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Chapter 26 Principles of Periodontal Surgery: Periodontal Regeneration…
Chapter 26 Principles of Periodontal Surgery: Periodontal Regeneration
Periodontal Regeneration is defined as healing after periodontal surgery that result in the reconstruction of lost tissue, including supporting alveolar bone and cementum and functional oriented periodontal ligament
Periodontal Regenerative surgery is "ADDING" bone
Growth Factors- are found only in living tissue cells such as bone , platelets, and marcophages
For Regeneration to occur cells capable of forming new cementum, PDL, and supporting alveolar bone must migrate into the periodontal osseous defect and product this tissue
The Cells are Osteoblasts, Fiberblasts, and Cementoblasts
Once inflammation is resolved with initial periodontal therapy like SRP the periodontal tissue regeneration involves surgery using bone graft, or bone substitute material, membrane and modulators of tissue healing are aimed to regenerate the periodontal attachment apparatus lost due to periodontitis
THE PRIMARY GOAL: IS TO PRESERVE THE NATURAL TOOTH/TEETH,
The Secondary Goal is to: reduce probing depth, gain clinical attachment, filling of the osseous defects with new bone, regeneration of new supporting alveolar bone, new cementum and functionally oriented periodontal ligament
Bone Graft or Bone Substitutes Categories
Allografts( bone graft naturally occurring) Demineralized freeze-dried bone obtained from human cadavers
Alloplasts(Bone substitute can be synthetics) Manufactures which mean there is zero risk of disease transmission but not as effective in formating bone as are graft materials
Autografts (bone graft naturally occurring) Comes from patients own body
Xenograft (Processed from bones of another species) Can come from cows
Surgery Open Flap Debridement: with out the placement of bone you are repairing the area but not regenerating
Cells Involve in Regeneration
Gingival Connective tissue
Periodontal ligament- PDL
Gingival Epithelium( it is the fastest growing tissue migrating at 0.5-1.0mm per day
Supporting Alveolar bone
Cementum
Membranes are placed on the the tooth covering the periodontal bony defect
Types of Membranes
Absorbable: appeared half a decade after nonabsorbable membranes, the advantage is you do not need a 2nd surgery to remove it, the barrier remain in place for a minimum of 3 to 4 weeks but several bacteria like p.gingivalis have been shown to attach to bioabsorbable membranes which can cause a bacterial infection
Non-Absorbable: Was the first ti be used and studies clinically, it has to be removed which mean a second surgery 6 to8 weeks later to removed the barrier. Infrabony defects show positive results with nonabsorbable membranes
Patients might be prescribed antibiotics before and after treatment to prevent infection the first post op is 7 to 14 days. professional maintenance and plaque control can correlate with the successful clinical results of regenerative therapies including open flap debridement. Smoking has been shown to have a negative influence on the result of regenerative therapy