Surgical Periodontal Therapy and Regeneration
What this domain tests
Surgical access, resective procedures, and regenerative techniques. The exam asks when surgery is indicated, what determines predictability, and how to avoid complications.
Principles
- Access flap surgery improves visibility and root debridement but does not by itself regenerate attachment.
- Osseous resective surgery recontours bone to eliminate pockets. It sacrifices support and is best for shallow, wide defects with thick bone.
- Regeneration requires four elements: exclusion of epithelium and gingival connective tissue, space maintenance, clot stability, and primary wound closure.
- GTR uses barrier membranes; bone grafts provide scaffold and space maintenance; enamel matrix derivative is biologically active; combinations are often used.
- Best regeneration: deep, narrow, three-wall intrabony defects, mandibular molars, adequate plaque control, and a nonsmoker.
- Poor predictability: furcation involvement, one-wall defects, smoking, poor hygiene, and membrane exposure.
Worked example
A 45-year-old nonsmoker has a 7-mm probing depth on the mesial of a mandibular molar, a 5-mm deep three-wall intrabony defect, and excellent plaque control. After SRP and re-evaluation, GTR with a resorbable membrane plus particulate graft is reasonable. If the defect were a Class II furcation with 2-mm horizontal involvement, regeneration would be less predictable and a tunnel or resective approach might be considered.
Traps
- Promising regeneration in the presence of heavy plaque or smoking.
- Forgetting primary closure; membrane exposure compromises results.
- Using resective surgery in a patient with a high smile line and thin biotype without considering esthetics.
- Confusing bone fill with true periodontal regeneration (new cementum, PDL, bone).