perio surgery Flashcards
(8 cards)
defn of perio regeneration
is the reproduction or reconstruction of a lost or injured part in a way that the architecture and function of the lost tissues are completely restored (Glossary of perio terms 1992)
histologically we will obsreve the formation/ restoration of PDL, alveolar bone and cementum
unlike repair, where the lost perio tissue is replaced by long JE or CT adhesion which is different from original architecture
indications and contraindications of GTR
indications
- deep PPD
- narrow 2/3 walled infrabony defects
- furcation grade II
contras
- very severe defects
- horizontal defects
objectivs of GTR
1) increase perio attachment
2) decrease deep pockets to facilitate maintenance by patient and clinician
3) reduce vertical and horizontal component of furcation defects
indications and contra for gingivectomy
indications
- suprabony pockets
- if we wanna recontour gingiva
contraindications
- infra bony pockets (since base of pocket is lower than bone, no point removing the gum)
- lack of attached gingiva
- aesthetic regions (bc gingivect will cause look of longer teeth)
what is the rationale of GTR
- place a biocompatible physical barrier between root surface and flap, to create periodontal space
- guides the coronal migration of progenitor cells from PDL onto curretted root sufaces
- prevents formation of LJE as lje prevents formation of new CT attachments
- manipulates repopulation of the wound such that pluripotent progeniot cells from PDL proliferates and migrates into healing area: differentiate into fibroblasts, cementoblasts, osteoblasts which can form new PDL, cementum and bone
2 types of membrane used for GTR
1) NON RESORBABLE ePTFE
- requires removal 4-6 weeks after placement
2) RESORBABLE (polyactic acid/collagen)
- biodegradable over 1-2 months
which scenarios give the most predictable outcomes of success for GTR
- class II furcations
- 2/3 wall osseous defects
- complete bone fill for class III furcation is unpredictable, rare
