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| 2010-22 |
| 22-1 |
ISSN (Print) 1013-9052
EISSN 1658-3558
The Saudi Dental Journal,
P.O. Box 52500,
Riyadh 11563,
Kingdom of Saudi Arabia
P.O. Box 52500,
Riyadh 11563,
Kingdom of Saudi Arabia
| Tel. |
966-1-467-7328 |
| Fax. |
933-1-467-7308 / 966-1-467-7534 |
| Email |
saudidj@ksu.edu.sa |
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Editorial
Periodontal Surgery - Changing trends
and future perspectives
Periodontal disease is characterized by destruction of
connective tissue, apical proliferation of the epithelium, and loss of
supporting alveolar bone attachment level.
The ultimate goal of periodontal therapy is not only to arrest the progress of the periodontal disease but also to create an environment for the body so as restitution, in areas where the supporting tissues have been destroyed by periodontal disease, will take place. The former part of the goal is possible to attain, either with or without periodontal surgery, as long as maintenance care on individualized regular intervals is performed. Serious efforts to obtain "new attachment" or "baneful of infrabony pockets" were performed during the 1950's when Waerhaug, Carranza and Shaffer and Zander presented successful "reattachment". These attempts were followed by Bjorn et al,1 who covered affected roots with a mucoperiosteal flap and isolated the affected roots from "bacterial contamination and epithelial down growth". The results did not only show new attachment but also ankylosis and root resorption. In the 1970's citric acid was used to obtain a compatible root surface for colonization of collagen fibers and gain of attachment level but this gain was small and did not significantly differ from that obtained by regular periodontal surgery without using citric acid. Other approaches tested were various grafting procedures. The reported results were inconsistent. A significant advance in creating new attachment was achieved when Nyman et al2 published results of successful new attachment. The attachment was observed 3 months postsurgicaily after covering a human lower lateral incisor root with a membrane -a millipore filter surrounding the root like a skirt. Coronal proliferation of the periodontal membrane with collagen fibers inserted in newly formed root cementum was histologically verified. This procedure guided tissue regeneration was performed by raising a mucoperiosteal flap and covering the affected area with a teflon membrane. The teflon inhibited gingival fibroblast from colonizing the affected root surfaces and permitted the periodontal membrane and new cementum to grow coronally. The Gothenburg-group has also reported totally new attachments in 90% of furcation-involved first molars (degree II) covered with membranes (expanded teflon - Goretex-filter) compared to 20% in the homologous control molars.3Reports from USA using similar non-resorbable or resorbable membranes showed less success of attachment level gain. The above reports demonstrate that it is possible today to obtain new attachment - a regeneration of new connective tissue on an area of the root surface which has earlier been exposed to the oral cavity, formation of new cementum with inserted collagen fibers - in an area where the root has been deprived of its connective tissue attachment. Further studies are needed to evaluate success rate and predictability. Parallel to these studies, others have been performed. Blomlof et al4 reported regeneration of infrabony defects in monkeys after a main flap procedure and cleaning the root cementum with a detergent and maintaining the root cementum. The future might reveal other procedures. The guided tissue regeneration procedure has been shown to be promising not only in periodontally affected dentitions but also in augmentation procedures. The procedure is used when, for example, bone coverage of partially denuded sections of titanium implants is necessary, where restitution of bone defects after cyst removal is needed, and where shrinkage of the alveolar crest after extraction is to be avoided. The future might give periodontists or oral surgeons tools which help the body regenerate bone in severely damaged dentitions by treating affected root surfaces with substances like fibronectine combined with transforming growth factor (TGF), epidermal growth factor (EGF), or some other ingredients. What was impossible yesterday is a reality today. Axel Bergenholtz, DDS, Dr Odont Member, Editorial Board References
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