Viva voce in periodontal regeneration
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This document discusses periodontal regeneration and the various considerations and techniques involved. It covers soft skills like terminology and concepts as well as hard skills like surgical procedures. Key aspects that are addressed include different types of regenerative grafts and biomaterials like autografts, allografts, xenografts and growth factors. The document also compares guided bone regeneration techniques using membranes versus more natural regeneration approaches. Selection of the appropriate regenerative materials and surgical protocols are emphasized for achieving optimal periodontal regeneration outcomes.
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Viva voce in periodontal regeneration
- 6. PERIODONTAL REPAIR* PERIODONTAL REGENERATION** True or False† PERIODONTAL BIOENGINEERING REGENERATIVE PERIODONTAL BIOENGINEERING~ *Ellegaard, 1973 **AAP, 2005 †Hammarström, 1998 ~Lu, 2013
- 7. Polson AJ. Periodontal Regeneration: Current Status and Directions Quintessence Publishing Co Inc., U.S. (1 June 1994)
- 8. Carter DR, Beaupre GS, Giori NJ, Helms JA. Mechanobiology of skeletal regeneration. Clin Orthop Relat Res. 1998; 355: S41–55.
- 9. Calori GM, Giannoudis PV. Bone Healing by the ‘Diamond Concept’. Injury 2011 Nov;42(11):1191-3. doi: 10.1016/j.injury.2011.04.016.
- 10. At 1-year post-extraction, the strain magnitudes had increased significantly around furcations…
- 11. *Darby, 2011 & Buser, 2013 *
- 12. I Generation* • Material should match Bone • Immunological inertness II Generation • Bioactive or biodegradable coatings • Replamineform grafts** III Generation • Progenitor cells and growth factors • Repair and Regeneration *Hench, 2002; **Berman, 1986 Grafts Biomaterial Biologics
- 13. Sculean (2015) has classified regenerative materials used in periodontics into 1) Grafts: 1.Autogenous 2.Allogeneic 3.Xenografts and 4. Osteoblastic cell constructs 2) Biomaterials: 1) Bone derivatives a) Allogenic- DFDBA/FDBA b) Xenogeneic- Biocoral, Bio-Oss 2) Bone substitutes/Synthetic bone a) Ceramics- HA, TCP, CaSO4, Ca3 (PO4)2, Bioactive glasses b) Polymers- HTR, PLA, PGA 3) Biologics: 1) Growth factors: PDGF, TGF, IGF, VEGF 2) Differentiation factors: BMPs 3) Matrix factors: Fibronectin 4) Peptides: GEM-21S 5) Small molecules: Prostaglandin antagonists 6) PRP 4) Combinational
- 14. GUIDED VS “NATURAL” REGENERATION * Leukocyte-Platelet Rich Fibrin The key principle of NBR is to protect the bone regenerative compartment with L-PRF membranes only, and to avoid the use of GBR membranes. * Del Corso, 2012
- 15. BONE FILL BONE REGENERATION GRAFT CONSOLIDITION* *Chick, 2013 The presence of contiguous trabeculae between graft and bone.
- 16. Patient Factors Defect Morphology Graft Material* Surgery* Healing Hard Skills PERIODONTAL REGENERATION * Dumitrescu, 2011
- 17. Source of Graft Type of Graft Characteristics Barrier? Post-op sequelae? SELECTION OF REGENERATIVE MATERIAL* * Dumitrescu, 2011; Horowitz, 2014
- 18. SURGICAL PROTOCOL Wang HL, Boyapati L. "PASS" principles for predictable bone regeneration. Implant Dent. 2006;15:8–17 Approach SFE Conventional MIST Technique Periosteal flaps Passive closure Barrier GTR/GBR NTE/NBR Uneventful events
Editor's Notes
- Repair: Healing without restoration of the tooth apparatus Regeneration: ” to restore the structure and function of the periodontium This Definition of periodontal regeneration ” … to restore the structure and function of the periodontium. This means structure and function of the gingiva, alveolar bone, root cementum and periodontal ligament must be restored.” Bosshardt and Suclean 2009 Chen et al 2010. True and False perio regeneration: Thus, if the ambition is to regenerate the periodontal ligament and the alveolar bone that have been lost due to periodontitis, it should aim at reestablishing a new cementum and neighboring cells”. Lars Hammarström. Bioengineering: The use of artificial tissues, organs, or organ components to replace damaged or absent parts of the body. Stress is placed on the use of grafts/scaffolds. Regenerative Medicine is the promise of regenerating damaged tissues and organs in the body by replacing damaged tissue and/or by stimulating the body's own repair mechanisms to heal previously irreparable tissues or organs.
- Bioanatomical factors: Root surface, vascularity, fiber orientation and defect anatomy Biochemical factors: Z potential of the bone, survivability of the graft. Use of the regenerative material.
- Hench. As pointed by Navarro et al.these generations are not chronological but technological, since there is currently active research and development for each. Grafting refers to a surgical procedure to move tissue from one site to another on the body, or from another person, or another material without bringing its own blood supply with it. A biomaterial is a biological or synthetic substance which can be introduced into body tissue as part of an implanted medical device or used to replace an organ or bodily function e.g.: Bone grafts and scaffolds. Biologics is when a preparation that is synthesized from living organisms or their products and used as a diagnostic, preventive, or therapeutic agent. e.g.: growth factors (Kim, 2014).
- Plaque control, habits, residual infection and systemic factors are important patient related factors. Defect morphology: contained defect 3-8mm, angle between 25-37 degrees two or three walls. Larger grafts, less autogenous bone in the graft and fewer bony walls increase the amount of healing time
- When bony reconstruction is presented to the surgeon, many choices must be weighed before the proper graft material is chosen (Kuo et al. 2007). Selection of graft material is guided by: 1. Biologic acceptability 2. Predictability 3. Resorbability 4. Clinical feasibility 5. Minimal operative hazards 6. Minimal postoperative sequelae 7. Patient acceptance (AlGhamdi et al. 2010a and references therein) A range of 125–1,000 mm is acceptable with 250–750 mm most commonly available for particle size of grafts used in periodontal treatment. A minimal pore size of 100 mm is needed between particles to allow vascularization and bone formation. Particles less than 100 mm in size elicit a macrophage response and are rapidly resorbed with little or no new bone formation (Zaner and Yukna 1984; AlGhamdi et al. 2010a).