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What is the primary role of stem cells in pulp therapy following injury?
Which of the following factors influences the rate and form of periapical disease progression?
In the context of oral mucosal wound healing, which phase is characterized by the formation of granulation tissue?
What is the main reason for leaving a small amount of partly demineralized dentine during carious lesion treatment?
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Which cell types have limited regeneration potential following injury in pulp and periapical tissues?
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What distinguishes regeneration from repair in the context of wound healing?
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Which factor is NOT mentioned as influencing cell proliferation during healing?
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In terms of oral mucosal wound healing, what characteristic is emphasized?
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Which type of cells are categorized as permanent cells?
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What is the primary reason oral mucosal tissues do not scar after wound healing?
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What phase of wound healing is characterized by the formation of granulation tissue?
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Which of the following best describes labile cells?
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What might hinder oral wound healing in a patient?
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What is the ideal outcome if periodontal ligament cells are the first to migrate to cover a denuded root surface?
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What primarily continues to wash out bacterial remnants from the periodontal pocket after treatment?
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During the initial phase of wound healing in the periodontal context, how long does it typically take for the pocket wall to become fully epithelialized?
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What type of collagen forms to replace granulation tissue following periodontal treatment, and when does it begin to appear?
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Which cell type's migration directly influences the type of attachment formed after periodontal healing?
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What pathological outcome follows when bone cells are the first to contact the tooth surface?
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In the context of wound healing, when does collagen repair mature fully following periodontal treatment?
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What role does tissue tone in gingivae play in the adaptation after periodontal treatment?
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What is the consequence of early epithelial reattachment during the healing of periodontal pockets?
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What typically triggers acute inflammatory reactions in the soft tissue of the periodontal pocket?
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What is a primary characteristic of the oral mucosal wound healing process?
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Which factor is least likely to influence the healing process of oral wounds?
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What distinguishes chronic gingivitis from periodontitis?
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Which phase of wound healing is primarily characterized by cell proliferation?
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What is the effect of the local bacterial environment on oral wound healing?
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During which phase of wound healing does re-epithelialization primarily occur?
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Which of the following is NOT typically observed in a healthy gum condition?
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What type of inflammatory response is characterized by lymphocytic infiltrate in chronic gingivitis?
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What is a key sign indicating the presence of periodontitis?
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Which condition is most characteristic of the remodeling phase of wound healing?
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Which of the following statements accurately describes the balance in periodontal health?
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What is an essential factor in facilitating spontaneous regeneration of periodontal tissues?
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Which characteristic is true regarding gingivitis and its treatment?
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Which of the following is a method utilized to manage periodontitis effectively?
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What role do periodontal ligament cells play in tissue healing?
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Which phase of wound healing is primarily affected by the proliferation of local cells?
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Which factor is crucial in maintaining oral health after periodontal treatment?
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What is a likely outcome when plaque levels are kept minimal in gingivitis?
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What condition can lead to a burst of tissue destruction in the periodontium?
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Which of the following is NOT a recommended practice for periodontal healing?
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Study Notes
Introduction to Wound Healing
- Tissues are composed of parenchymal (functional) and mesenchymal (support) cells within an extracellular matrix.
- A wound is a break in the integrity of skin or mucosa, disrupting structure or function.
- Wounds can be caused by surgery, trauma, chemicals, heat/cold, friction/shear force, pressure or disease.
- Cell proliferation is crucial for tissue restoration.
- Cells are categorized by mitotic activity: labile (constantly dividing), stable (divide in response to injury), and permanent (do not divide).
- Healing involves proliferation, migration, and differentiation of cells, regulated by growth factors and extracellular matrix components.
Healing Processes
- Regeneration: Complete restoration of the original tissue through parenchymal cell proliferation.
- Repair: Incomplete regeneration, replacing lost tissue with granulation tissue that matures into fibrous tissue and a scar.
Oral Mucosal Wound Healing
- Oral mucosal wounds heal with minimal scarring compared to skin wounds.
- Gingival wounds heal without scars.
- Tongue wounds heal quickly with little inflammation and altered TGF-β response.
Possible Reasons for Minimal Scarring in Oral Mucosa
- Distinct fibroblast phenotype.
- Dependant on which cell type populates the surface first (e.g., epithelial cells, connective tissue cells, bone cells).
Healing in the Periodontium
- If epithelial cells populate the root surface first, a long junctional epithelium forms.
- If connective tissue cells populate the root surface first, attachment will be through connective tissue adhesion.
- If bone cells are first to proliferate, root resorption and ankylosis result.
- If periodontal ligament cells migrate and cover the root surface, new connective tissue attachment forms, which is ideal.
Clinical Healing
- Bacterial remnants are washed out of the pocket by blood and crevicular fluid.
- A new gingival sulcus forms near the crest of the gingiva after 14 days.
- Gingival shrinkage occurs due to resolution of edema.
- Collagen repair matures fully after 12 weeks.
- Little to no connective tissue reattachment occurs between the treated pocket lining and root surface, instead relying on long junctional epithelium and tissue tone.
Histological Healing
- An acute inflammatory reaction occurs within hours in the soft tissue pocket wall.
- Pocket epithelium proliferates and the pocket wall is fully epithelialized after 2 days.
- Epithelial reattachment commences at the apical extremity of the pocket after 5 days and progresses coronally.
