oral wound healing (larjava/oral wound healing) || front matter
TRANSCRIPT
Oral Wound HealingCell Biology and Clinical Management
Edited by
Hannu LarjavaProfessor and Chair, Division of PeriodonticsFaculty of DentistryUniversity of British ColumbiaVancouverBC, Canada
A John Wiley & Sons, Ltd., Publication
Larjava_ffirs.indd iiiLarjava_ffirs.indd iii 2/3/2012 12:50:13 PM2/3/2012 12:50:13 PM
This edition fi rst published 2012 by John Wiley & Sons, Inc
© 2012 John Wiley & Sons, Inc
Wiley-Blackwell is an imprint of John Wiley & Sons, Inc formed by the merger of Wiley’s global Scientifi c,
Technical and Medical business with Blackwell Publishing.
Registered Offi ceJohn Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
Editorial Offi ces2121 State Avenue, Ames, Iowa 50014-8300, USA
The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
9600 Garsington Road, Oxford, OX4 2DQ, UK
For details of our global editorial offi ces, for customer services and for information about how to
apply for permission to reuse the copyright material in this book please see our website at
www.wiley.com/wiley-blackwell.
Authorization to photocopy items for internal or personal use, or the internal or personal use of specifi c clients,
is granted by Blackwell Publishing, provided that the base fee is paid directly to the Copyright Clearance Center,
222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license
by CCC, a separate system of payments has been arranged. The fee codes for users of the Transactional
Reporting Service are ISBN-13: 978-0-8138-0481-1/2007.
Designations used by companies to distinguish their products are often claimed as trademarks. All brand names
and product names used in this book are trade names, service marks, trademarks or registered trademarks of
their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This
publication is designed to provide accurate and authoritative information in regard to the subject matter covered.
It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional
advice or other expert assistance is required, the services of a competent professional should be sought.
Library of Congress Cataloging-in-Publication Data
Oral wound healing : cell biology and clinical management / edited by Hannu Larjava.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-8138-0481-1 (hardcover : alk. paper)
I. Larjava, Hannu.
[DNLM: 1. Periodontal Diseases–rehabilitation. 2. Mouth–injuries. 3. Oral Surgical
Procedures–rehabilitation. 4. Wound Healing. WU 240]
617.6′32–dc23
2011042663
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be
available in electronic books.
Set in 10/12pt Times by SPi Publisher Services, Pondicherry, India
1 2012
Larjava_ffirs.indd ivLarjava_ffirs.indd iv 2/3/2012 12:50:13 PM2/3/2012 12:50:13 PM
Contents
Contributors xiii
Preface xvii
1 Oral Wound Healing: An Overview 1 Hannu Larjava
Clotting and inflammation (chapters 2, 3 and 4) 1
Re-epithelialization and granulation tissue formation (chapters 5 and 6) 2
Angiogenesis (chapter 7) 3
Healing of extraction sockets (chapter 8) 4
Flap design for periodontal wound healing (chapter 9) 4
Regeneration of periodontal tissues (chapters 10 and 11) 5
Osteointegration and soft tissue healing around
dental implants (chapter 12) 6
The pulp healing process (chapter 13) 7
Dermal wound healing and burn wounds (chapter 14) 7
Healing of large dentofacial defects (chapter 15) 8
References 9
2 Hemostasis, Coagulation and Complications 11 Carol Oakley and Hannu Larjava
Introduction 11
Primary hemostasis 12
Secondary hemostasis and the coagulation system 13
Tertiary hemostasis 16
Tissue factor 16
Von willebrand factor 17
Other coagulation factors 17
Cell-centric model of hemostasis: from initiation to propagation 18
The procoagulant membrane 20
Membrane particles 22
Endothelium and hemostasis 22
Pro- and anticoagulant functions 22
Platelets 24
Coagulation and wound healing 26
Limitations of the waterfall cascade model and screening laboratory tests 26
Implications for laboratory tests 27
Larjava_ftoc.indd vLarjava_ftoc.indd v 2/14/2012 5:31:55 PM2/14/2012 5:31:55 PM
