Wound healing in the tissues of the periodontium following periradicular surgery: I—the incisional wound

By Harrison JW.

Date: 07/1992
Journal: JOE

 Purpose:

to describe the events of the wound healing response of mucoperiosteal tissues to incisional wounding at postsurgical periods of 1 to 4 days and 14 and 28 days.

Materials and methods:

-n: 4 Rehsus monkeys were included 6 flaps were incorporated in each monkey (sub-marginal flap (Ochsenbein Leubke) and intrasulcular triangular flap) with a total of 26 experimental flaps.

-Each flap was retracted for 15 min with frequent saline irrigation. Flaps were sutured by interrupted plain gut sutures and was allowed to fully absorb.

-The animals were placed on a soft diet supplemented with vit.C and fresh fruit postoperatively for 4 days or until sacrifice. One crushed tablet of Vicodin was added to the food daily for 2 days (or until sacrifice).

-Monkeys were sacrificed and both jaws were sectioned, fixed, and decalcified.  Each flap was divided to 2 blocks (block for vertical incision and a block for a horizontal incision) with a total of 48 blocks. Blocks were embedded, sectioned, and stained with H&E, Masson’s trichrome, and  Snook’s reticulin stain and examined by light microscope.

-Evaluation of the soft tissue wound-healing by 3 aspects: clotting and inflammation, epithelial healing,

and connective tissue healing.

-Summary:

-The healing response of vertical incision were the same between the two flaps

-Healing of horizontal incision of the two flaps differed greatly at earlier post-op period (1-4 days).

-Healing of horizontal incision in the sub-marginal flap varied greatly within the sample.

 Clinical significance:

Healing in this study had positive results because of the vital epithelial and ct at the root surface which provided reattachment to the root surface rather than new attachment (delayed healing + new cementum + require root surface demineralization) and it provided rapid epithelial seal which MPs to populate the wound site. The study’s result was achieved by:

1- retraction of the mucoperiosteal flap at the vertical incision site

2- constant irrigation with saline to not dehydrate the cells

3- no planning was done on the root surface to not remove the cells Failure to do so will delay healing and will create apical epithelial downgrowth (healing by long JE) as the level of epi migration is dependent on the C.t attachment to the cementum.