Periodontitis

[plusalpha]

Hello!

I just had a quick clinical question which has been in the back of my mind while treating patients in dental school.
Several of my patients with periodontitis asked me this question: "Can you not use bone graft to grow my bone and gum back?", and in fact I was curious about this too. What can and cannot bone grafts do? What are its limitations?

Thank you!

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[cmsmith85]

Hello!

I just had a quick clinical question which has been in the back of my mind while treating patients in dental school.
Several of my patients with periodontitis asked me this question: "Can you not use bone graft to grow my bone and gum back?", and in fact I was curious about this too. What can and cannot bone grafts do? What are its limitations?

Thank you!

Not a periodontist here, but it usually has something to do with how many walls are left. When you do bone grafting in a spot of horizontal bone loss, there's nothing for the graft to be up against and it just isn't successful. But I'll let a periodontist chime in for a better explanation.

 

[P7898]

Not a periodontist here, but it usually has something to do with how many walls are left. When you do bone grafting in a spot of horizontal bone loss, there's nothing for the graft to be up against and it just isn't successful. But I'll let a periodontist chime in for a better explanation.

Not one either. But I understand GTR and Ridge Augmentation and cmsmith85 is right. Sometimes though if there is a way to use fixation screws and membranes to gain vertical height it can be done to grow bone but everyone responds differently from what I have read.

There is a connective tissue graft and a free gingival graft. Connective tissue graft is mainly for root coverage procedures. However your limitations for root coverage can be found in literature depending on how much of the root is exposed and if any of the adjacent teeth have recession because they give you an idea of how far the free gingival margin can get on the recessed tooth.

Free gingival graft is mainly used to increase the width of keratinized tissue. So if someone had orthodontics and does not have a lot of WKT; then this would be a good procedure - commonly on the lower mandibular anteriors when correcting a bite. But these help basically insulated the roots and make the patient less sensitive and a bunch of other reasons. You always want a certain amount 2mm or more around teeth or implants.

It is a very cool field though. Regeneration is great and I will do bone grafting and some ridge preservation if it came my way and predictable. GTR or guided tissue regeneration is good for a three wall infra bony defect - however these are vertical defects and you can sometimes see this on a bitewing. However I am just a GP so my knowledge is more theoretical than practical because I do the general stuff all day long. But it is good to know it in depth so you know how your specialist can help you take care of your patients.

Would like a Periodontist to chime in too.

 

[PerioDont]

Hello!

I just had a quick clinical question which has been in the back of my mind while treating patients in dental school.
Several of my patients with periodontitis asked me this question: "Can you not use bone graft to grow my bone and gum back?", and in fact I was curious about this too. What can and cannot bone grafts do? What are its limitations?

Thank you!

I agree with the above.

I’d love it to be but it’s not quite as simple as that. It mainly depends on the walls and shape of the defect which cannot be known till surgically entering the site.

Even once bone graft is placed there is not a guarantee of osseointegration.

As far as re growing gums, you can do gingival grafting as mentioned above. However there is limitations to how much can be augmented - you can look at the Miller recession classification online.

 

[schmoob]

Hello!

I just had a quick clinical question which has been in the back of my mind while treating patients in dental school.
Several of my patients with periodontitis asked me this question: "Can you not use bone graft to grow my bone and gum back?", and in fact I was curious about this too. What can and cannot bone grafts do? What are its limitations?

Thank you!

What exactly do you mean by periodontitis? Are you talking about vertical bone loss and pocketing? Or are you talking about generalized horizontal bone loss one would see in ridge atrophy from edentulism?