vi Contents
Pre-surgical evaluation to prevent bleeding problems 27
Medical history 27
Diet and herbal supplements 29
Clinical examination 29
Presurgical planning 30
Control of intra-operative/primary bleeding 30
Post-operative/secondary bleeding 31
Conclusions 32
References 32
3 Inflammation and Wound Healing 39 Anna Turabelidze and Luisa Ann DiPietro
Introduction 39
The innate immune response in wounds 39
Inflammatory cell infiltration into wounds 40
Inflammatory cell function in wounds 41
Neutrophils 41
Mast cells 42
Macrophages 43
T lymphocytes 43
Gamma delta T-cells or dentritic epidermal T-cells (DETCs) 44
Cytokines and chemokines in wounds 44
Interleukin-1 (IL-1) 45
Interleukin-6 (IL-6) 45
Interleukin-8 (IL-8 or CXCL8) 45
Tumor necrosis factor (TNF alpha) 46
Macrophage chemoattractant protein (MCP-1 or CCL2) 46
Interferon inducible protein 10 (IP-10 or CXCL10) 46
Stromal cell-derived factor (SDF-1 or CXCL12) 46
Transforming growth factor-beta (TGF-b) 47
Inflammation in oral mucosal wounds 47
Inflammation in fetal wounds 48
Role of inflammation in keloids 49
Inflammation and diabetic wounds 49
Conclusions 50
References 50
4 Specialized Pro-resolving Lipid Derived Fatty Acid Mediators: Wiring the Circuitry of Effector Immune Homeostasis 57
Gabrielle Fredman and Charles N. Serhan
Inflammation: the cardinal signs 57
Complete resolution and tissue homeostasis is the ideal
outcome of acute inflammation 58
Lipoxins, resolvins, protectins and maresins: semper vigilantes
of anti-inflammation and pro-resolution 60
Lipoxins 62
Resolvins 62
Larjava_ftoc.indd viLarjava_ftoc.indd vi 2/14/2012 5:31:55 PM2/14/2012 5:31:55 PM
Contents vii
Protectins 65
Maresins 65
Resolution of inflammation is an actively regulated
process in vivo 66
Resolvins and protectins are protective in experimental
models of inflammatory diseases 67
Specialized pro-resolving lipid mediators in oral medicine:
restoration of tissue homeostasis in experimental periodontitis 70
Resolution and wound healing 72
Anti-inflammation vs. Pro-resolution 72
Resolution toxicity 73
Clinical implications and the development of stable analogs 74
Conclusions 74
Acknowledgments 75
References 75
5 Re-epithelialization of Wounds 81 Leeni Koivisto, Lari Häkkinen and Hannu Larjava
Introduction 81
Keratinocytes form a protective barrier between an organism
and its environment 81
Keratinocytes are activated rapidly to restore the epithelial
barrier after wounding 82
Many different factors contribute to re-epithelialization 84
Keratinocytes become exposed to novel extracellular matrix molecules in wounds 85
Integrins are signaling molecules that mediate cell adhesion to extracellular matrix and cell migration 87
Cytokines and growth factors are important mediators of wound healing 95
Serine proteases and matrix metalloproteinases modulate extracellular matrix and generate biologically active molecules 102
Levels of divalent cations in the wound fluid affect re-epithelialization 105
Wound-induced electrical field directs re-epithelialization 106
Final stages of re-epithelialization 106
Failure to re-epithelialize: chronic wounds 107
Conclusions 107
References 108
6 Granulation Tissue Formation and Remodeling 125 Lari Häkkinen, Hannu Larjava and Leeni Koivisto
Introduction 125
Overview of connective tissue response to wounding 126
Wound healing stages 129
Origin and identity of wound fibroblasts 129
Granulation tissue formation 134
Larjava_ftoc.indd viiLarjava_ftoc.indd vii 2/14/2012 5:31:55 PM2/14/2012 5:31:55 PM
viii Contents
Activation of connective tissue cells 135
Cell proliferation 138
Cell migration 141
Matrix deposition and wound contraction 144
Transforming growth factor-b 149
Connective tissue remodeling 151
Downregulation of cell proliferation and cellularity 152
ECM degradation 152
ECM reorganization and increased stability by collagen cross-linking 154
Downregulation of ECM production 155
Re-emergence of quiescent fibroblast phenotype 156
Specific features of oral mucosal wound healing 157
Conclusions 159
