Relation between wound healing after surgery and susceptibility to periodontal disease

Abstract. In the present investigation wound healing was studied clinically in 8 younger (mean age 33.5 years) and 8 older patients (mean age 48 years), who were surgically treated for the same amount of severe periodontitis. This implies that the patients in the younger age group represented individuals with a higher degree of susceptibility to periodontal disease than the patients in the older age group. After surgery all patients were subjected to a carefully controlled oral hygiene program. Patients were recalled weekly until 8 weeks post surgery and again after 15 weeks for a final examination. At every recall session oral hygiene measurements were carried out and the bleeding tendency of the pockets was determined after probing with a standardized pressure. Bleeding on the basis of mechanical trauma after probing was considered to be a clinical parameter for wound healing in a plaque free environment.
Results indicate that the oral hygiene program resulted in equally low plaque scores in both age groups. However, in a period from 5–15 weeks after surgery younger patients showed significantly more bleeding pockets than older patients. Furthermore it was found in both groups that the more loss of attachment there was, the slower the rate of wound healing.
It was concluded that the time span for wound healing is longer in patients who are more susceptible to periodontal disease, than in those who are less susceptible.     

Low-intensity pulsed ultrasound accelerates periodontal wound healing after flap surgery

Background and Objective:  A study was conducted to evaluate the effects of low-intensity pulsed ultrasound on wound healing in periodontal tissues after mucoperiosteal flap surgery.
Material and Methods:  Bony defects were surgically produced bilaterally at the mesial roots of the mandibular fourth premolars in four beagle dogs. The flaps were repositioned to cover the defects and sutured after scaling and planing of the root surface to remove cementum. The affected area in the experimental group was exposed to low-intensity pulsed ultrasound, daily for 20 min, for a period of 4 wk from postoperative day 1 using a probe, 13 mm in diameter. On the control side, no ultrasound was emitted from the probe placed contralaterally. After the experiment, tissue samples were dissected out and fixed in 10% formalin for histological and immunohistochemical analyses.
Results:  The experimental group showed that the processes in regeneration of both cementum and mandibular bone were accelerated by low-intensity pulsed ultrasound compared with the control group. In addition, the expression level of heat shock protein 70 was higher in the gingival epithelial cells of the low-intensity pulsed ultrasound-treated tooth.
Conclusion:  Our results suggest that osteoblasts, as well as cells in periodontal ligament and gingival epithelium, respond to mechanical stress loaded by low-intensity pulsed ultrasound, and that ultrasound accelerates periodontal wound healing and bone repair.     

Role of attached gingiva for maintenance of periodontal health

The present study was undertaken to analyze the role of attached gingiva for the maintenance of periodontal health in sites with normal and reduced height of the supporting apparatus. Furthermore, the effect of excision and grafting of gingiva on some parameters describing dimensions and location of the periodontal tissues was evaluated. 7 beagle dogs were used. A baseline examination comprised assessments of dental plaque, gingival conditions, attachment level, position of the gingival margin and width of the keratinized and the attached gingiva. In the right side of the jaws (experimental side) a 6-month period of periodontal tissue breakdown was followed by surgical excision of the entire zone of the gingiva. After another 4-month period of healing with daily plaque control, a gingival graft was inserted in one quadrant of the experimental side to regain a zone of attached gingiva while the other quadrant of the experimental side was left ungrafted. In the left side of the jaws (control side), the teeth were subjected to daily meticulous plaque control during the entire study. In one of the control quadrants the entire zone of the keratinized and attached gingiva was excised at a time point corresponding to the grafting procedure in the experimental side, while the gingiva in the remaining control jaw quadrant was left unoperated. Clinical examinations of all control and experimental tooth units were repeated at certain time intervals during the course of the study. The final examination was carried out 4 months after grafting. The results of the experiment showed that in sites exposed to careful plaque control measures gingival health could be established and maintained without sign of recession of the gingival margin or loss of attachment, independent of (1) presence or absence of attached gingiva, (2) width of keratinized gingiva or (3) height of the supporting attachment apparatus. Following surgical excision of the entire gingiva, all buccal sites regained a zone of keratinized gingiva, but most sites were lacking attached gingiva. Furthermore, grafting of gingival tissue significantly increased the width of the keratinized and the attached gingiva but had no obvious effect on the position of the gingival margin or the level of the attachment.     

