Reconstructive Periodontal Therapy: A Holistic Approach

Abstract Body: The major goal of periodontal therapy has been shifted from repair to reconstruction of periodontal tissues thereby reversing the damage to the periodontium caused by the disease process. The possibility of gaining periodontal support will improve the patient’s function, comfort and aesthetics. The first evolutionary stage of periodontal regeneration focused on bone graft materials. Autogenic, allogenic, xenogenic and alloplastic bone graft materials have been used for regeneration purpose. Since these techniques have had limited success, other regenerative approaches have been suggested that utilize tissue-engineering techniques. This concept began with guided tissue regeneration (GTR). Treatment of intrabony defects with GTR has yielded successful clinical and histological results with nonresorbable and bioabsorbable membranes. However, the membrane may collapse into the defects and reduced amounts of bone can be formed due to the lack of space for progenitor cell population. Combined techniques have been an option in creating a space for the regenerating tissues underneath the membranes and suggest the use of additional properties of the graft materials. Advances in molecular biology set the ground for a new concept in periodontal regeneration by emphasizing the importance of biologic mediators. The discovery of the presence of the enamel matrix layer between the peripheral dentin and the developing cementum, periodontal ligament and alveolar bone, has provided the fundamental concept for enamel matrix protein derivative supported tissue engineering. Polypeptide growth factors are an enchanting group of agents as biologic mediators because of their regulatory effects on proliferation and differentiation of cells from bone and connective tissues. Platelet rich plasma/fibrin, with the content of these polypeptide growth factors, may contribute to periodontal regeneration. This lecture will focus on all the aforementioned technique sensitive approaches in clinical practice with the limiting factors that may contribute to inadequate clinical and biological outcomes.