Acknowledgments 159
References 159
7 Angiogenesis and Wound Healing: Basic Discoveries, Clinical Implications and Therapeutic Opportunities 175
Peter J. Polverini
Introduction 175
How blood vessels develop 175
Early mechanistic insights into the angiogenic response:
from solid tumors to chronic inflammation and wound healing 177
The role of other inflammatory cells in angiogenesis 179
Matrix molecules 180
Vascular endothelial growth factor and the modern era
of angiogenesis research 181
Signaling networks of potential importance in wound
neovascularization 182
Inhibitors of angiogenesis: important counterweights in wound
neovascularization 184
The role of aberrant wound angiogenesis in the pathogenesis
of diabetes mellitus 186
Conclusions 187
References 188
8 Wound Healing of Extraction Sockets 195 Roberto Farina and Leonardo Trombelli
Healing of extraction sockets 195
Histological aspects 195
Clinical aspects 199
Factors influencing the healing of extraction sockets 202
Smoking 202
Flapless tooth extraction 202
Location of the edentulous site 202
Larjava_ftoc.indd viiiLarjava_ftoc.indd viii 2/14/2012 5:31:55 PM2/14/2012 5:31:55 PM
Contents ix
Single versus multiple extractions 203
Chlorhexidine mouth rinse following tooth extraction 203
Healing of extraction sockets following immediate implant placement 203
Histological aspects 204
Clinical aspects 204
Healing determinants of extraction sockets after immediate implant placement 206
Does the use of reconstructive technologies alter the healing
of extraction sockets? 211
Graft materials 211
Barrier membranes 215
Bioactive agents 216
Combination of different reconstructive technologies 217
Conclusions 223
References 223
9 Flap Designs for Periodontal Healing 229 Leonardo Trombelli and Roberto Farina
Flap management, wound stability and periodontal regeneration 229
Flap designs to achieve primary closure 230
Techniques without preservation of the interdental supracrestal soft tissues and with double flap elevation 230
Techniques with preservation of the interdental supracrestal soft tissues and with double flap elevation 231
Techniques with preservation of the interdental supracrestal soft tissues and with a single flap elevation: the Single Flap Approach 233
Surgical treatment of periodontal intraosseous defects:
technical hints 237
Conclusions 240
References 241
10 Periodontal Regeneration: Experimental Observations – Clinical Consequences 243
Ulf M.E. Wikesjö, Cristiano Susin, Jaebum Lee,
Douglas P. Dickinson and Giuseppe Polimeni
Introduction 243
Wound healing 244
Periodontal wound healing 245
Periodontal regeneration – new attachment 247
Wound stability 248
Space provision 251
Wound closure for primary intention healing 256
Conclusions 256
Acknowledgment 257
References 257
Larjava_ftoc.indd ixLarjava_ftoc.indd ix 2/14/2012 5:31:55 PM2/14/2012 5:31:55 PM
x Contents
11 Biological Agents and Cell Therapies in Periodontal Regeneration 261 Hannu Larjava, Yi Yang, Edward Putnins, Jyrki Heino
and Lari Häkkinen
Introduction 261
Adjunct growth factors in periodontal wound repair 261
PDGF and IGF-1 in periodontal regeneration 262
Platelet-rich plasma in periodontal therapy 265
FGF-2 in periodontal regeneration 265
Growth and differentiation factor-5 in periodontal regeneration 266
Other growth factors in periodontal regeneration 267
Bioactive collagen-derived peptide in periodontal
regeneration (PepGen P-15®) 267
Enamel matrix proteins in periodontal regeneration and
wound healing 269
Stem cells in periodontal wound healing 273
Conclusions 275
References 275
12 Wound Healing Around Dental Implants 287 Cristina Cunha Villar, Guy Huynh-Ba, Michael P. Mills
and David L. Cochran
Introduction 287
Historical development 287
Titanium – the metal of choice 290
Healing following implant placement 291
Peri-implant soft tissue healing 291
Implant/peri-implant mucosa interface 292
Peri-implant hard tissue healing 294
From healing to clinical application 296
Implant stability testing 297
Destructive methods 297
Non-destructive methods 298
Wound healing and loading protocols 302
