Periodontal healing

1. Periodontal
Wound
Healing
Dr. Mohammad Eissa Ahmadi
‫ن‬‫ی‬
‫ر‬‫ف‬‫ا‬‫ان‬‫ج‬‫د‬‫ب‬‫و‬‫دا‬‫خ‬‫ام‬‫ن‬‫ب‬
‫ر‬‫ف‬‫ا‬‫ان‬‫ب‬‫رز‬‫ب‬‫ن‬‫خ‬‫س‬‫م‬‫ی‬‫ک‬‫ح‬
‫ن‬‫ی‬
Prof.Dr.Hassina “Shadab” &
Prof.Dr Elaha somaya “Ghafary”
Supervised
by
Of Periodontics
Department

2. References
10 01
09 02
08 03
04
05
06
07
Introduction
Outcome of periodontal
wound healing
Pattern in the
periodontal tissue
Complication
Factor that affect healing
Healing after
periodontal therapy
Healing after
periodontal surgery
Advanced regenerative approach to
periodontal tissue reconstruction
Conclusion
CONTENT
Periodontal wound healing (Perio-W.H)

3. • The response of the body to a
pathologic and/or traumatic
• In periodontology, this process can
result
repair, new attachment, or regeneration.
Introduction to healing

4. Outcome of periodontal wound healing
4
Ustad Ghafary
Tunnel .Tech | Khalid 36year
Repair
Re attachment
New attachment
Regeneration
Resorption
Ankylosis
Loss or blunting of some
portion of a root
Fusion of the tooth and the
alveolar bone
reattachment of
the gingiva
newly generated fibers are
embedded in new cementum

5. Partial thickness healing
 Closed by epithelization
 Lamina propria
 Minimal collagen deposite
23%
Healing by second intention
 Wound fill with granulation tissue
 Fibrosis > regeneration
45%
Healing by first intention
 Suturing
 Regeneration > fibrosis
 Minimal tissue loss
12%
Type of Periodontal wound healing
8%
Healing by third intention
 Great loos of tissue
 Contraction of the wound
 Granulation tissue formation
12%
Pattern in the periodontal tissue

6. Factor that affect healing
Systemic factors
Local factors
Trauma
to
the
tissue
Medications
Oral hygiene instruction
Nutrition
Disease
Venous
sufficiency
hereditary healing disorders
diabetes
Plaque
microorganism
Foreign body
Oxygenation
Vit B –complex
protein
Vit D
glucocortic
oid steroids
Sex
Sex hormones
Stress
Ischemia
Age
chemotherapy
Smoking
Immunoco
mpromised
conditions
Infection

7. Inflammatory phase
Granulation phase
Matrix formation
Remodeling

8. Frameworks 8
“‫ال‬‫ن‬‫ب‬‫ود‬‫ی‬
‫ر‬‫ب‬-‫ای‬‫ه‬‫داوی‬‫ب‬‫داز‬‫ع‬‫ی‬-‫م‬‫ی‬‫م‬‫ر‬‫ب‬”
Soft tissue
Advanced regenerative
approach to periodontal
tissue reconstruction
Hard tissue
Harvesting the graft
Nonsurgical therapy
Surgical therapy
Advanced
regenerative
Phase 1 Gingivect
omy
Periodontal
flap surgery
Apical
positional flap
Osseous
surgery
Soft tissue
grafting
Periodontal tissue regeneration

9. Phase 1
Non surgical therapy
Scaling & SRP
initial pocket
depth reduction
secondary pocket
reduction
(LJE) rather
than new connective
tissue (CT) attachment.
Non surgical
therapy
following SRP
1w
Increased gingival recession
following SRP
3w
Magnusson I, Runstad L, Nyman S, Lindhe J. A long junctional epithelium: A locus minoris resistentiae in plaque infection? J Clin Periodontol 1983;10:333–340

10. GINGIVECTOMY
0.5mm , complete healing of the outer surface
occurred after 2 weeks
migratory velocity of epithelial cells
Required 4 to 5 weeks
The healing of the new gingival sulcus
10
7 to 14 days
After 12 days, new epithelial attachment is regenerated against the
enamel and root cementum
complete epithelialization
following gingivectomy
“Orban “
radioautographic and histologic
investigation
Regeneration of the free gingiva takes 3 to 9 days
Maturation and functional orientation of the CT needs more than 5 weeks

11. HEALING FOLLOWING SURGICAL DEPIGMENTATION
Immediately: clot formation takes place and
acute inflammation of the underlying tissues.
Replacement of clot by GT, Capillaries of the
PDL (Periodontal Ligament) migrate into GT
Within 2 weeks, capillaries connect with gingival
vessels.
As healing takes place, initially vascularity
increases then gradually decreases.
Surface epithelialization is complete by 5 - 14 days.
In 3 - 4 weeks: Complete epithelial repair takes
place.

