Periodontal Flap Surgery

How Periodontal Surgery Can Save Your Teeth

(Continued)

Growth Factors — The Magic Molecules

The cells responsible for initiating wound healing are known as stem cells. Stem cells are mobilized from the bloodstream, the periodontal ligament, and the surrounding bone. The stem cells move into surgically created wounds where together with growth factors they grow, proliferate, and differentiate into a new periodontal ligament.

Growth factors are naturally occurring substances capable of stimulating these remarkable activities. In simpler words, they transform and heal into new and specific tissues.

Certain of these growth factors have also been synthesized artificially and are used in periodontal wound healing along with bone grafting techniques to enhance regeneration. Research regarding their use is on-going.

Bone Management And Grafting

Bone, the basic building block that encases the teeth in health, can be managed either by mechanically reshaping it or by grafting techniques, encouraging regeneration where it has been lost. In actuality, it is usually managed by a combination of both techniques:

Mechanical reshaping of the bone, known as osteoplasty (“osteo” – bone; “plasty” – reshaping), is an art form that involves re-sculpting bone that has become altered by the disease process to give it a more normal form. Thus, it allows the bone to heal normally.
Bone grafting, placing bone or bone substitutes into defects created by the disease process, acts like a scaffold upon which the body generates its own, new bone.

Guided Tissue Regeneration

One method of ingeniously solving this problem is with the advent of sub-gingival (“sub” – under; “gingival” – gum) barrier membranes, sort of minute, subterranean band-aids. These effectively stop growth of the gum tissue cells by keeping them out, thus enabling the regeneration of new periodontal ligament by guiding cell growth. The technique is therefore known as guided tissue regeneration. It is accomplished by placing the membranes directly around the teeth at the level of the bone to stop cells from growing where they are not wanted. In essence, they keep the bad guys out and the good guys in. Technology has advanced to the point where the membranes last exactly the appropriate amount of time needed for healing, and then dissolve so that they do not have to be removed.

Regeneration of new periodontal ligament attachment to root surfaces affected by periodontal disease is a challenge. It has always been a race between the cells that give rise to new periodontal attachment which grows upwards from the base of the periodontal surgical site, and new gum tissue cells that grow down the root surface. Based on research, this dilemma can now be solved by actually guiding the cells into the right place.

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Review Date: 11/1/2010
Authored By: Dr. Robert London
Reviewed By: Dr. Garry A. Rayant, Editor-in-Chief, Dear Doctor, Inc.