Podcast
Questions and Answers
The prognosis of furcation-involved teeth can be improved by traditional surgical therapy.
The prognosis of furcation-involved teeth can be improved by traditional surgical therapy.
False
Regenerative periodontal therapy can be successfully used to treat 'hopeless' teeth with deep vertical defects.
Regenerative periodontal therapy can be successfully used to treat 'hopeless' teeth with deep vertical defects.
True
The stability of new attachment gained through guided tissue regeneration (GTR) procedures cannot be maintained long term.
The stability of new attachment gained through guided tissue regeneration (GTR) procedures cannot be maintained long term.
False
Poor oral hygiene is a factor that can lead to attachment loss.
Poor oral hygiene is a factor that can lead to attachment loss.
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The long-term effects of periodontal regeneration are still unknown.
The long-term effects of periodontal regeneration are still unknown.
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Cigarette smoking is not a risk factor for attachment loss.
Cigarette smoking is not a risk factor for attachment loss.
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Regenerative periodontal therapy can only be used for teeth with minimal damage.
Regenerative periodontal therapy can only be used for teeth with minimal damage.
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The prognosis of a tooth can be changed from 'questionable' to 'favorable' with regenerative periodontal therapy.
The prognosis of a tooth can be changed from 'questionable' to 'favorable' with regenerative periodontal therapy.
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A one-wall defect is a type of bone defect that occurs in the interproximal space.
A one-wall defect is a type of bone defect that occurs in the interproximal space.
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Radiographs are the primary method of diagnosing periodontal bone defects.
Radiographs are the primary method of diagnosing periodontal bone defects.
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Furcation involvement is a type of periodontal bone defect.
Furcation involvement is a type of periodontal bone defect.
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A good knowledge of anatomy is not necessary for diagnosing periodontal bone defects.
A good knowledge of anatomy is not necessary for diagnosing periodontal bone defects.
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Radiographs can provide information about the morphology of interradicular bone resorption.
Radiographs can provide information about the morphology of interradicular bone resorption.
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Periodontal treatment always results in recession of the gingival margin after healing.
Periodontal treatment always results in recession of the gingival margin after healing.
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Regenerative surgical procedures are used to eradicate bone defects.
Regenerative surgical procedures are used to eradicate bone defects.
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The indication for applying regenerative periodontal therapy is solely based on esthetic considerations.
The indication for applying regenerative periodontal therapy is solely based on esthetic considerations.
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Periodontal ligament cells can differentiate to osteoblasts to form new bone and to cementoblasts to form new cementum during the healing process after periodontal surgery.
Periodontal ligament cells can differentiate to osteoblasts to form new bone and to cementoblasts to form new cementum during the healing process after periodontal surgery.
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Guided tissue regeneration involves the placement of a physical barrier to prevent the migration of periodontal ligament cells.
Guided tissue regeneration involves the placement of a physical barrier to prevent the migration of periodontal ligament cells.
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Non-resorbable membranes are no longer used in periodontal therapy.
Non-resorbable membranes are no longer used in periodontal therapy.
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Polytetrafluoroethylene (PTFE) membranes are effective in maxillary molar furcation problems.
Polytetrafluoroethylene (PTFE) membranes are effective in maxillary molar furcation problems.
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Resorbable membranes are made of collagen, polylactic acid, or polyglycolic acid.
Resorbable membranes are made of collagen, polylactic acid, or polyglycolic acid.
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Titanium-supported non-resorbable membranes are preferred for small intrabony defects.
Titanium-supported non-resorbable membranes are preferred for small intrabony defects.
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Collagen for bioabsorbable membranes is obtained from human sources.
Collagen for bioabsorbable membranes is obtained from human sources.
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A second surgical intervention is not necessary when using resorbable membranes.
A second surgical intervention is not necessary when using resorbable membranes.
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Grafting materials in periodontal bony defects can be classified according to their function in healing into only two categories.
Grafting materials in periodontal bony defects can be classified according to their function in healing into only two categories.
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Osteoconductive grafting materials contribute to new bone formation per se.
Osteoconductive grafting materials contribute to new bone formation per se.
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Scaling of teeth before surgery is not necessary in all grafting procedures.
Scaling of teeth before surgery is not necessary in all grafting procedures.
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The papilla preservation method is not recommended for flap technique in periodontal surgery.
The papilla preservation method is not recommended for flap technique in periodontal surgery.
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Autogenous grafts are not considered to be the gold standard in periodontal treatment.
Autogenous grafts are not considered to be the gold standard in periodontal treatment.