- Involution of pocket epithelium forms a new long junctional epithelium.
- New JE is initially weak, requiring careful oral hygiene to prevent relapse.
- Formation of functional collagen lags behind the healing of the dento-epithelial junction, with immature collagen appearing after 3 weeks.
- Collagen matures fully after 12 weeks.
Periapical Disease
- Inflammatory changes occur in the periapical part of the periodontal ligament.
- Periapical periodontitis typically occurs due to pulp necrosis and may lead to adjacent bone resorption.
- Removal of the source of periapical tissue damage usually allows healing.
Causes of Pulp Necrosis
- Trauma.
- Alterations in plaque flora or host response to plaque, leading to tissue damage and destruction.
Objectives of Periodontal Therapy
- Restore structure and function of periodontal tissues.
- Eliminate factors responsible for inflammation and calculus.
- Achieve a disease-free periodontium through the following:
- Complete removal of bacteria and calcified biofilm.
- Create a smooth root surface for healing.
- Enable periodontal ligament cells to proliferate (guided tissue regeneration).
- Utilize advanced cellular biology techniques for tissue regeneration.
Healing in Gingivitis
- Gingivitis can be induced within 7-14 days by stopping oral hygiene and reverts to healthy tissue when hygiene is resumed.
- Gingivitis is caused by plaque accumulation at the gingival margins.
- Gingivitis is reversible if plaque levels are minimal.
- Only about 15% of individuals with gingivitis progress to periodontitis.
Healing in Periodontitis
- Requires elimination of risk factors (plaque retentive factors, smoking, alcohol, systemic diseases).
- Maintain good oral hygiene (brushing, flossing, mouthwash).
- Professional mechanical plaque removal (PMPR) with supra and subgingival scaling.
- Antimicrobials are adjunctive to plaque control and mechanical biofilm disruption.
- Periodontal surgeries and bone grafts may be necessary to address bone resorption and attachment loss.
- Earlier identification of "at-risk" genotypes will likely alter prevalence and treatment in the future.
Cells that Proliferate on the Exposed Root Surface Determine Attachment
- Presence of bacteria that stimulate wound healing.
- Moist environment and growth factors in saliva (e.g., EGF).
- Rapid but transient inflammatory response.
- Remodelling of wound matrix is rapid, with near-normal tissue architecture by 60 days.
Patient Factors Influencing Healing
- Tissue site.
- Patient age.
Healthy Gum
- No or minimal (less than 15%) bleeding on probing.
- No attachment loss.
- No bone loss.
- No calculus.
- No plaque retentive factors.
Gingivitis
- Bleeding on probing.
- Signs of inflammation and swelling (redness).
- Calculus may be present.
- Plaque retentive factors may be present.
- No loss of attachment.
- No bone loss.
Periodontitis
- Bleeding on probing.
- Signs of inflammation and swelling (redness).
- Supra and subgingival calculus may be present.
- Plaque retentive factors may be present.
- Attachment loss (apical migration of junctional epithelium).
- Bone loss.
- Furcation involvement may be present.
- Pocket formation.
Periapical Disease
- Bacteria (caries).
- Restorative procedures.
- May also follow endodontic treatment:
- Instrumentation beyond the apex.
- Medicaments through the apex.
- Diffusion of:
- Products of autolysis of pulp and inflammatory cells.
- Bacteria, bacterial metabolites, and products of bacterial death.
- From pulp into periapical tissues.
- Damages cells in cementum, periodontal ligament, and bone.
- Provokes an inflammatory reaction.
Initial Acute Inflammatory Reaction
- Usually mild, with vascular dilation, edema, and neutrophil exudation.
- Clinically, the tooth may be extruded from the socket with mild pain on biting.
- Tooth may be tender to percussion (TTP).
Progressive Periapical Disease
- Continued diffusion of damaging material from the apical foramen leads to lesion progression.
- Rate and form of the lesion depend on:
- Nature and severity of damaging agents.
- Resistance of the host.
Dynamic Tissue Reaction
- Ranges from acute to chronic.
- Produces a range of conditions:
- Acute periapical periodontitis.
- Periapical granuloma.
- Periapical cyst.
- Acute periapical abscess.
Pulp Therapy and Wound Healing
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Methods of pulp therapy:
- Stepwise Excavation/Indirect Pulp Capping.
- Direct Pulp Capping.
- Superficial/Cervical Pulpotomy
- Pulpectomy
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Pulp and periapical tissues have limited regeneration potential.
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Healing involves recruitment of progenitor/stem cells to transform into specific cell types for pulp tissue restoration.
Stepwise Excavation/Indirect Pulp Capping
- Pulps under deep caries are inflamed due to microbes and their byproducts.
- When inflammation is reversible, it can be controlled by removing the cause and restoring the tooth to prevent leakage.
- Leaving a small amount of partly demineralized dentin may be necessary to maintain pulp vitality.
Direct Pulp Capping
- Indicated in pinpoint pulp exposure with minimal bleeding and sound dentin surrounding the exposure.
- Aims to control reversible inflammation by removing microorganisms and restoring the tooth to prevent contamination.
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Description
This quiz explores the processes involved in wound healing, including cell proliferation, tissue restoration, and the distinctions between regeneration and repair. It emphasizes the role of different cell types and the extracellular matrix in the healing process, particularly in oral mucosal wounds.