12. Periodontal flap surgery
Adaptation (4 day) Open flap debridement
Lateral positional flap
Coronally advanced flap
Proliferation(4-21day)
Attachment (21-28day)
Maturation (28day-6mont)
▪ Attachment
▪ Revascularization
▪ Strength needed to separate the flap from the tooth surface
▪ Incision design
▪ Removal or preservation of pocket epithelium
Type of flap
Following periodontal pedicle flap (Wilderman)
new attachment +
LJE(20%) & CT with
fibers parallel to the root
surface

13. ‫مطالعه‬
‫طراحی‬
‫نمونه‬ ‫حجم‬
‫فلپ‬
-
PARTIAL THICKNESS
‫فلپ‬
full- thickness
Donnenfeld
‫وهمکاران‬
43
(
1964
)
Human
13
patients
/ (NA )
‫ندارد‬ ‫کاربرد‬
BL: 0.63 mm
Pfeifer
‫همکاران‬ ‫و‬
40
(
1965
)
Human
1
patients
Very minor osteoclastic
activity
BL: 0.63 mm
Pfeifer
‫و‬
Heller
42
(
1971
)
Human
2
patients
Healing by LJE
Healing by LJE in the
coronal half and CT in
the apical half
Wood
‫همکاران‬ ‫و‬
41
(
1972
)
Human
7
patients
BL: 0.98 mm
BL: 0.62 mm
Fickl
‫همکاران‬ ‫و‬
44
(
2011
)
Animal
(dog)
5 dogs
BL: 0.12 ± 0.38 mm
BL: 0.64 ± 0.14 mm
Outcomes following partial- or full-thickness flap elevation

14. Apical positional flap
Pfeifer
2-10 day = 2-3mm denouded bone
initial healing
phase
second stage
young proliferative
tissue,” primarily from
the mesenchymal cells
of the PDL
formation of attached
gingiva(function)
0.63 mean bone loss,
mean apical migration
from the CEJ
of the epithelial
attachment 0.69mm
In 12week

15. PHYSICAL THERAPIST CV PHYSICAL THERAPIST CV PHYSICAL THERAPIST CV PHYSICAL THERAPIST CV PHYSICAL THERAPIST CV PHYSICAL
PHYSICAL THERAPIST CV PHYSICAL THERAPIST CV PHYSICAL THERAPIST CV PHYSICAL THERAPIST CV PHYSICAL THERAPIST CV PHYSICAL
Healing following Osseous surgery
Resective Osseous Surgery Wilderman (1970)
‫زمانی‬ ‫درباره‬ ‫استخوان‬ ‫ترمیم‬ ‫حداکثرمیزان‬
3
‫تا‬
4
‫نازک‬ ‫دراستخوان‬ ‫ویژه‬ ‫به‬ ‫هفته‬
‫استخوان‬ ‫با‬ ‫ماهگی‬ ‫درشش‬ ‫نابالغ‬ ‫استخوان‬
intermediate bone
‫ودر‬
18
‫ماهگی‬
‫شد‬ ‫جایگزین‬ ‫بالغ‬ ‫بااستخوان‬
‫اولیه‬ ‫کرستال‬ ‫استخوان‬ ‫ازتحلیل‬
1.2
‫وسپس‬ ‫متر‬ ‫میلی‬
0.4
‫استخوان‬ ‫متررسوب‬ ‫میلی‬
‫متوسط‬ ‫منجربه‬ ‫خبردادندکه‬ ‫جدید‬
0.8
‫گردید‬ ‫کرستال‬ ‫استخوان‬ ‫ارتفاع‬ ‫کاهش‬ ‫متر‬ ‫میلی‬
Moghaddas
‫و‬
Stahl
‫کرستال‬ ‫استخوان‬ ‫ارتفاع‬ ‫میانگین‬ ‫تحلیل‬
‫در‬
6
‫ماه‬
‫ترتیب‬ ‫به‬
23/0
‫میلی‬
‫متر‬
)
‫ابنتررادیکوالر‬
(
,
55/0
‫میلی‬
‫متر‬
)
‫رادیکوالر‬
(
‫و‬
8/0
‫میلی‬
‫متر‬
)
‫فورکا‬
(