Conclusions 303
References 304
13 The Pulp Healing Process: From Generation to Regeneration 313 Stéphane Simon, Anthony J. Smith, Philip J. Lumley,
Paul R. Cooper, and Ariane Berdal
From generation to regeneration 313
The dentine–pulp complex 314
The odontoblast: a key cell for regenerative endodontics 316
Pulpal responses to injury 320
At the molecular level 323
Reparative dentinogenesis and pulp capping 324
Conclusion 328
References 328
Larjava_ftoc.indd xLarjava_ftoc.indd x 2/14/2012 5:31:56 PM2/14/2012 5:31:56 PM
Contents xi
14 Dermal Wound Healing and Burn Wounds 333 Anthony Papp
Introduction 333
Burn injury 333
Skin anatomy 334
Epidermis 334
Dermis 335
Skin vasculature 335
Skin appendages and subcutaneous fat 336
Burn depth 336
Epidermal burns 337
Dermal burns 337
Full thickness burns 338
Wound healing 338
Treatment 340
Conservative treatment 340
Surgical treatment 341
Special features in perioral burns 342
Conclusions 343
References 344
15 Healing of Large Dentofacial Defects 347 George K.B. Sándor, Robert P. Carmichael, Leena P. Ylikontiola,
Ahmed Jan, Marc G. DuVal and Cameron M.L. Clokie
Introduction 347
The need for bone 349
Bone healing 349
Primary bone healing 349
Secondary bone healing 349
Gap osseous healing and bone grafts 350
Growth factors 350
Blood supply and the soft tissue envelope 351
Vasculoendothelial growth factor (VEGF) effects 351
Angiogenesis 352
Surgical maneuvers to induce and promote healing of
large defects 355
Periosteal healing 355
Tent pole procedures 355
Sinus lifting/lateral ridge augmentation 359
Hyperbaric oxygen therapy (HBOT) 371
Distraction osteogenesis 372
The distracting dental implant 377
Guidance of implant placement 378
Tissue engineering with growth factors BMPs and VEGF 378
Tissue engineering with stem cells and growth factors 381
The field of tissue engineering 381
Sources of stem cells 381
Stimulating stem cells 381
Larjava_ftoc.indd xiLarjava_ftoc.indd xi 2/14/2012 5:31:56 PM2/14/2012 5:31:56 PM
xii Contents
Manipulating the construct 382
Future directions 382
Specifically difficult wounds 383
Maxillectomy cavities 383
Wound infections necrotizing fasciitis 387
Conclusions 391
References 392
Index 397
Larjava_ftoc.indd xiiLarjava_ftoc.indd xii 2/14/2012 5:31:56 PM2/14/2012 5:31:56 PM
Editor
Hannu Larjava, DDS, PhD, Dip Perio
Professor and Chair, Division
of Periodontics
Faculty of Dentistry
University of British Columbia
Vancouver, BC, Canada
Contributors
Ariane Berdal, DDS, MPhil, DSc
Centre de Recherche des Cordeliers
Physiologie Orale Moléculaire
Paris, France
Robert P. Carmichael, DMD, MSc,
FRCDC
Chief of Dentistry, Bloorview Kids Rehab
Director, Ontario Cleft Lip and Palate
Program
Co-ordinator of Prosthodontics, Hospital
for Sick Children
Assistant Professor, University of Toronto
Toronto, Ontario, Canada
Cameron M.L. Clokie, DDS, PhD,
FRCDC
Professor and Director of Graduate
Program in Oral and Maxillofacial
Surgery and Anaesthesia
University of Toronto
Toronto, Ontario, Canada
David L. Cochran, DDS, MS, PhD, MMSci
Chair and Professor
Department of Periodontics
University of Texas Health Science
Center at San Antonio
San Antonio, TX, USA
Paul R. Cooper, BSc, PhD
Senior Lecturer in Molecular Biology
Oral Biology
School of Dentistry
University of Birmingham
St Chad’s Queensway
Birmingham, UK
Douglas P. Dickinson, PhD
Associate Professor
Department of Oral Biology
Georgia Health Sciences University
College of Dental Medicine
Augusta, Georgia, USA
Luisa Ann DiPietro, DDS, PhD
Professor and Director
Center for Wound Healing
and Tissue Regeneration
College of Dentistry
University of Illinois at Chicago
Chicago, IL, USA
Marc G. DuVal, DDS
Chief Resident, Graduate Program
in Oral and Maxillofacial Surgery
and Anaesthesia
University of Toronto
Toronto, Ontario, Canada
Roberto Farina, DDS, PhD, MSc
Research Assistant
Research Centre for the Study
of Periodontal and Peri-implant Diseases
University of Ferrara
Ferrara, Italy
Contributors
Larjava_fbetw.indd xiiiLarjava_fbetw.indd xiii 2/15/2012 6:00:01 PM2/15/2012 6:00:01 PM
xiv Contributors
