Periodontal Therapy and Tissue Regeneration

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Questions and Answers

What is the ultimate goal of periodontal therapy?

To achieve complete restitution of the destroyed supporting apparatus (correct)

Only to arrest the progression of periodontal disease

To induce chronic inflammatory conditions

To remove bacterial plaque and prevent its formation

What is the term for the continuous process of replacing mature and dead cells with new cells and tissues in the periodontium?

Guided tissue regeneration

Wear and tear repair (correct)

Wound healing

Healing by scar

What hinders the healing process in chronic inflammatory periodontal diseases?

Bacterial products and bacteria (correct)

Removal of bacterial plaque

Mobilization of epithelial and connective tissue cells

Embedding of new PDL fibers into new cementum

What is the result of repair in the periodontium?

Restoration of the continuity of the diseased marginal gingiva Signup and view all the answers

What is the term for the process of embedding new PDL fibers into new cementum and attachment of epithelium to a previously denuded tooth surface?

New attachment Signup and view all the answers

What type of cells develop into fibroblasts, osteoblasts, and cementoblasts in the periodontium?

Undifferentiated connective tissue cells Signup and view all the answers

What is the role of periodontal treatment in the healing process?

To remove bacterial plaque and prevent its formation Signup and view all the answers

What is the term for the growth and differentiation of new cells and intercellular substances to form new tissues in the periodontium?

Regeneration Signup and view all the answers

What is the term used to describe the reunion of the connective tissues with a root surface on which viable periodontal ligament tissue is present?

Reattachment Signup and view all the answers

What is the significance of the term 'new attachment' in periodontal therapy?

It describes the formation of new fibers that attach to new cementum Signup and view all the answers

What is the outcome of therapy if the oral epithelium proliferates along the tooth surface before the other tissues reach the area?

Long junctional epithelium Signup and view all the answers

What is the role of the periodontal ligament in the healing of a periodontal pocket?

It synthesizes and remodels the 3 connective tissues of the alveolar part of the periodontium Signup and view all the answers

What is the possible outcome of therapy if the bone cells arrive first during the healing of a periodontal pocket?

Root resorption and ankylosis Signup and view all the answers

What is the significance of epithelial adaptation in periodontal therapy?

It is a close apposition of the gingival epithelium to the tooth surface without complete obliteration of the pocket Signup and view all the answers

What is the basis for new attachment in periodontal therapy?

Regeneration of PDL Signup and view all the answers

What is the possible outcome of therapy if the gingival connective tissue cells are the first to populate the area during the healing of a periodontal pocket?

Fibers parallel to the tooth surface and remodeling of the alveolar bone Signup and view all the answers

Study Notes

Guided Tissue Regeneration (GTR)

The ultimate goal of periodontal therapy is to not only stop the progression of periodontal disease but also to restore the damaged supporting apparatus.

Periodontal Healing

Regeneration: the growth and differentiation of new cells and intercellular substances to form new tissues, occurring by growth from the same type of tissue that has been destroyed or from its precursor.
Regeneration in the periodontium:
- Gingival epithelium is replaced by epithelium.
- Connective tissue, PDL, bone, and cementum are derived from undifferentiated connective tissue cells that develop into fibroblasts, osteoblasts, and cementoblasts.

Regeneration under Normal Conditions

Regeneration of the periodontium is a continuous physiologic process, where new cells and tissues continuously replace mature and dead cells, termed "wear and tear repair".

Regeneration during Destructive Periodontal Disease

Most gingival and periodontal diseases are chronic inflammatory conditions, and regeneration is part of the healing process.
Bacteria and bacterial products can prevent healing from proceeding to completion, but removing bacterial plaque and preventing its reformation allows the inherent regenerative capacity of tissues to establish.

Repair and New Attachment

Repair: restoration of the continuity of the diseased marginal gingiva and re-establishment of a normal gingival sulcus at the same level as the base of a preexisting pocket, involving mobilization of epithelial and connective tissue cells with increased mitotic division.
New attachment: the embedding of new PDL fibers into new cementum and attachment of epithelium to a tooth surface previously denuded by disease.

Reattachment and Epithelial Adaptation

Reattachment: the reunion of the connective tissues with a root surface on which viable periodontal ligament tissue is present, used to describe the healing of areas of the root not previously exposed to pockets.
Epithelial adaptation: close apposition of the gingival epithelium to the tooth surface without complete obliteration of the pocket, which may be as resistant to disease as true connective tissue attachments.

Regeneration of PDL and New Attachment

Regeneration of PDL is the basis for new attachment because PDL provides continuity between the alveolar bone and cementum, and contains cells that can synthesize and remodel the 3 connective tissues of the alveolar part of the periodontium.

Possible Outcomes of Therapy

During healing stages of a periodontal pocket, the area is invaded by cells from 4 different sources, modifying the final outcome of pocket healing:
- Oral epithelium: results in a long junctional epithelium.
- Gingival connective tissue: results in fibers parallel to the tooth surface and remodeling of the alveolar bone, with no attachment to the cementum (recurrence of pocket).
- Bone: may result in root resorption and ankylosis.
- Periodontal ligament: results in new formation of cementum and PDL (new attachment).

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Description

Understand the goals of periodontal therapy, including the arrest of disease progression and restitution of destroyed tissues. Learn about aspects of periodontal healing, including regeneration and repair.