Group C. Initiator paper. Periodontal regeneration--fact or fiction?

Numerous techniques have been tried and tested to regenerate tissues lost to periodontal disease. While there has been some success to date, more work is required to move this to a reliable and clinically predictable procedure. Much of the future success for such treatments will rely largely on our understanding of the biology of both developmental and regenerative processes. Nonetheless, despite the noble goal of periodontal regeneration, the relevance of re-creation of a connective tissue attachment has been questioned. Since formation of a long junctional epithelial attachment to the tooth following a variety of periodontal treatment procedures has been shown to be no more susceptible to further breakdown than a non-diseased site, the question arises as to what purpose do we seek the ultimate outcome of periodontal regeneration? The answer lies in the "fact and fiction" of periodontal regeneration. There is no doubt that the regenerative procedures that have been developed can be shown to be biologically successful at the histological level. Furthermore, the results of periodontal regeneration (particularly guided tissue regeneration) have been stable over the long term (at least up to 10 years). However, the techniques currently under use which show the greatest promise (guided tissue regeneration and growth factors) are still clinically unpredictable because of their highly technique-sensitive nature. In addition, whether the slight clinical improvements offered by these procedures over routine open flap debridement procedures are of cost or patient benefit with regards to improved periodontal health and retention of teeth remains to be established. The next phase in regenerative technologies will undoubtedly involve a deeper understanding of the molecular signaling (both intra- and extra-cellular) and cellular differentiation processes involved in the regenerative processes. So in answer to the question of whether periodontal regeneration is fact or fiction, the answer clearly is that it is both. However, with more work it will become established fact with little fiction and the desired clinical endpoint of predictable regeneration of the periodontal tissues damaged by inflammation to their original form and function will be achieved.