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Step 3 for the treatment of periodontal diseases: surgical regeneration of the periodontium Devan S Raindi Jay Parmar Iain Chapple Dental Update 2024 51:5, 707-709.
Surgical regeneration can offer significant benefits in the management of teeth affected by severe periodontitis that continue to demonstrate pocketing following steps 1 and 2 of periodontal therapy. To gain the maximum benefit from this treatment modality, an understanding of the biological principles of regeneration, appropriate case selection and the latest surgical techniques are required. The most recent S3-level guideline released by the European Federation of Periodontology (EFP) and adoloped by the British Society of Periodontology is evidence based, and can support the clinician in such decision-making.
CPD/Clinical Relevance: Surgical regenerative techniques can play an important role in the treatment of complex periodontal defects.
Article
The ultimate goal of periodontal therapy is to restore periodontal tissue architecture, namely alveolar bone, cementum, periodontal ligament and gingival tissue to its original form and level of attachment. Despite significant advances in regenerative biology and surgical techniques over recent decades, case selection remains the most important criterion when considering whether a surgical regenerative approach is appropriate for a specific site in an individual patient. This article provides an overview of regenerative biology, surgical factors and the current S3-level guidelines when considering surgical regenerative techniques in the treatment of periodontitis.
Regenerative periodontology requires an understanding of the biological principles of wound healing to enable the clinician to guide or manipulate the process clinically to attain optimal outcomes. Before considering regenerative biology, it is important to understand the different healing scenarios for the periodontium following surgical intervention, namely:
The first concept in regenerative wound healing was known as ‘domain theory’, leading to a focus on guiding the correct cells to the root surface by exclusion of the epithelial and gingival connective tissue cells, allowing development of new alveolar bone and periodontal ligament rather than a long junctional epithelium or gingival connective tissue attachment.2 Based on this theory, the first successful regenerative procedure was completed in 1982 on a lower lateral incisor using a non-resorbable membrane, which aimed to prevent occupation of the wound with epithelial and gingival connective tissue cells – a concept termed guided-tissue regeneration (GTR).3
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