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PERIODONTAL REGENERATION: RETURN TO THE FUTURE

Collaborators

27 Feb 2017

Periodontal regeneration is booming. Periodontics once again has a major role in interdisciplinary treatment; plus, the indication of dental implants is becoming increasingly specific. In this context, the use of techniques such as regeneration allows highly predictable improvement of prognosis for many teeth, facilitating long-term stability.

Periodontal regeneration comprises all treatments aimed at the recovery and reconstruction of lost periodontal tissues.

Basically, the main techniques include the use of bone grafts of different origin, including human allografts, xenografts from different species, and alloplastics, which are synthesised in the laboratory.

To obtain optimum periodontal regeneration, the most important principle is keeping epithelial cells from surrounding tissues out of the osseous defect, “a barrier that we can establish through the use of membranes that physically impede the passage of these cells”, explains Dr. Andrés Pascual La Rocca, associate director of the journal Periodoncia Clínica.

Currently, some of the most commonly used membranes include collagen or polymer membranes, as well as non-resorbable ones, such as high density-PTFE membranes. Even so, according to Dr. Pascual La Rocca, the use of polypeptide growth factors, enamel matrix protein derivatives and even bone morphogenetic proteins (BMPs) has been associated with very positive outcomes when using different periodontal regeneration techniques.

FUNCTION & AESTHETICS

Periodontal regeneration is indicated in order to manage intrabony defects around the teeth. The objective is to use the regeneration procedure as a starting point to improve levels of tooth support and attachment.

But in order to proceed with these techniques Dr. Pascual La Rocca warns, “we must consider the general prognosis of the tooth, as well as the morphology of the defect”; and he reminds us that “the regenerative potential of intrabony defects will be better, the greater the number of remaining walls there are.”

However, apart from the positive functional repercussions that periodontal regeneration procedures may have, aesthetic implications are being given progressively greater value. As Dr. Pascual La Rocca points out, “the aesthetic requirements of our patients have changed in recent decades, demanding new techniques and procedures that will produce as few unfavourable periodontal treatment outcomes as possible.”

Given these conditions, the use of micro-surgical instruments together with high magnification has enabled the development of minimally invasive techniques that minimise treatment sequelae when combined with the appropriate and specific materials.

A PROMISING FUTURE

In the field of periodontal regeneration, lines of research are aimed at the improvement of bio-materials, offering better performance and reducing possible complications associated with their use.

It is already assumed that the patient’s own cells will, in the near future, be the main source of regeneration. “Stem cell research is promising, and based on the results obtained recently and in a very short time, we have great expectations for this line of research,” says Dr. Pascual La Rocca, who does not hesitate to point out how “in the future we will be able to recreate biological processes more easily, thereby reducing complications.”

Another particularly relevant field, both in the present and in the future, is bioengineering applied to periodontal regeneration. As Dr. Pascual La Rocca states, “bioengineering facilitates the development and growth of specific tissue cells; we can thus restore lost tissues.”

One of the main limitations in this area is currently due to the scope of these technologies, but as they develop, the outlook is very encouraging.

However, the success of periodontal regeneration is based, above all, on adequate interdisciplinary collaboration. According to Dr. Pascual La Rocca, “the implementation of any periodontal procedure must be in accordance with a general treatment plan that meets the overall objective of health and functionality.” And in his view, “without an interdisciplinary approach it is impossible to achieve the ultimate goals of periodontal regeneration.”

Occasionally, the collaboration between specialities, such as endodontics and orthodontics, may bring about great benefits in periodontal regenerative therapy; and, conversely, periodontal regeneration improves the prognosis after other dental treatments.

Regeneration techniques have been well studied and their efficacy has been rigorously documented, proving to be highly effective and predictable. However, they should always be considered and proposed as part of a treatment plan. It is also important to know what progress is being made with different techniques and biomaterials since “we can thus offer our patients different alternatives and improve the prognosis of teeth affected by periodontal disease,” concludes Dr. Pascual La Rocca. 

 

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