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Periodontal Surgery

Where Art Meets Science

By Dr. D. Walter Cohen


Innovations in regeneration

The last two decades have seen an explosion of knowledge and new techniques to regenerate periodontal tissues. Up until the 1980's most surgery was “resective” in nature — removing diseased tissue. From the 1960s to the 1980s soft tissue gingival (gum) grafting techniques to increase gum tissue were predictably successful. Regeneration techniques were already understood from wound healing studies and knowledge of the cell types that “coded” for new gingival, gum tissue. However techniques were less predictable when attempting to regenerate lost alveolar (tooth supporting bone) and the adjacent periodontal ligament.

Regenerating Periodontal Tissues

The periodontal ligament is a thin, fibrous ligament that connects the tooth root to the bony socket. Normally, teeth do not contact the bone directly; a tooth is suspended in its bony socket by the periodontal ligament which is attached to the tooth root via cementum.

Without new periodontal ligament formation, new attachment and bone regeneration is impossible. In the past, the difficulty had been stopping gum tissue cells growing down the freshly cleaned roots before the new periodontal ligament cells had a chance to grow and reattach to the root surface cementum. Stopping the gum tissue cells from advancing was the race that science needed to win in order to regenerate new periodontal attachment.

Guided Tissue Regeneration

Periodontal tissue regeneration was ingeniously solved with the advent of sub-gingival (sub-under, gingival-gum) “barrier membranes,” sort of minute subterranean band-aids. These barriers stop the growth of gum tissue cells and allows regeneration of new periodontal ligament by guiding cell growth. This technique is known as “Guided Tissue Regeneration.” Membrane technology has now advanced to the point where membranes will last exactly the appropriate amount of time needed for healing and then dissolve so that they don't have to be removed.

Growth Factors — Magic Molecules

Most recently, basic science has further demystified wound healing with an understanding of growth factors. The process of inflammation, the body's response to injury and infection causes the attraction of particular cells and liberation of their components, so-called growth factors — “magic molecules” which initiate and promote wound healing. The ability to isolate these substances, determine their roles and then to be able to manufacture them has allowed periodontal and other surgical specialists to use growth factors to regenerate tissues, making results more predictable and healing uneventful.


Today's highly sophisticated and meticulous surgical techniques allow the periodontal surgeon to regenerate and reconstruct lost and missing tissues. Modern procedures are kinder to the patients; are carried out with local anesthesia (numbing the area/s) in combination with either oral (anti-anxiety) sedation or intravenous conscious sedation (twilight sleep). There are minimal post surgical issues, minimal discomfort and little bleeding, either during or after surgery. Periodontal surgery includes elements of art, experience and a great deal of scientific knowledge of techniques and wound healing to prolong the life of your teeth with greater predictability than ever before.

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