Gabrielle Fredman, PhD
Post Doctoral Fellow
Center for Experimental Therapeutics
and Reperfusion Injury
Department of Anesthesiology,
Perioperative, and Pain Medicine
Brigham and Women’s Hospital/Harvard
Medical School
Boston, Massachusetts, USA
Lari Häkkinen, DDS, PhD
Associate Professor
Laboratory of Periodontal Biology
Department of Oral Biological
and Medical Sciences
Faculty of Dentistry
University of British Columbia
Vancouver, BC, Canada
Jyrki Heino, MD, PhD
Professor
Department of Biochemistry
and Food Chemistry
University of Turku
Turku, Finland
Guy Huynh-Ba, DDS, Dr Med Dent, MS
Assistant Professor
Department of Periodontics
University of Texas Health Science
Center at San Antonio
San Antonio, TX, USA
Ahmed Jan, DDS
Chief Resident in Oral and Maxillofacial
Surgery and Anesthesia
University of Toronto
Toronto, Canada
Leeni Koivisto, PhD
Research Associate
Laboratory of Periodontal Biology
Department of Oral Biological
and Medical Sciences
Faculty of Dentistry
University of British Columbia
Vancouver, BC, Canada
Jaebum Lee, DDS, MSD, PhD
Chief Clinical Scientist
Laboratory for Applied Periodontal
and Craniofacial Regeneration
Departments of Periodontics
and Oral Biology
Georgia Health Sciences University
College of Dental Medicine
Augusta, Georgia, USA
Philip J. Lumley, DDS, PhD
Director and Head
The School of Dentistry
University of Birmingham
Birmingham, UK
Michael P. Mills, DMD, MS
Clinical Associate Professor
Department of Periodontics
University of Texas Health Science
Center at San Antonio
San Antonio, TX, USA
Carol Oakley, DDS, MSc, PhD
Clinical Associate Professor
Department of Oral Biological
and Medical Sciences
Faculty of Dentistry
University of British Columbia
Vancouver, BC, Canada
Anthony Papp, MD, PhD, FRCSC
Medical Director BC Professional
Firefi ghters’ Burn,
Plastic and Trauma Unit
Vancouver General Hospital
Vancouver, BC,
Canada
Giuseppe Polimeni, DDS, MS
Clinical Associate Professor, Senior
Clinical Scientist
Laboratory for Applied Periodontal
and Craniofacial Regeneration
Departments of Periodontics
and Oral Biology
Medical College of Georgia School
of Dentistry
Augusta, Georgia, USA
Larjava_fbetw.indd xivLarjava_fbetw.indd xiv 2/15/2012 6:00:01 PM2/15/2012 6:00:01 PM
Contributors xv
Peter J. Polverini, DDS, DMSc
Professor and Dean
University of Michigan
School of Dentistry
Ann Arbor, Michigan, USA
Edward Putnins, PhD, DMD, Dip Perio,
MSC, MRCD(C)
Associate Dean Research, Graduate
and Post Graduate Studies
University of British Columbia
Faculty of Dentistry
Department of Oral Biological
and Medical Sciences
Vancouver, BC, Canada
George K.B. Sándor, MD, DDS, PhD,
Dr Habil, FRCDC, FRCSC, FACS
Professor of Tissue Engineering
Regea Institute for Regenerative
Medicine
University of Tampere
Tampere, Finland
Professor of Oral and Maxillofacial
Surgery
University of Oulu
Oulu, Finland
Charles N. Serhan, PhD
The Simon Gelman Professor
of Anaesthesia (Biochemistry
and Molecular Pharmacology) Harvard
Medical School
Director, Center for Experimental
Therapeutics and Reperfusion
Injury
Department of Anesthesiology,
Perioperative, and Pain Medicine
Brigham and Women’s Hospital
Professor, Harvard School of Dental
Medicine, Oral Medicine, Infection
and Immunity
Boston, Massachusetts, USA
Stéphane Simon, DDS, PhD
Maitre de Conférence Hospitalo-
Universitaire
Department of Oral Biology
University of Paris Diderot
Paris, France
Groupe Hospitalier Pitié
Salpétrière
Paris, France
Associate Researcher
University of Birmingham
Birmingham, UK
Anthony J. Smith, PhD
Professor in Oral Biology
School of Dentistry
University of Birmingham
Birmingham, UK
Cristiano Susin, DDS, MSD, PhD
Associate Professor of Periodontics,
Oral Biology and Graduate Studies
Associate Director, Laboratory
for Applied Periodontal and
Craniofacial Regeneration
Director, Clinical Research
Georgia Health Sciences University
College of Dental Medicine
Augusta, Georgia, USA
Leonardo Trombelli, DDS, PhD,
Professor and Director, Research
Centre for the Study of Periodontal
and Peri-implant Diseases
Director, Dental Clinic,