16. Surgeon: ustad “Shadab”

19. Soft tissue grafting
Enter your sub headline here
healing of a CTG is a combination of LJE
and CT attachment, with no (or minimal)
new bone or cementum formation
This is a sample text that you
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FGG CTG
• 1.5- to 2 increase in FGG shrinkage over
the periosteum
• The shrinkage of FGG has been divided
into primary and secondary contraction
• Creeping attachment
1. replacing alveolar mucosa
2. increasing the vestibular depth
3. gaining keratinized gingiva before crown
preparation
4. root coverage
1. Plasmatic circulation
2. Revascularization
3. Organic union
1. Initial
2. Revascularization
3. Maturation

20. ‫فاز‬
‫منضم‬ ‫نسج‬
‫اپیتلیوم‬
‫اولیه‬
(
initial
)
(
3
-
0
‫روز‬
)
•
‫راجدامی‬ ‫وپیوند‬ ‫پریوستئوم‬ ‫که‬ ‫فیبرین‬ ‫نازک‬ ‫الیه‬
‫کند‬
.
•
‫ندار‬ ‫وجود‬ ‫پیوند‬ ‫ازبسترتا‬ ‫خونی‬ ‫ازوجودعروق‬ ‫شواهدی‬
‫د‬
.
•
‫خون‬ ‫گردش‬
"
‫پالسماتیک‬
: "
‫باترشح‬ ‫فقط‬ ‫تغذیه‬
‫شود‬ ‫می‬ ‫پیوندانجام‬ ‫ازمیان‬ ‫اگزوداازپریوستئوم‬
.
•
Degeneration
•
‫خارجی‬ ‫طبقات‬ ‫شدن‬ ‫دسکوآمه‬
•
‫ها‬ ‫لکوسیت‬
Re-vascularization
11-4
‫روز‬
•
‫الویول‬ ‫کرست‬ ‫تحلیل‬ ‫حداقل‬
,
‫بد‬ ‫سالم‬ ‫پریوستیوم‬
‫تحلیل‬ ‫ون‬
.
•
‫روزچهارم‬
:
‫وپری‬ ‫پیوند‬ ‫بین‬ ‫هادرناحیه‬ ‫فیبروبالست‬
‫وستیوم‬
.
‫ظاهرشدند‬ ‫درپیوند‬ ‫عروق‬
.
•
‫روزهفتم‬
:
‫مویرگی‬ ‫زدن‬ ‫جوانه‬ ‫متراکم‬ ‫شبکه‬
‫درسراسرپیوند‬
.
‫اپیتلیالیزه‬ ‫مارجینل‬ ‫بیره‬
•
‫روزیازدهم‬
:
‫پریوس‬ ‫و‬ ‫پیوند‬ ‫بین‬ ‫فیبری‬ ‫پیوستگی‬
‫تیوم‬
.
‫بیره‬
‫شد‬ ‫مشاهده‬ ‫آزاد‬
.
‫از‬ ‫جدید‬ ‫مارجینال‬ ‫بیره‬
granulation
tissue
‫بامنشأ‬
PDL
‫است‬ ‫شده‬ ‫تشکیل‬
.
•
‫روزپنجم‬
:
‫ش‬ ‫دسکوآمه‬ ‫و‬ ‫جنریشن‬ ‫دی‬ ‫اپیتلیوم‬
‫د‬
.
•
‫اپ‬ ‫به‬ ‫اپیتلیال‬ ‫های‬ ‫ریج‬ ‫قسمت‬ ‫ترین‬ ‫عمیق‬
‫یتلیالیزه‬
‫کند‬ ‫می‬ ‫کمک‬ ‫پیوند‬ ‫مجدد‬ ‫شدن‬
.
•
‫پی‬ ‫روی‬ ‫مجاور‬ ‫انساج‬ ‫از‬ ‫اپیتلیوم‬ ‫نازک‬ ‫الیه‬
‫وند‬
‫است‬ ‫تکثیرشده‬
.
•
‫روزیازدهم‬
:
epithelization
‫کامل‬
‫بلوغ‬
(
maturation
)
(
42
-
11
‫روز‬
)
•
‫چهاردهم‬ ‫روز‬
:
‫الی‬ ‫بیشتر‬ ‫گیری‬ ‫وجهت‬ ‫تراکم‬ ‫افزایش‬
‫اف‬
‫وپریوستیوم‬ ‫پیوند‬ ‫تماس‬ ‫درسطح‬ ‫منضم‬ ‫نسج‬
.
•
‫ضخامت‬ ‫افزایش‬
•
‫چهاردهم‬ ‫روز‬
:
‫توسع‬ ‫کامال‬ ‫اپیتلیال‬ ‫های‬ ‫ریج‬
‫ه‬
‫است‬ ‫یافته‬
.
•
‫وهشتم‬ ‫بیست‬ ‫روز‬
:
keratinization
‫آغازمیشود‬
.

