Guided tissue

regeneration

Prepared by : Shrutiba Gohil Guided by : Dr Mayank Parmar Dr Bansari Shah Dr Mayur Parmar

CONTENTS INTRODUCTION INDICATIONS CONTRAINDICATIONS IDEAL PROPERTIES CLASSIFICATION PROCEDURE POST OPERATIVE CONSIDERATIONS CONCLUSION

What is guided tissue regeneration? The method for prevention of epithelial migration

along the cemental wall of the pocket and maintaining space for clot stabilization is a technique called guided tissue regeneration ( GTR ).

GTR consists of placing barriers of different types ( membranes ) to cover the bone & periodontal ligament, thus temporarily separating them from gingival epithelium and connective tissue.

This Method is derieved from the Classic Studies Of Nyman, Lindhe, Karring, & Gottlow and is based on the assumption that only the periodontal ligament cells have the potential for regeneration of attachment apparatus of the tooth.

Excluding the epithelium and the gingival connective tissue from the root surface during the post surgical healing phase not only prevents epithelial migration into the wound but also favors repopulation of the area by the cells from the periodontal ligament and the bone.

Type specific area repopulation theory Melcher in 1976 gave this theory. It stated that the curetted root surface

may be repopulated by 1) epithelial cells. 2) gingival connective tissue cells. 3) bone cells. 4) periodontal ligament cells.

Indications Class 2 furcation. Infra bony defect. Recession defect. To restore PDL attachment in narrow 2 or 3

walled infra bony defect. Alveolar ridge augmentation. Repair of apicocetomy defect.

Contraindications

In cases where flap vascularity will be compromised.

Very severe defect minimal remaining periodontium.

Horizontal defects. In cases of flap perforation.

Ideal properties

It should be bio compatible & or allow tissue regeneration.

It should be non toxic and non cariogenic. It should be chemically inert. It should be able of being sterilized. It should be easy to handle during surgery.

It should be sufficiently rigid so as to maintain a space between it and the root surface.

It should be supplied in different design to suit the specific clinic situation.

It should be easily stored & should have a long shelf life.

It should be easily retrievable in case of complication.

It should be cost effective.

Gottlow’s classification

First generation ( non resorbable ). Second generation ( resorbable ). Third generation

( resorbable with growth factor ).

First generation membranes Millipore filter. Expanded polytetraflouroethylene

membrane ( e – PTFE ). Nucleopore membrane. Rubber dam.

Second generation membrane

Collagen membrane. Poly lactic acid membrane. ( guidor ) Vicryl mesh. Cargile membrane. Oxidized cellulose membrane. Hydrolyzable polyester.

Third generation membrane

They are bio resorbable membrane with added growth factors.

Non bioresorbable membrane It Is biocompatible porous material

possessing two unique microstructure. One is the open microstructure of its collar

which is designed to retard or inhibit the apical proliferation of epithelium through contact inhibition.

The other is occlusive membrane which acts as a barrier to the gingival connective tissue & underlying root surface.

Different shapes and sizes of expanded PTFEa membranes are available.

The use of polytetraflouroethylene membranes has been tested in controlled clinical studies in mandibular molar furcations and has shown statistically significant decreases in pocket depths and in improvement in attachment levels after 6 months but bone level measurements have been inconclusive.

Non bioresorbable membranes are available in four configuration

Wrap around. Interproximal. Single tooth wide. Single tooth narrow.

Bioresorbable membrane

Composed of ploylactic acid bonded with a citric acid ester.

It is designed to provide initial barrier function during the early stages of healing ( minimum of 6 week ) & during later stages, the barrier is slowly resorbed and replaced by the periodontal tissue underlying root surface.

Procedure for placement of the membrane Raise the mucoperiosteal flap with vertical

incisions,extending a minimum of two teeth anteriorly and one tooth distally to the tooth being treated.

Debride the osseous defect & thoroughly plane the roots.

Trim the membrane to the approximate size of the area being treated. The apical border of the material should extend 3 to 4 mm apical to the margin of the defect & laterally 2 to 3 mm beyond the defect.

The occlusal border of the membrane should be placed 2 mm apical to the cementoenamel junction.

Suture the membrane tightly around the tooth with a sling suture.

Suture the flap back in its original position or slightly coronal to it, using independent sutures interdentally and in the vertical incisions.

The flap should cover the membrane completely.

Postoperative considerations

Peridox mouthwash should be given for 10 days and if the material becomes exodontia, Peridox should be used untill removal.

Antibiotic coverage (7 to 10 days) Tetracycline 250 mg q.i.d. Doxycycline 100 mg b.i.d. Use of periodontal dressing is optional.

Flossing at the treatment site is to be avoided while material is in place.

The patient should be seen biweekly if there is no exposure & weekly if exposure is present.

Do not attempt to cover the previously exposed material.

The material should be removed immediately if any complication develops.

CONCLUSION

Guided tissue regeneration as a procedure attempt regeneration through differential tissue responses.

It concluded that GTR was not an experimental procedure & that is showed predictability for connective tissue attachment in infra bony defect & in grade 2 furcation involvement.