Role of myofibroblasts in normal and pathological periodontal wound healing

Myofibroblasts represent specific subpopulations of cells with important roles in tissue remodeling in both health and disease. They are not usually found in resting healthy tissues. However, they increase in number during the proliferative phase of wound healing. In these conditions, myofibroblasts secrete and organize different molecular components of the extracellular matrix that with time will reconstitute and hopefully regenerate the damaged tissue. Importantly, these cell populations must be eliminated after wound healing has been completed. However, deficiencies in their differentiation or the persistence of this cell population has been associated with the development of delayed wound healing and fibrosis, respectively. In the present review, we analyze the involvement of myofibroblasts in periodontal wound healing and their potential contribution to tissue homeostasis and disease.     

纤维调节素在人类牙周细胞损伤愈合中的免疫组织化学表达

目的研究纤维调节素在牙周细胞损伤愈合中的表达,探讨纤维调节素在牙周损伤愈合中的作用。方法培养人类牙周细胞（牙龈成纤维细胞、牙周膜成纤维细胞和成骨细胞）;在培养了牙周细胞的载玻片上做损伤细胞的圆形创口,建立牙周细胞损伤模型,跟踪观察7 d;用免疫组织化学染色的方法,观察纤维调节素在牙周细胞损伤愈合过程中的表达。结果牙周细胞损伤后第1天,纤维调节素较强表达于损伤边缘新移行的细胞;随后,纤维调节素对损伤区新近移行的细胞的表达强于创口周围的细胞。结论纤维调节素强烈表达于损伤区新近移行的牙周细胞,可能参与牙周损伤愈合的早期活动。     

Longitudinal Comparison of Cytokines in Peri‐Implant Fluid and Gingival Crevicular Fluid in Healthy Mouths

Background: Peri‐implant and gingival tissues provide important sealing and protective functions around implants and teeth, but comparisons of the immunologic responses of these tissues after implant placement have not been conducted. Cytokine levels were measured in peri‐implant crevicular fluid (PICF) and gingival crevicular fluid (GCF) as surrogate measures of immune function at subcrestally placed dental implants and healthy periodontal sites during a 1‐year monitoring period. Methods: A total of 27 dental implants were placed subcrestally in 21 periodontally healthy patients (mean age: 49.0 ± 13.4 years). Repeated clinical and cytokine measurements were obtained over 12 months. GCF and PICF samples were collected and analyzed by cytokine microarray. Data were examined by non‐parametric analysis of variance. Results: Plaque and bleeding indices were similar among all patients (P >0.05) at baseline. During 1 year of monitoring, the mean volumes of PICF and GCF were similar (P >0.05). The levels of interleukin (IL)‐4, ‐6, ‐10, and ‐12p70, tumor necrosis factor‐α, and interferon‐γ in GCF and PICF were not significantly different and did not vary over time (P >0.05). The levels of IL‐1α were higher in GCF than PICF at 1, 2, 6, and 12 months, as were the levels of IL‐8 at 1, 2, 4, 6, and 12 months (P <0.001). Transforming growth factor‐β1 in PICF and GCF exhibited time‐dependent increases, and vascular endothelial growth factor was reduced at 1 year without differences between PICF and GCF (P >0.05). Conclusion: Within the limitations of this study design, it can be concluded that after subcrestal implant placement, the immune response of peri‐implant and periodontal tissues, as assessed by cytokine levels in PICF and GCF, is similar.     

Evaluation of the healing response following placement of Coe-pak and an experimental pack after periodontal flap surgery

Abstract 2 periodontal dressings. Coe-pak* and RD8 (a product under development). were assessed following periodontal surgery, using a double-blind study of randomised split-mouth design, with each patient acting as their own control. Matched sites were selected for periodontal flap surgery under local analgesia. Sites were randomly allocated to each group. The dressings were applied by a single operator and both patients and clinical assessors were blind as to the dressing employed. The dressings were assessed as to their handling properties, m addition to a 7-day post-operative assessment of the surgical sites and a subjective patient report. Maximum pain levels were relatively low (4 in a scale 0–10); subjects reported more pain and analgesics required with RD8 than with Coe-pak, This was reflected in the results of the patient assessment which indicated that 5O% preferred Coe-pak, compared to 25%. who preferred the RD8 dressing. The results showed RD8 to be an acceptable periodontal dressing when compared to Coe-pak, There were no statistically significant differences between treated sites in both groups with regard to post-operative plaque scores, bleeding scores or tissue healing.     

