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Principles of new attachment

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Cing Sian Dal
Cing Sian Dal

The document outlines principles of new attachment after periodontal treatment: 1) Complete removal of epithelial attachment and granulation tissue from the soft tissue wall to create a healthy connective tissue wall. 2) Thorough removal of pathologic cementum and creation of a biologically acceptable root surface through root planing. 3) Tight adaptation and immobilization of the soft tissue wall to the root surface during healing to facilitate new attachment. 4) Effective pre- and post-surgical plaque control to optimize healing and new attachment formation.

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Principles of New Attachment 1. Proper preparation of the soft tissue wall Complete removal of Epithelial attachment Epithelial lining of the pocket Granulation tissue (inflammatory cells and altered connective tissues) Resulting in a healthy, densely collagenous, basically non-inflammed connective tissue wall with epithelium only at its coronal crest. If epithelial attachment remains, it will be joined by proliferating epithelium from the adjacent gingiva epithelial barrier between the healing soft tissue and the root surface 2. Proper preparation of the root surface Changes in cementum diseased cementum A. Structural changes i. Presence of pathologic granules ii. Areas of increased mineralization iii. Areas of demineralization Degeneration of remnants of Sharpys fibers Softened cementum B. Chemical changes Increased mineral content of exposed cementum Absorbed materials may be toxic C. Cytotoxic changes Bacterial penetration into the cementum Embedded endotoxins in the cementum Creation of biologically acceptable root surface is of prime importance. Through root planing is essential 3. Proper preparation of the soft tissue to the root surface Tight adaptation Immobilization during healing period Intimate contact of the connective tissue of the gingival wall to the root surface new attachment. Coronal epithelium sealto protect against plaque formation. Immobilization by mean of sutures, pressure and dressings.
4. Effective etiology control pre-surgically and post-surgically Effective plaque control essential for optimal healing leading to maximum new attachment. Periodontal procedures to achieve newattachment 1. Subgingival curettage 2. GTR 3. Excisional new attachment procedure 4. Modified excisional new attachment procedure 5. Access flap operation

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Principles of new attachment

  • 1. Principles of New Attachment 1. Proper preparation of the soft tissue wall Complete removal of Epithelial attachment Epithelial lining of the pocket Granulation tissue (inflammatory cells and altered connective tissues) Resulting in a healthy, densely collagenous, basically non-inflammed connective tissue wall with epithelium only at its coronal crest. If epithelial attachment remains, it will be joined by proliferating epithelium from the adjacent gingiva epithelial barrier between the healing soft tissue and the root surface 2. Proper preparation of the root surface Changes in cementum diseased cementum A. Structural changes i. Presence of pathologic granules ii. Areas of increased mineralization iii. Areas of demineralization Degeneration of remnants of Sharpys fibers Softened cementum B. Chemical changes Increased mineral content of exposed cementum Absorbed materials may be toxic C. Cytotoxic changes Bacterial penetration into the cementum Embedded endotoxins in the cementum Creation of biologically acceptable root surface is of prime importance. Through root planing is essential 3. Proper preparation of the soft tissue to the root surface Tight adaptation Immobilization during healing period Intimate contact of the connective tissue of the gingival wall to the root surface new attachment. Coronal epithelium sealto protect against plaque formation. Immobilization by mean of sutures, pressure and dressings.
  • 2. 4. Effective etiology control pre-surgically and post-surgically Effective plaque control essential for optimal healing leading to maximum new attachment. Periodontal procedures to achieve newattachment 1. Subgingival curettage 2. GTR 3. Excisional new attachment procedure 4. Modified excisional new attachment procedure 5. Access flap operation