Periodontal Wound Healing and Tissue Regeneration: A Narrative Review

Abstract

Periodontal disease is a major public health issue, and various periodontal therapies have been performed to regenerate periodontal tissues. The periodontium is a complex structure composed of specialized tissues that support the teeth, and most periodontal surgeries are invasive procedures, including a resection of the gingiva or the alveolar bone. The periodontal wound healing process is slightly different from cutaneous wound healing and is similar to fetal healing, being almost scar-free. The aim of this review article is to provide an overview of periodontal wound healing and discuss various surgical and pharmaceutical approaches to achieve stable wound healing and improve the treatment outcomes. In addition, detrimental and limiting factors that induce a compromised prognosis are discussed, along with the perspective and future direction for successful periodontal tissue regeneration.

Keywords: periodontal tissue regeneration; periodontium; wound healing.

Figure 1

The structure of periodontium.

Figure 2

Wound healing process. After injury, wound healing begins with the following process: 1. hemostasis and coagulation, 2. inflammation, 3. cell proliferation, and 4. wound remodeling and maturation.

Figure 3

Extraction socket healing. (A) Re-epithelization is in progress at post op. 1 week. (B) Alveolar bone loss is observed after 6 months of socket healing; the convex alveolar bone has become concave (arrow).

Figure 4

GTR. (A) Severe alveolar bone defect around tooth (*) is observed. (B) After cleaning the defect, bone grafting was performed. (C) Preoperative condition observed in radiograph. (D) Postoperative periodontal tissue regeneration was observed in radiograph.

Figure 5

Periodontal dressing application. (A) After tooth extraction, collagen material was applied to the extraction socket. (B) Coe-Pak was applied to the surgical site to protect the wound.