Aesthetic osseous surgery in the treatment of periodontitis.

Although defect or defect morphology continue to prevail as the basis for treatment in current periodontology, diagnosis must be the basis for periodontal therapy (20). The periodontal therapist should aim at eliminating the causative and contributing factors of the disease. Based on diagnosis, the integration of reparativeproceduresmayleadtodefinitivetreatment,which canhelpmaintaintherapeuticresults(Fig.1)(20). Regeneration of lost periodontal attachment (that is, cementum, periodontal ligament and alveolar bone) remains an important goal of periodontal therapy (5). However, the inductive events, which regulate the differentiation and maturation of the periodontal attachment tissues, are not well understood (30). Considering the complexity of organogenesis in tooth development (32), it may be difficult to perceive that the mere placement of devices such as membranes, allografts and growth factors in a subgingival site is sufficient to induce the formation of original periodontal tissue architecture. ‘‘Regenerative’’ surgical procedures continue to be performed in hopes of an occasional dramatic result. Most such results are observed in isolated areas of the dentition associated with infrequently significant osseous repair. The nature of periodontal attachment after ‘‘regenerative’’ periodontal surgery is proposed to consist of de novo cementogenesis with inserting functional collagen fibers (10). However, ‘‘regeneration’’ of the periodontium may mostly represent a reparative process; that is cemental repair, connective tissue reattachment at those portions of the root not destroyed by periodontal disease or a long junctional epithelium in sites effected by the periodontal lesion (13). The wide range of probing attachment gain obtained after periodontal therapy is probably due to the complexity of the reparative process of periodontal wound healing (37). Partial versus complete destruction of cementum and the occurrence of specific periodontal pathogens (Fig. 1, 2) may in part explain the variability in the reparative potential of periodontal tissues.