University Hospital
University of Ferrara
Ferrara, Italy
Anna Turabelidze, BS
Center for Wound Healing and Tissue
Regeneration
College of Dentistry
University of Illinois at Chicago
Chicago, IL, USA
Larjava_fbetw.indd xvLarjava_fbetw.indd xv 2/15/2012 6:00:01 PM2/15/2012 6:00:01 PM
xvi Contributors
Cristina Cunha Villar, DDS, MS, PhD
Assistant Professor
Department of Periodontics
University of Texas Health Science
Center at San Antonio
San Antonio, TX, USA
Ulf M.E. Wikesjö, DDS, DMD, PhD,
Diplomate ABP
Professor, Director
Laboratory for Applied Periodontal and
Craniofacial Regeneration
Departments of Periodontics and Oral
Biology
Georgia Health Sciences University
College of Dental Medicine
Medical College of Georgia School of
Dentistry
Augusta, Georgia, USA
Yi Yang, DDS, MSD, MSC, PhD
University of British Columbia
Vancouver, BC, Canada
Leena P. Ylikontiola, MD, DDS, PhD
Assistant Professor, Institute of Dentistry
University of Oulu
Co-ordinator of Cleft Lip and Palate
Surgery
Oulu University Hospital
Oulu, Finland
Larjava_fbetw.indd xviLarjava_fbetw.indd xvi 2/15/2012 6:00:01 PM2/15/2012 6:00:01 PM
Our understanding about wound healing has vastly increased over the last decade. Currently,
the PubMed search with the words ‘wound healing’ results in almost a hundred thousand
citations. These publications range from basic science to clinical studies and cover multiple
disciplines in biology and medicine. Explosion of new knowledge makes it difficult to pro-
cess the information and condense it into meaningful concepts. The goal of this book was to
filtrate the massive information to summaries of wound healing topics that were written by
experts in the field. These experts covered not only their own endeavors but also the science
at large in their topic area.
At the time of planning this book, there was no comprehensive book covering recent
advancements in the field of oral wound care. Wound healing books covering healing of skin
and other organs existed and had been extremely successful for dermatologists, wound heal-
ing researchers and other health professionals. Wounds are common in oral cavity, ranging
from wounds on pulp tissue after tooth preparation to those caused by surgical procedures
on soft tissue and bone. Oral wound care has several special features and covers unique
processes such as soft tissue healing, healing of bone and extraction socket, regeneration of
periodontal structures and healing around dental implants. Although many of these pro-
cesses have been described in review articles over the years, there was no reference material
(book) that covered the entire topic of oral wound healing. This book is the first one that
focuses on wound healing in the oral cavity.
This book is intended for a diverse audience, from clinicians to wound healing students.
The topics of the book can be useful especially for residents and graduate students who are
in training programs aimed at surgical management of oral tissues (such as oral surgery,
periodontics, endodontics and oral medicine) and for oral biology or other researchers who
are investigating wound healing. In addition, undergraduate students and general practition-
ers who are advancing their training in surgical sciences would also benefit from the infor-
mation presented in this book.
Oral Wound Healing is divided into 15 chapters. The first seven chapters cover the fun-
damentals of wound healing and they are organized to reflect the sequence of wound healing
events, starting from blood clotting and ending with angiogenesis. The last eight chapters
cover more clinical aspects of wound healing, ranging from healing of extraction sockets to
large craniofacial defects.
I would like to express my deep gratitude to the contributors, without whom this book
would have never seen completion. I would also like to thank Ms Melissa Wahl for patiently
waiting for the final work and for John Wiley & Sons, Inc. for publishing the book.
Preface
Larjava_fpref.indd xviiLarjava_fpref.indd xvii 2/3/2012 12:50:05 PM2/3/2012 12:50:05 PM