WOUND HEALING.pptxbbbbbbbbbbbbbbbbbbbbbbbbbbb

1. WOUND HEALING Dr. A ebeena babu Post graduate

2. WHAT IS HEALING?? Healing is the body response to restore normal structure & function Healing refers to replacement of damaged tissue by living tissue to restore function.

3. Objectives of wound healing Epithelial regeneration -results in scarring and replacement by a similar type tissue Connective tissue repair- replacement of the lost tissue by granulation tissue

4. Factors affecting healing Location of wound (vascularity, mobility) Physical factors (trauma, temp, radiation) Circulatory factors (anemia, dehydration ) Nutritional factors (protein, vitamins, minerals ) Age Infection Hormonal factors (corticosteroids, DM etc ) Miscellaneous factors (suture materials, chemical tissue adhesives)

5. COMPLICATIONS Infection : infection of the wound delay the healing process. common in maxillofacial trauma cases

6. Keloid and hypertrophic scar formation: keloid are overgrown scar tissues with no tendency for resolution. occurs in wounds ,which heal without any complications. common site: chest , back, and shoulders Hypertrophy scar occurs in wound where healing is delayed. more cellular and vascular

7. Pigmentary changes: H ypopigmentation or hyper pigmented area

8. Implantation cyst: Epithelial cells may slide or get entrapped into the wound and later they form implantation cyst.

9. Cicatrization Late reduction in the size of the scar in contrast to wound contraction

10. HEALING OF EXTRACTION WOUND

11. HEALING OF EXTRACTION WOUND Five stages : Immediate reaction First week Second week Third week Fourth week

12. Immediate Reaction Blood filled socket coagulation Fibrin meshwork, entrapped RBC Ends of torn blood vessels in PDL get sealed off 24-48 hours- vasodilation, engorged blood vessels, leukocytes mobilized

13. First week epithelium begins to cover its surface Clot acts as scaffold for healing process, cells migrate here Clot replaced by granulation tissue, Resorption on crest of alveolar bone Proliferation of fibroblasts Endothelial cell proliferation, organization of clot

14. Second week Epithelialization complete in small sockets Clot becomes organized, Osteoid trabeculae extend outwards from wall of alveolus Fragments of necrotic bone get resorbed/sequestrated PDL degenerates

15. Third week Epithelialization complete in all sockets Clot organization complete New osteoid forming around periphery of socket Cortical bone of alveolus undergoes remodeling rounding of crest

16. Fourth week Deposition and remodeling of bone. Early stages --Poorly calcified bone radiolucent. Radiographic evidence of bone formation does not become evident until 6-8 weeks after extraction. Crest of healed socket lies lower than adjacent teeth. Surgical extraction buccal and lingual cortical plates destroyed.

17. Immediate Reaction First week Second week Third week Fourth week Blood filled socket epithelium begins to cover its surface Epithelialization complete in small sockets Epithelialization complete in all sockets Fibrin meshwork, entrapped RBC Clot replaced by granulation tissue Clot becomes organized Clot organization complete Deposition and remodeling of bone Endothelial cell proliferation, organization of clot Proliferation of fibroblasts. Endothelial cell proliferation, organization of clot Necrotic bone get resorbed Osteoid trabeculae extend outwards from wall of alveolus Clot organization complete New osteoid forming around periphery of socket Radiographic evidence of bone formation does not become evident until 6-8 weeks after extraction

18. Complications Dry Socket Fibrous healing

19. Dry socket Synonyms : Alveolitis sicca dolorosa, Alveolalagia , Alveolar osteitis Definition : A focal osteomyelitis in which the blood clot has disintegrated or been lost with the production of foul odor, severe pain but no suppuration Etiology Difficult / traumatic extractions Mostly common impacted third molars

20. Pathogenesis Trauma/ infection inflammation of bone marrow release of tissue activators plasminogen to plasmin (fibrinolysis) releases kinins PAIN

21. Microbiology Fusiform bacilli, Vincent’s spirochetes C/F Throbbing ache caused by thermal and chemical irritation Symptoms start on 3rd or 5th day after extraction If untreated last for 7-14 days Foul odour , socket generally empty. May contain partially necrotic blood clot Treatment Relief of pain Palliative