显微牙周外科技术在种植体周附着龈增宽术中的应用

目的 探讨显微牙周外科技术在种植体附着龈增宽术中的临床应用效果。方法 对20例种植体周附着龈不足或缺失的患者,采用显微牙周外科技术增宽种植体周的附着龈。术后观察游离龈瓣的存活状态,并记录术前、术后即刻、术后1年时附着龈的宽度,计算术后1年附着龈的收缩率。结果 20例患者的游离龈瓣均存活,术后1年附着龈宽度为（3.05±0.44）mm,与术前相比增加了（2.56±0.31）mm,与术后即刻相比减小了（2.13±0.28）mm,附着龈收缩率为41.22%±5.04%。结论 显微牙周外科技术应用于附着龈增宽术可获得较高的成功率,能较好地提高种植体周附着龈的质量。     

Soft-tissue wound healing following periodontal surgery and Emdogain application

OBJECTIVES: The aim of the present study was to examine, by clinical means and as patient perception of post-operative events, the effect of Emdogain (enamel matrix derivative (EMD)) on the healing of soft-tissue wounds following periodontal surgery in comparison to flap surgeries without application of EMD. MATERIAL AND METHODS: For this study, 22 subjects (nine female and 13 male) who were scheduled for periodontal flap surgery were selected. The mean age for all patients was 49.9 (SD 8.7) years (range, 32-67). Six women and five men were assigned to the test group and three women and eight men were assigned to the control group. All subjects were scheduled, after re-evaluation of the periodontal status 8 weeks after initial treatment, to undergo surgery of the soft tissues, because of existing of probing pocket depth (5 mm or more), on at least three teeth. At random, 11 patients were assigned to control treatment and 11 patients were placed in the test group. All underwent one periodontal flap surgery for the purpose of this study. A modified Widman flap was performed. Patients in the test group received an application of EMD underneath the mucoperiostal flaps and onto the exposed root surfaces. Clinical measurements were taken at four different points in time, at the time of surgery, 1, 4 and 8 weeks after surgery. All subjects filled out a questionnaire every day for the first 7 days following surgery to evaluate post-operative complaints. RESULTS: Of all parameters evaluated none showed a significant difference between the control and EMD groups, except for gingival swelling at the 1-week assessment, where the EMD group exhibited a higher swelling score. The questionnaire revealed that complaints of oozing of blood from the wound was twice more prevalent 1 day post-surgery in the control (n=6) as in the EMD group (n=3). CONCLUSION: This study shows that the early woundhealing of periodontal flap-surgeries in those sites treated with Emdogain is not different from control sites.     

Effect of professional tooth cleaning on healing after periodontal surgery

Abstract The investigation was undertaken to find out whether favourable conditions for healing after periodontal surgery would develop in patients whose oral hygiene was professionally maintained at a high standard. The study was performed on 20 patients with advanced periodontal disease. Following an initial examination, comprising plaque index and gingival index scoring, measurement of pocket depths and loss of attachment, the patients were randomly distributed between a test and a control group. The patients first received detailed instructions for oral hygiene and were then subjected to periodontal surgery with the reverse bevel flap procedure. After surgery, the patients of the test group received professional cleaning of the teeth once every 2 weeks. The patients of the control group were recalled for scaling of the teeth once every 6 months. All patients were re-examined after 6, 12 and 24 months. It was found that the control patients were unable to maintain a high standard of oral hygiene with the result that the treatment of the periodontal disease failed. The patients of the test group maintained a high standard of oral hygiene, and the treatment of the periodontal disease was, therefore, successful.     