21. Free gingival graft procedure
Surgeon : ustad Ghafary

23. Palatal harvesting
• Techniques
• Thickness
• Biologic material
• Growth factors

24. •
‫ضخامت‬
‫فلپ‬
‫کمتراز‬
2
‫میلی‬
‫متر‬
•
‫طول‬
‫فلپ‬
‫کمتراز‬
14
‫میلی‬
‫متر‬
•
‫محافظت‬
‫وجلوگیری‬
‫ازموادها‬
‫درناحیه‬
‫اهدأ‬
‫کننده‬
−
‫سیانواکریالت‬
−
‫فکتورهای‬
‫رشدی‬
:
platelet-rich plasma,
91
platelet-rich fibrin,
92
platelet-rich
fibrin+ cyanoacrylate
+
−
‫تداوی‬
‫با‬
‫اوزون‬
−
Medicinal plant extracted
94
−
‫هیالورونیک‬
‫اسید‬
−
‫لیزر‬
‫دیوید‬
‫ازجراحی‬ ‫پس‬ ‫دردهای‬ ‫دهنده‬ ‫کاهش‬ ‫فکتورهای‬
•
‫مریضان‬
‫غیرسیگاری‬
•
‫فکتورهای‬
‫رشدی‬
:
platelet-rich plasma,
91
platelet-rich fibrin + cyanoacrylate
88
•
Medicinal plant extracted
•
‫هیالورونیک‬
‫اسید‬
•
‫تداوی‬
‫با‬
‫اوزون‬
•
Topical erythropoietin
98
•
Aminoguanidine, an advanced glycation end-products inhibitor, and
•
N-phenacyl thiazolium bromide, a glycated cross-link breaker
99
•
Topically applied antimicrobial agents
100
•
Chondroitin sulfate
‫فکتورهای‬
‫تسریع‬
‫دهنده‬
epithelization
‫درناحیه‬
‫اهدأ‬
‫کننده‬
BOX 14-2 Factors affecting patient morbidity and donor site epithelialization following FGG harvesting

26. Flap+GBR+GTR
Advanced regenerative

27. Complications During Wound Healing
This is a sample text that you can edit.
You can change font(size, color, name), or
apply any desired formatting.
01
According to Curtis et al, osseous
surgery was 3 times to cause swelling,
bleeding, and infection than mucogingival surgery.
02
• patient morbidity
• excessive
• palatal hemorrhage
• palatal pain
• failure in the graft union resulting in graft necrosis
• delayed healing
• exostoses
• unpleasant esthetic results
03
• membrane exposure
• Infection
• swelling
• erythema
• flap sloughing or perforation
• postoperative pain
04
Swelling
GTR
Pain
management
FGG complication

28. CONCLUSION
Enter your sub headline here
A
B
CONCLUSION
Wound healing is a
complex process especially
when compromised by
local and systemic factors
Only profound understanding of biological and
clinical variables affecting the outcome of
periodontal treatment procedures will allow
clinicians to manipulate biological and clinical
factors effectively in order to optimize the
clinical result and increase the predictability of
therapy.

29. References
Mediators of Periodontal Osseous Destruction and
Remodeling: Principles and Implications for Diagnosis
and Therapy J Periodontol 2002;73:1377-139
06
The use of free gingival grafts for aesthetic
purposes. Periodontology 2010, Vol. 27, 2001,
05
Periodontal Wound Healing. Clinical Dentistry, Vol
3, James Clark
04
Sabiston’s Text Book Of Surgery; 16th Edition
03
American Academy of Periodontology. Glossary of
Periodontal
Terms. American Academy of Periodontology, 2001.
02
PERIODONTICS The Complete Summary
Fernando Suárez López del Amo, dds, ms 2023
01
‫از‬ ‫دارم‬ ‫یژه‬‫و‬ ‫تشکری‬
!
‫تادان‬‫اس‬
‫همرابمن‬ ‫و‬ ‫یز‬‫ز‬‫ع‬ ‫اهامنی‬‫ر‬
‫امروزی‬ ‫درکنفرانس‬ ‫که‬ ‫عزیزان‬ ‫شما‬ ‫و‬
‫رساندید‬ ‫هم‬ ‫به‬ ‫حضور‬

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