}  reconstruct or reconstitute all gingival and

osseous structures lost through disease.

}  Repair:
◦  Healing of a wound by tissue that does not fully
restore the architecture or function of the part, as
in the case of a long junctional epithelium or
ankylosis.
}  The reunion of connective tissue with a
healthy root surface on which viable
periodontal tissue is present without new
cementum, as in the case of trauma or after a
supracrestal fiberotomy.
}  The reunion of connective tissue with an
unhealthy or previously diseased root surface
that has been deprived of its periodontal
ligament. This reunion may or may not occur
by formation of new cementum with inserting
collagen fibers, as in the case of GTR.
}  Reproduction or reconstitution of the lost or
injured parts by restoration of new bone,
cementum, and a periodontal ligament
(reunion of connective tissue) on an
unhealthy or previously diseased root
surface.
}  Ideally, complete restoration would also
restore total function
}  non–bone graft–associated new attachment

}  bone graft–associated new attachment.

Many procedures combine both approaches.

}  the removal of the junctional and pocket epithelium;
}  the prevention of their migration into the healing area
after therapy;
}  clot stabilization, wound protection, and space creation;
}  guided tissue regeneration;
}  the biomodification of the root surface;
}  selection of the proper graft materials;
}  biologic mediators (growth factors) and enamel matrix
proteins to enhance or direct healing; and finally
}  the combination of graft materials, membranes, and
biologic mediators used to enhance new attachment
and bone growth.
}  1. Plaque control
}  2 Underlying system disease (eg, diabetes)
}  3. Root preparation
}  4. Adequate wound closure
}  5. Complete soft tissue approximation
}  6. Periodontal maintenance, short and long term
}  7. Traumatic injury to teeth and tissues
}  8. Defect morphology
}  9. Type of graft material
}  10. Patient’s repair potential
1. Removal of plaque, calculus, softened
cementum, and the junctional epithelium from
the root surface

2. Removal of all granulation tissue from the bony

defect

3. Removal of all connective tissue and periodontal

ligament fibers covering the bone

4. Decortification of dense or sclerotic bone

}  Periodontal reconstruction without the use of
bone grafts in meticulously treated three-wall
defects (intrabony defects) and in periodontal
and endodontic abscesses.
Periodontal Fullthickness Flap is closed Flap closed
pocket with flap without a with
angular bone reflected. membrane membrane in
loss place.

. Only bone and PDL cells can occupy the defect

}  The graft simply delays the epithelium from
proliferating into the healing area
}  The method for the prevention of epithelial
migration along the cemental wall of the
pocket and maintaining space for clot
stabilization
}  nonresorbable membranes
◦  polytetrafluoroethylene (PTFE)
◦  titanium-reinforced expanded polytetrafluoroethylene
(ePTFE)

}  resorbable membranes

◦  OsseoQuest (Gore),
–  a combination of polyglycolic acid, polylactic acid, and
trimethylene carbonate that resorbs at 6 to 14 months;
◦  BioGuide (Osteohealth),
–  a bilayer porcine-derived collagen;
◦  Atrisorb (Block Drug)
–  a polylactic acid gel; and
◦  BioMend (Calcitech),
–  a bovine Achilles tendon collagen that resorbs in 4 to 18 weeks
}  1. Increase the bone level
}  2. Reduce crestal bone loss
}  3. Increase the clinical attachment level
}  4. Reduce probing depth when compared with open
flap surgery
}  5. Increase clinical attachment level and reduce
probing depth when combined with guided tissue
regeneration (GTR) compared with grafts alone
}  6. Support formation of a new attachment apparatus
◦  a. autogenous bone grafts
◦  b. demineralized freeze-dried bone allografts(DFDBA)
◦  c. xenografts (Bio-Oss®, Osteohealth,Uniondale, New York)
◦  d. enamel matrix derivative (Emdogain® Straumann, Basel,
Switzerland).
}  (1) autografts
◦  are bone obtained from the same individual;

}  (2) allografts

◦  are bone obtained from a different individual of the
same species;

}  (3) xenografts

◦  are bone from a different species.
Osseous defect mesial to a second premolar

Reentry 6 months later

BEFORE AFTER 6 MONTHS
incipient involvement into a flute
of furcation with suprabony
pockets and no interradicular
bone loss
Grade II: any involvement of the
interradicular bone without a
through-and-through ability to
probe
through-and-through loss of through-and-through loss of
interradicular bone interradicular bone, with total
exposure of furcation owing to
gingival recession
loss of interradicular through-and-
loss of interradicular bone
bone less than or through loss of
greater than one-third
equal to one-third interradicular
but not through and bone
through
}  Scaling and Curettage, Gingivectomy,
Odontoplasty
}  Furcation Plasty—Odontoplasty and
Osteoplasty
}  Grafting

}  Tunnel Preparation

}  Root Resection
Glickman I II III or IV
(1958)
Lindhe - I II III
(1983)
Tarnow - A, B, or C A, B, or C A, B, or C
(1984)
Treatment Scaling and root Odontoplasty; Odontoplasty Root
planing; Osteoplasty Osteoplasty; Sectioning;
Gingivectomy; Grafting; tunnel
Odontoplasty GTR preparation;
Flap and Ca GTR
Tunnel
preparation
Root resection
Osteoplasty and odontoplasty
}  The furcation area is characterized by defects,
the walls of which are primarily of tooth
structure.

}  Therefore, although the area is capable of

holding a graft, it has little or no vascularity to
support one. For this reason, the success of
grafts is limited in furcations

}  Grafts are indicated where destruction of the

furcation is only partial (grade I or II) or where
deep vertical lesions have still left some bone on
the inner aspect of the roots
 deep grade II furcation

Xenograft (Bio-Oss) placed

Reentry 12 months later

Resorbable membrane positioned and
sutured
}  Tunnel preparation is the surgical exposure
of the furcation, which is indicated for
advanced grade II and III lesions in which
resection is not possible
}  It requires roots that are long and divergent
and is generally indicated for the mandibular
molars. It often fails because of decay in the
furcation area
Grade III furcation prior to correction Tunnel preparation completed

Small interdental brush is

inserted into and through the
furcation to show that the
inner portion of the furcation
can be cleaned