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Autogenous grafts can only be harvested from intraoral sites.
Autogenous grafts can only be harvested from intraoral sites.
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Block grafts are preferred over small bony chips in periodontal surgery.
Block grafts are preferred over small bony chips in periodontal surgery.
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The use of hip marrow (iliac crest marrow) is a commonly preferred approach in periodontal regenerative surgery.
The use of hip marrow (iliac crest marrow) is a commonly preferred approach in periodontal regenerative surgery.
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Barrier membranes must be trimmed after placement.
Barrier membranes must be trimmed after placement.
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Periodontal regeneration can only be used to treat class II furcation defects.
Periodontal regeneration can only be used to treat class II furcation defects.
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Root surface biomodification alone can provide more favorable treatment results than GTR alone.
Root surface biomodification alone can provide more favorable treatment results than GTR alone.
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Good oral hygiene and infection control are not necessary for long-term maintenance of periodontal regeneration.
Good oral hygiene and infection control are not necessary for long-term maintenance of periodontal regeneration.
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Barrier membranes should allow the passage of undesirable cell types into the healing area.
Barrier membranes should allow the passage of undesirable cell types into the healing area.
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Second surgery is always necessary after the initial treatment.
Second surgery is always necessary after the initial treatment.
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Treatment with flap surgery alone can provide better treatment results than treatment with flap surgery + barrier membranes + graft materials.
Treatment with flap surgery alone can provide better treatment results than treatment with flap surgery + barrier membranes + graft materials.
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Periodontal regeneration has not demonstrated significant clinical improvements in intrabony defects and furcation problems.
Periodontal regeneration has not demonstrated significant clinical improvements in intrabony defects and furcation problems.
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Study Notes
Periodontal Bone Defects
- Occur between two adjacent roots, typically in narrow interproximal spaces
- Classified as one-wall, two-wall, or three-wall defects, or interproximal craters
- Identification mainly based on morphology after raising a periodontal flap, rather than radiographic evaluation
Diagnosis and Radiographs
- Radiographs taken with parallel technique and good diagnostic quality help with diagnosis
- Information about attachment levels is crucial for proper diagnosis
- Radiographs of good diagnostic quality provide information about interradicular bone resorption
Clinical Indications of Regenerative Periodontal Therapy
- Prevent poor esthetics in anterior areas of the dentition
- Improve function or long-term prognosis of treated teeth
- Indicated for furcation-involved teeth, especially when the furcation area is inaccessible to adequate instrumentation
Regenerative Periodontal Therapy
- Can restore lost periodontal attachment in bone defects
- Can improve long-term prognosis of furcation-involved teeth
- Can be successful in treating "hopeless" teeth with deep vertical defects or through-and-through furcations
Long-term Effects and Benefits of Regeneration
- Clinical research indicates that attachment level gains can be maintained on a long-term basis
- Stability of new attachment gained through guided tissue regeneration (GTR) procedures can be maintained
- Risk factors for attachment loss include poor compliance with supportive periodontal care, poor oral hygiene, and cigarette smoking
Grafting Materials
- Classified into osteoproliferative, osteoconductive, and osteoinductive materials
- Autogenous grafts are considered the gold standard in periodontal treatment, promoting bone healing through osteogenesis and/or osteoconduction
Autogenous Grafts
- Can be harvested from intraoral and extraoral sites
- Common sources include edentulous areas of the jaw, healing extraction sites, maxillary tuberosities, or the mandibular retromolar area
Guided Tissue Regeneration (GTR)
- Involves the placement of a physical barrier to ensure that the periodontitis-affected root surface becomes repopulated by cells from the periodontal ligament
- Typically performed in combination with bone grafting materials
- Membranes used can be resorbable or non-resorbable, with titanium-supported non-resorbable membranes preferred for large intrabony defects or implants
Barrier Membranes
- Must meet certain criteria, including biocompatibility, ability to act as a barrier, and ease of trimming and placement
- Resorbable membranes are made of collagen, polylactic acid, or polyglycolic acid, and are preferred to avoid the need for a second surgical intervention
Clinical Outcomes
- Periodontal regeneration has demonstrated significant clinical improvements in intrabony defects and furcation problems
- Treatment with flap surgery, barrier membranes, and graft materials provides better treatment results than flap surgery alone
- Combined use of root surface biomodification and GTR provides more favorable treatment results
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Description
Identify and classify periodontitis bone defects, including one-wall, two-wall, and three-wall defects, and interproximal craters.
