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Clinical guide to periodontology: Reconstructive periodontal treatment
I N B R I E F
Informs surgical techniques for the regeneration of the periodontal ligament include the use of membranes and grafts, and the application of biological agents and growth factors.
Highlights surgical treatment of gingival recession can be achieved by coverage of exposed root surfaces with soft tissue and by the creation of new keratinised and attached gingiva.
PRACTICE
P. D. Floyd,1 M. Ide2 and R. M. Palmer*3
Regeneration of the lost tissues of the periodontium is an ideal therapeutic goal and has been the subject of much research and ingenious clinical techniques. Reconstructive or regenerative techniques are used either singly or in combination for threemain purposes: (1) to regain lost periodontal ligament attachment, (2) to provide a wider zone of attached gingiva, and (3) to cover previously exposed root surfaces.
REGENERATION OF THE PERIODONTAL LIGAMENT
Regeneration involves re-formation of cementum, bone and periodontal ligament, attached to the mineralised tissues by Sharpeys bres. A simple way to appreciate the events involved would be to consider the healing of an infrabony pocket treated by replaced ap surgery and to consider how this may be modied (Fig.1). Preservation of soft tissue aps that are closely approximated to the tooth surfaces should give maximum protection to the underlying clot and connective tissues.
The clot acts as a glue between the ap, tooth surface and underlying tissues and acts as a scaffold for the healing process. The clot is rapidly organised by capillaries and broblasts, which proliferate from the adjacent tissues, gingival connective tissue, bone and periodontal ligament. The gingival epithelium rapidly divides and migrates on the connective tissue aspect of the ap to
eventually contact the tooth surface and form a junctional epithelium. This rapid epithelial migration has been held responsible for the prevention of a connective tissue attachment following routine surgical procedures. Is it worth recalling here that the post-disease compromised state of the root surface may also have an impact on healing.
Cell division, migration, differentiation, adhesion, matrix deposition, organisation and compartmentalisation in this process are extremely complex. These factors are only simplistically addressed in current therapeutic procedures. Initially, the alveolar bone that has been exposed during surgery undergoes resorption, which is more pronounced following prolonged...