
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10
Q

Growth Factors

A
  • Diverse group of polypeptide molecules
  • released by cells in the inflamed area
  • regulate growth & development of organs
  • Types:
    • Autocrine
    • Paracrine
    • Endocrine
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11
Q

What cells can secrete growth factors?

A
  • Macrophages
  • Endothelial Cells
  • Fibroblasts
  • platelets
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12
Q

What are the different Growth Factors

A
  • PDGF
    • Platelet Driven Growth Factor
  • IGF
    • Insulin-Like Growth Factor
  • FGF
    • Fibroblast Growth Factor
  • TGF
    • Transforming Growth Factor
  • VEGF
    • Vascular Endothelial Growth Factor
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13
Q

Healing after SRP: Process

A
  • Immediately after:
    • blood clot fills gingival sulcus
    • Hemorrhaging within the tissue
    • PMN Leukocytes on wound surface
  • within 2 days:
    • Granulation tissue
  • 5-7 days:
    • epithelialization of CT in sulcus
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14
Q

Healing after SRP: Clinical Appearance

A
  • Immediately after:
    • Gingiva appears:
      • hemorrhagic
      • bright red
  • 2-7 days:
    • Gingiva
      • redder than normal but less than previous days
    • Gingiva margin:
      • Reduced height
  • After 2 weeks:
    • Gingiva:
      • normal color, consistency, surface texture, contour
    • Gingival margin:
      • well adapted to tooth
    • Immature collagen appears
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15
Q

What does healing after SRP result in?

A

Form long junctional epithelium

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16
Q

Healing after SRP: Will new CT fibers reform and insert into new cementum?

A
  • Possible-coronal to the PDL
17
Q

Healing after SRP: How resistant will this healing be to future bacterial challenges?

A

Similar to a non-diseased site

18
Q

Healing after Gingivectomy: Timeline

A
  • Initial Response
    • form protective blood clot
    • acute inflammation
    • necrosis of underlying tissue
    • Granulation tissue replaces clot
  • 12-24 hours:
    • Epithelial cells begin migrating to wound site
  • 24 hours:
    • CT cells (Angioblasts) Migrate to wound site
  • 36 hours:
    • Peak epithelial cell activity
      • fixed to fibrin layer by hemidesmosomes & new basement membrane
  • day 3:
    • Fibroblasts appear
    • Granulation tissue grows coronally
      • creates new gingival margin and sulcus
  • Day 5-14:
    • Epithelium is made w/less keratin than before surgery
  • Week 4:
    • Epithelium complete repair
  • Week 7
    • CT complete repair
19
Q

What layer does the epithelial cells arise from during wound closure?

A

Stratum Spinosum

20
Q

Healing after Gingtivectomy: How long does it take the epithelium vs the CT to become completely repaired?

A
  • Epithelium
    • 4 weeks
  • CT
    • 7 weeks
21
Q

Healing After Flap Surgery: Soft Tissue Reaction timeline

A
  • 0-24 hours:
    • Blood clot w/granulation cells connects the flap to the tooth/bone
  • 24-72 hours:
    • space b/w tooth and flap lessen
    • Epithelial cells migrate
  • 1 week:
    • epithelial attachment to root
      • hemidesmosomes
      • basal lamina
    • Blood clot is replaced by granulation tissue
  • 2 weeks:
    • Collagen aligns parallel to tooth
    • Weak Flap Connection to tooth/bone due to immature collagen fibers
    • Normal Clinical Appearance
  • 4 weeks/1 month:
    • Gingival Crevice full epithelialized w/well defined epithelial attachment
    • Functional collagen fibers are mature
22
Q

What is granulation tissue derived from?

A
  • Gingival CT
  • Bone marrow
  • PDL
23
Q

Healing After Osteoplasty: Bone Reaction time line

A
  • day 1-3:
    • Superficial bone necrosis
  • Day 4-6:
    • Peak Osteoclastic activity (resorption)
  • After 6 days:
    • Osteoclastic activity declines
    • Bone Loss=1 mm
  • Week 3-4:
    • Peak Bone Repair
      • new bone formation
      • osteoblast activity 1 year after
    • Cancellous Bone
      • Interdental area
      • no net bone loss
    • Radicular Bone
      • mild marginal loss
24
Q

Major Growth Factors In wound healing:

Fibroblast Proliferation

Fibroblast Migration

Chemotactic For Macrophages

Neovascularization

Collagen Synthesis

Colagen Secretion

A

week 87 (7 decks)

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