Periondontal regeneration – the Holy Grail: part one
Periodontal disease results in the breakdown of the supportive apparatus around the tooth. The resultant pockets harbour pathogens allowing continuing breakdown.
As those of you who regularly read my articles will know, I am a great advocate of the benefits of non-surgical therapy. It produces great results in an extremely cost-effective way that, with ongoing supportive care, will remain stable for many years, if not a lifetime, allowing patients to retain their teeth.
What are the limitations, though? One of the main ones is that the healing involves the development of a long junctional epithelium. This is relatively weak and can rapidly unzip should there be renewal of the disease process.
It may also be damaged by the injudicious use of instruments and iatrogenic damage. Additionally, it can result in the unpredictable recession of the gingival architecture caused by a lack of underlying supportive bone. A real problem if in the aesthetic zone.
Periodontal regeneration involves the restoration of cementum, periodontal ligament and bone. It allows creation of the ideal periodontal architecture that can provide the following benefits:
• A periodontal apparatus that is less likely to break down than an area that has healed by development of the long junctional epithelium
• The provision of added support for a tooth that may be involved in the support of dental restorative work
• The maintenance of gingival architecture that may prove critical in the aesthetic zone. It is surprising how often a tooth can be saved but the resultant appearance is seen as a failed treatment by the patient
• Regeneration may allow for easier maintenance procedures. By reducing the pocket depth and getting bony infill in areas such as furcations it may allow for a more manageable maintenance protocol. Life may be made easier for the patient at home resulting in improved compliance.
Striving for predictability
Over the last few years a number of different techniques have been developed to capture the Holy Grail of periodontal regeneration. Before considering these in more detail, I feel it must be said that I believe that regeneration can be achieved non-surgically – albeit somewhat unpredictably.
I have often seen infill of vertical defects with radio-opaque material following the non-surgical phase. The exact nature of the infill material cannot be verified without block section and histological analysis, but I am convinced that there is some form of regeneration going on. This is unpredictable and so in further articles I will consider ways that predictability may be achieved.