Dentaltown August 2021 - 40
Fig. 4: Access fl ap according to modifi ed papilla preservation
technique (MPPT) surgical protocol.
attachment and bone gained, although
it has been demonstrated that deep and
shallow defects have the same potential
for regeneration. In other words, after the
treatment of deep defects, we'd expect to
achieve linear amounts of attachment gain
that are larger in absolute value than those
obtained after the treatment of shallow
defects, but both deep and shallow defects
can express a regenerative potential up to
the complete resolution of the intrabony
component of the defect.
Another important morphological
characteristic of the defect is the width of
the intrabony component: the angle that
the bony wall of the defect forms with the
long axis of the tooth. Wider defects have
been associated with reduced amounts of
clinical attachment level and bone gain.
It has also been shown that the number
of residual bony walls is correlated with the
outcomes of various regenerative approaches,
but note that the number of walls and the
width of the defect are infl uential when
nonsupportive biomaterials are used.
Nevertheless, the infl uence of defect
Fig. 5: Reactive tissue debridement with Gracey curettes.
anatomy appears to be mitigated, to some
extent, when a more stable and long-lasting
combination of barrier membrane and bone
replacement material is applied.
As far as surgery-related factors, key
concepts for successful regeneration include:
* The presence of space for the
formation of the blood clot at the
interface between the fl ap and the
root surface, which can be provided
by the use of self-supporting
membranes and/or graft biomaterials.
* The stability of the blood clot.
(That's why membranes should be
fi xed with pins or titanium screws.)
Fig. 6: Root surface decontamination by the means
of ultrasonic inserts.
* The soft-tissue protection of the
interdental area, to avoid surgical
wound dehiscence and thus bacterial
contamination of the underlying
membrane. Its incidence could be
greatly reduced with the use of access
fl aps specifi cally designed to preserve
the interdental tissues, such as papilla
preservation techniques.
40 AUGUST 2021 // dentaltown.com
http://www.dentaltown.com
Dentaltown August 2021
Table of Contents for the Digital Edition of Dentaltown August 2021
Dentaltown August 2021 - Intro
Dentaltown August 2021 - Cover1
Dentaltown August 2021 - Cover2
Dentaltown August 2021 - 1
Dentaltown August 2021 - 2
Dentaltown August 2021 - 3
Dentaltown August 2021 - 4
Dentaltown August 2021 - 5
Dentaltown August 2021 - 6
Dentaltown August 2021 - 7
Dentaltown August 2021 - 8
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Dentaltown August 2021 - Cover3
Dentaltown August 2021 - Cover4
Dentaltown August 2021 - SI_1
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