periodontal disease- healing

Question 1

what is the result of periodontal therapy/healing?

Answer 1

• reduced ppd’s due to resolved inflammation and gingival shrinkage (due to tightening of gingival cuff by newly formed collagen fibres)
• formation of new LJE

Question 2

why should you not probe pockets before 10-12 weeks?

Answer 2

• granulation tissue forms during healing which is fragile and can be penetrated by probe- impairs healing

Question 3

what should be checked and assessed after 10-12 weeks?

Answer 3

• patients OH and cooperation
• periodontal tissues to assess LOA, PPD, BOP, Mobility and furcation
• more accurate readings due to resolved inflammation

Question 4

what are the stages of wound healing following RSD?

Answer 4

• haemostasis
• acute inflammation
• proliferation
• remodelling

Question 5

what happens during haemostasis?

Answer 5

blood clot formation of closed wound almost immediately

Question 6

what happens during acute inflammation?

Answer 6

5 cardinal signs
- vasodilation and increased vascular permeability
- increase inf GCF, increase in neutrophils and macrophages
- increased exudate (fluid and immune cells) at site- swelling
- increased blood flow- heat and redness
- subsides within 24-48 hrs

Question 7

what is seen immunologically following acute inflammation from healing?

Answer 7

• reduced symptoms - redness/swelling/pain
• reduced vasodilation
• reduced no of neutrophils
• resolved ulceration of pockets
• reduced GCF
• increase fibroblasts and collagen laid down

Question 8

why do we want pockets of <4mm following RSD?

Answer 8

• can be adequately kept clean with good OH at home
• cleansable pockets

Question 9

what will be seen following successful RSD?

Answer 9

• resolved inflammation and therefore reduced ppd’s of <4mm and no BOP at 4mm pockets (cleansable pockets)
• gingival shrinkage
• healthy gingivae- pink and firm
• good OH
• < 10% BOP
• increased tissue resistance
• formation of LJE
• comfortable patient

Question 10

define new attachment

Answer 10

• union of CT with previously pathogenically altered root surface

Question 11

what happens during proliferation stage?

Answer 11

made up of granulation tissue formation and angiogenesis

• epithelial cells proliferate rapidly filling space where blood clot forms to form new epithelial attachment as long junctional epithelium
• fibroblasts proliferate and lay down collagen forming ECM and providing elasticity to the tissue

Question 12

what is the LJE?

Answer 12

• forms rapidly and zips up pocket in an apical direction forming a new attachment which is fragile and weak from base of pocket to crown

Question 13

how does LJE attach to root surface?

Answer 13

via hemidesmosomes

Question 14

what proteins regulate healing?

Answer 14

cytokines- attract cells such as fibroblasts and neutrophils

Question 15

what are examples of cytokines?

Answer 15

interleukin 1
TNF