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Daryl E. Malena DDS Periodontics |
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Regeneration
of periodontal structures is a very challenging area of surgery.
Few other areas of surgery are faced with an operating field filled with bacteria. Furthermore,
gingival disease alters teeth in ways that cause them to be quite
reluctant to accept tissue reattachment after pockets have formed around
them.
For that reason, new agents and methods to enhance the results of periodontal surgery are constantly being introduced to the market. Much of the published research on these agents is funded by the companies that make them--and they are reluctant to compare one product with another (they only make control group comparisons). It is our job to consider each product based on the available research, and determine which might be improve on our current methods and be more helpful to our patients. For example, agents approved by the FDA and currently being actively marketed to periodontists include: Emdogain--enamel matrix protein derived from pigs, marketed to promote regeneration of bone and the attachment of gums to teeth. PepGen P-15--bovine (cow) bone morphogenic protein marketed to enhance bone grafts. AlloDerm--acellular dermal skin graft material used as a substitute for the patient's own donor tissue in gingival grafts. In addition there are several synthetic bone graft materials on the market, such as BioGlass. There are numerous sources of human bone graft materials including the American Red Cross. A number of barrier materials are on the market that are used to isolate slowly healing bone areas from the rapidly healing gingival tissue including collagen, polylactate and teflon. We use, or have used many of these products, but our preference continues to be to use autologous materials (those from the patient's own body). We have not found many advantages to using any other source of soft tissue, bone or growth factors other than those that the patient is already producing. An example of this is the occasional use of the patient's own platelets, known as Platelet Rich Plasma (PRP) that concentrates the growth factors that the platelets naturally provide to a healing wound. Most periodontal reconstructive surgery is very limited in its scope and the small amount of graft material needed is readily available in the area. In those cases where there would be advantages to using additional sources, we discuss discuss the matter with the patient in advance of the surgery. Select from the topics at the left, or use the Search feature to find what you are looking for. If you have questions, feel free to contact us. |
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