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One of the important goals of periodontal therapy is the
restoration of the lost periodontium and conversion of the
periodontitis affected root surface into a substrate, which is
biologically hospitable for epithelial and connective tissue cell
adherence and attachment. An objective of periodontal treatment is
the predictable regeneration of the periodontium in areas
previously affected by periodontal disease. Periodontitis affected
root surfaces show many changes and the root is commonly referred
to as 'pathologically exposed'. The traditional treatment of
pathologically altered root surfaces has relied on mechanical
removal of plaque and calculus, root bound toxins and contaminated
cementum. It is not possible to decontaminate a periodontitis
affected root surface completely by mechanical means alone. The
instrumented surface will inevitably be covered by a smear layer
which is usually comprised of remnants of dental calculus, necrosed
root cementum, flecks of hydroxyapatite crystals, microorganisms
and their products. The root surface serves as a wound margin
during regeneration so it is necessary to rehabilitate the root
surface for cell attachment and fiber insertion.
Growth factors are a class of natural biologic mediators which
regulate key cellular events in tissue repair i.e. cell
proliferation, chemotaxis (directed migration), differentiation and
matrix synthesis via binding to specific cell surface receptors.
The expression of various growth and differentiation factors
following bone and soft tissue injury like what happens in a
periodontal disease may regulate the repair and regeneration
process. The capacity of these mitogenic growth factors to initiate
a programmed cellular cascade that results in the induction of bone
in a functionally conserved process utilized in embryonic
development recapitulated in post fetal osteogenesis and can be
re-exploited for the therapeutic initiation of periodontal tissue
regeneration.
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