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Periodontal tissue response, healing and monitoring
Figure 22.1 Healing of the periodontal tissues. GCF, gingival crevicular fluid.
Figure 22.2 (a) A periodontal lesion before treatment. (b) Early healing of a periodontal pocket. (c) Further healing of a periodontal pocket.
Figure 22.3 Indices for monitoring the response to periodontal therapy.
Figure 22.4 Decision making following monitoring the response to periodontal therapy.
Following oral hygiene measures and root surface debridement there are two potential outcomes:
1 The tissue may respond by healing.
2 The tissue may fail to heal.
Following thorough root surface debridement and implementation of good oral hygiene, changes will occur in the bacterial flora and periodontal tissues.
Bacterial flora
There is a reduction in the total numbers of microorganisms in the periodontal pockets. The residual bacterial flora shifts from predominantly Gram-negative anaerobic to one that is largely Gram-positive aerobic and associated with periodontal health, partly because of the reduction in plaque bulk allowing in higher oxygen concentrations within the plaque.
Tissue response and healing
The response to root surface debridement is summarised in Figs 22.1 and 22.2. As the periodontal tissue heals there is a reduction in redness and swelling and the tissue becomes pink and firm. Clinically it feels more fibrous and the gingival cuff tightens. Bleeding on probing and suppuration subsides.
A reduction in pocket depths results from a combination of events:
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