Grafting the future: Saving More Teeth in Practice

Periodontal disease classification in veterinary dentistry is based on the degree of bone loss around tooth roots, with the worst-affected root of a multirooted tooth determining staging. Attachment loss (AL) does not necessarily equal periodontal pocket depth (PP), as root exposure (RE) or gingival enlargement (GE) must also be considered. In cases of root exposure, AL is calculated as PP+RE. For more details, resources are available at: https://tooth.vet/wvc-perio.
Treatment decisions are influenced by patient comorbidities, owner compliance, and tooth size variation. Generally, closed root planing is indicated for PP depths of 1–4 mm, while pockets ≥5 mm often require open flap debridement surgery. This threshold varies with breed size, as normal values differ between large and small dogs. Evidence shows that residual plaque and calculus persist in closed pockets beyond 5 mm, reinforcing the value of open flap approaches. Reliance on local antimicrobials without thorough debridement can also lead to poor outcomes.
Open flap procedures provide key advantages: direct visualization and thorough debridement, removal of diseased pocket lining, improved healing through primary intention, evaluation and treatment of bony defects, and minimal alveolar bone loss during healing. In cases with vertical bone loss—especially on palatal aspects of maxillary canines—intrinsic defects may permit regenerative techniques.
Guided tissue regeneration (GTR) supports regrowth of periodontal ligament, bone, and cementum by excluding gingival soft tissue with a barrier membrane after debridement. Numerous barrier membranes and grafting products are available to veterinary practitioners, with new materials emerging each year. Product knowledge, including biological activity and source, aids in appropriate selection.
Bone grafts differ in biological properties. Osteopromotive materials encourage new bone formation, while osteoconductive surfaces provide scaffolds that enhance cellular attachment and migration. Many grafts combine these properties. Osteoinductive materials release growth factors that stimulate stem cells, while osteogenic grafts contain viable mesenchymal cells capable of directly generating bone, often harvested from the patient’s marrow. Most graft materials lack barrier function, making concurrent membrane use essential for GTR to prevent soft tissue invasion.
In summary, veterinary periodontal management relies on accurate staging, recognition of breed-related variation, and selection of appropriate treatment. Closed root planing is effective for shallow pockets, while open flap surgery ensures thorough debridement and better healing in deeper lesions. Regenerative techniques, including GTR and bone grafting, show promise for restoring lost periodontal support, though material selection requires familiarity with their properties. These strategies form a framework for tailored, evidence-based periodontal therapy in companion animals.