一种牙周细胞体外创面愈合模型的构建

目的:构建一种可用于牙周组织创面愈合规律研究的体外创面愈合模型,比较牙周膜细胞和牙龈成纤维细胞覆盖体外创面的速度。方法:体外培养人牙周膜、牙龈成纤维细胞至玻片上各自形成单层融合。以机械方法刮除部分融合层细胞,构成25mm×7mm的无细胞区域,即牙周细胞体外创面。创面形成后继续于100mL/L胎牛血清环境下培养2、6、9d。玻片细胞固定后以结晶紫染色。以计算机辅助图像分析系统对创面特定区域采图,进行细胞覆盖面积定量和统计分析。结果:在所构建牙周细胞体外创面上牙龈成纤维细胞的覆盖速度高于牙周膜细胞。创面形成后第9天,牙龈成纤维细胞覆盖采图区域面积的百分比均数为62.26%,牙周膜细胞则为44.15%,差异有显著性(P<0.05)。结论:实验以细胞覆盖创面面积综合衡量细胞增殖和移动能力,在实验构建的牙周细胞体外创面模型上,牙龈成纤维细胞覆盖创面速度高于牙周膜细胞,能够体现两者在覆盖创面能力上的差异。实验构建的体外创面模型可用于牙周细胞创面愈合能力的研究,对探讨牙周组织创面愈合机制及其调控规律有所裨益。     

Role of "diseased" root cementum in healing following treatment of periodontal disease

This clinical trial was undertaken to examine whether root debridement in the treatment of periodontal disease must include the removal of the exposed cementum in order to achieve periodontal health. The study included 11 adult patients with moderate to advanced periodontal disease. In a split-mouth design, the dentition of each patient was by random selection divided into test- and control quadrants comprising the incisors, canines and premolars. Following a baseline examination, all patients were given a case presentation and a detailed instruction in self-performed oral hygiene measures. The patients were then subjected to periodontal surgery. Following reverse bevel incisions, buccal and lingual mucoperiosteal flaps were elevated and all granulation tissue was removed. In 2 jaw quadrants (control quadrants) in each patient, the denuded root surfaces were carefully scaled and planed in order to remove soft and hard deposits as well as all cementum, using hand instruments and flame-formed diamond stones. In the contralateral quadrants (test quadrants) the roots were not scaled and planed but soft microbial deposits were removed by polishing the root surfaces with the but soft microbial deposits were removed by polishing the root surfaces with the use of rubber cups, interdental rubber tips and a polishing paste. Calculus in the test quadrants was removed by the use of a curette, but precaution was taken to avoid the removal of cementum. The flaps were repositioned to their original level and sutured. The patients were following active treatment enrolled in a supervised maintenance care program including "professional tooth cleaning" once every 2 weeks for a 3-month period.(ABSTRACT TRUNCATED AT 250 WORDS)     

低能量激光治疗在牙周组织愈合中的作用

近年来激光在口腔医学领域的应用日益广泛。在牙周治疗中,激光可用来进行牙结石去除、根面处理、软组织及骨修整等,参与到牙周治疗的各个环节,起到很好的辅助牙周治疗作用。低能量激光是指能量较温和、治疗时不产生热量的一类激光。在牙周治疗时可利用其生物刺激功能起到抑制牙周炎症、促进创口愈合及牙周组织再生等方面的作用。文章主要介绍低能量激光的特点、作用机制及临床使用方法,为低能量激光治疗在临床的进一步推广应用提供思路。     

Cytokines during periodontal wound healing: potential application for new therapeutic approach

Regeneration of periodontal tissues is one of the main goals of periodontal therapy. However, current treatment, including surgical approach, use of membrane to allow maturation of all periodontal tissues, or use of enamel matrix derivatives, presents limitations in their indications and outcomes leading to the development of new tissue engineering strategies. Several cytokines are considered as key molecules during periodontal destruction process. However, their role during each phase of periodontal wound healing remains unclear. Control and modulation of the inflammatory response and especially, release of cytokines or activation/inhibition in a time‐ and spatial‐controlled manner may be a potential perspective for periodontal tissue engineering. The aim of this review was to summarize the specific role of several cytokines during periodontal wound healing and the potential therapeutic interest of inflammatory modulation for periodontal regeneration especially related to the expression sequence of cytokines.