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PubMed1991

Regeneration procedures: grafting materials, guided tissue regeneration, and growth factors.

Flap debridement, bone grafting, and guided tissue regeneration have the capacity of regenerating bone, periodontal ligament, and cementum. Alloplastic materials are used to fill periodontal defects, and healing occurs by repair. While varying amounts of new bone may form with allografts, a long junctional epithelium is usually the mode of attachment. Flap debridement has been reported to successfully treat multiple walled intrabony defects. Healing results in bone regeneration. However, there is probably a long junctional epithelium adjacent to the root. Defects treated by guided tissue regeneration have been demonstrated to heal with new cementum, periodontal ligament, and bone. Recently, growth factors have been discussed as a possible means of enhancing wound healing.

Bone Transplantation↗
PubMed1991

Bone regeneration using the principle of guided tissue regeneration.

The biological principle of "guided tissue regeneration" (GTR) was developed for regenerating periodontal tissues, lost as a result of periodontal disease. This principle was based on the hypothesis that non-desirable types of tissue cells can be prevented from migrating into a wound by means of a membrane barrier and at the same time giving preference to those particular cells to repopulate the wound, which have the capacity to regenerate the desired type of tissue. This principle may have its application in many areas of surgery, aimed at regeneration of lost tissues. One such area is osseous surgery aimed at bone regeneration. In the present paper, a series of experiments in laboratory animals using the method of GTR for regeneration of various types of bone defects are presented as well as examples of application in humans for regeneration of jaw bone defects in conjunction with the placement of dental implants.

Alveolar Process↗
PubMed1990

Migration of epithelial cells on materials used in guided tissue regeneration.

Materials used in guided tissue regeneration were examined in an in vitro model for regenerating human junctional epithelium. The extent of epithelial migration from gingival explants (epibolus) between the explant and an experimental substratum was significantly greater with a Millipore filter (HA) than with a teflon membrane (Biopore; BO) and a teflon periodontal material (Goretex; GT). Epithelial cells attached to HA, formed a morphologically and functionally distinct layer of proliferating cells along the substratum. In contrast, epithelial cells did not attach to either teflon material. The cells adjacent to the teflon substrata were nonproliferative and exhibited signs of degeneration or cell differentiation. Furthermore, epithelial cell migration along BO was significantly greater than along GT. Our results suggest that the low protein-binding capacity of the teflon material and the rough-textured surface of GT inhibit epithelial cell migration. The results may provide a rationale for understanding the differences in epithelial behavior after conventional therapy for periodontitis and during guided tissue regeneration.

Adult↗
PubMed2003

Periodontal repair in dogs: a bioabsorbable calcium carbonate coral implant enhances space provision for alveolar bone regeneration in conjunction with guided tissue regeneration.

BACKGROUND: Collapse or compression of a barrier device into a periodontal defect or onto the root surface compromises outcomes following guided tissue regeneration (GTR). Bone biomaterials have been suggested to support regeneration of alveolar bone and to improve space provision with GTR devices. The objective of this study was to evaluate space provision, alveolar bone, and cementum regeneration following use of a bioabsorbable, calcium carbonate biomaterial in conjunction with GTR. METHODS: Routine, critical size, 5 to 6 mm, supraalveolar, periodontal defects were created in 5 young adult beagle dogs. Alternate jaw quadrants in consecutive animals received GTR and the coral biomaterial (cGTR) or GTR alone. The animals were euthanized 4 weeks postsurgery and tissue blocks processed for histometric analysis. RESULTS: The coral implant particles were surrounded by newly-formed bone or immersed in connective tissue and appeared to resorb and be replaced by bone. There was limited, if any, appreciable cementum regeneration. Space provision was enhanced in cGTR compared to GTR sites (6.1 +/- 1.6 versus 2.4 +/- 0.8 mm2; P<0.05). Bone regeneration (height) was significantly increased in cGTR compared to GTR sites averaging 1.9 +/- 0.6 and 1.2 +/- 0.6 mm, respectively (P<0.05). Bone regeneration (area) was 2-fold greater in cGTR sites compared to the GTR control (3.3 +/- 1.8 versus 1.4 +/- 0.5 mm2), however the difference was not statistically significant (P>0.05). CONCLUSIONS: The coral implant significantly enhanced space provision for GTR while alveolar bone formation appeared to be enhanced by its use. Increased healing intervals are needed to fully understand the biologic value of the coral implant as an adjunct to GTR.

Absorbable Implants↗
PubMed1999

Long-term clinical outcomes of abutments treated with guided tissue regeneration.

STATEMENT OF PROBLEM: Guided tissue regeneration (GTR) is an efficacious and predictable treatment modality for deep intrabony defects around natural teeth and abutments. However, long-term prognosis of abutments treated with regeneration has to be proven. PURPOSE: This study investigated the long-term stability of clinical outcomes obtained with regeneration in strategically important abutments. MATERIAL AND METHODS: Sixteen deep intrabony defects around strategically important abutments in 16 patients were treated according to the principles of GTR. After completion of initial periodontal therapy and placement of long-term provisional fixed partial dentures, nonresorbable membranes were applied. Membranes were removed after 6 weeks. All patients remained in a supervised recall program. Final fixed partial dentures were placed 1 year after surgery. Clinical outcomes were evaluated at 1 year and then 4 to 8 years after surgery. RESULTS: Clinical attachment level gains of 5.3 +/- 1.8 mm, reductions in pocket depth (6.1 +/- 2 mm), and increases in the percentage of radiographic bone support (31% +/- 18%) were observed at 1 year. At long-term follow-up visits, clinical attachment levels remained stable with respect to 1 year (-0.1 +/- 0.6 mm; P =.4). The percentage of radiographic bone support slightly increased as compared with 1 year (1% +/- 3%, P =. 04), and pocket depths (0.8 +/- 0.8 mm, P =.004). CONCLUSIONS: This study indicated that tooth support can be gained with GTR and maintained over time in patients recalled regularly.

Adult↗
PubMed1996

Periodontal healing following reconstructive surgery: effect of guided tissue regeneration.

Clinical healing following guided tissue regeneration (GTR) in deep intrabony pockets was compared to healing following gingival flap surgery alone (GFS). 15 patients received the GTR treatment including an expanded polytetrafluoroethylene membrane. 13 other patients received the control treatment GFS. A postsurgery protocol emphasizing wound stability and infection control was used. Treatment effects were evaluated 6 months postsurgery. Mean pre-surgery probing depth for the GTR and control treatments was 7.5 +/- 1.0 and 7.7 +/- 1.5 mm, respectively. Significant probing depth reduction (3.8 +/- 1.2 and 2.9 +/- 1.1 mm), attachment level improvement (2.4 +/- 2.1 and 2.2 +/- 1.2 mm) and bone fill (2.0 +/- 2.0 and 2.4 +/- 0.9 mm) followed the GTR and control protocols, respectively (p < 0.01). Significant differences between GTR and control treatments were observed in probing depth reduction (p < 0.01) and in gingival recession increase (1.7 +/- 1.5 and 0.7 +/- 0.9 mm, respectively; p < 0.05). The results suggest that GTR procedures compared to GFS have similar clinical potential in intrabony pockets, under the present protocol.

Adult↗
PubMed2001

Presence of interleukin-4-producing cells for human bone regeneration after application of guided tissue regeneration membranes.

To study the process of bone regeneration we examined three samples of periapical regenerative tissue obtained from two patients under a guided tissue regeneration treatment in endodontic surgery by the immunohistochemical and enzyme histochemical methods. The regenerative tissue consisted of a large number of fibroblast-like cells and a small number of mononuclear cells. Fibroblast-like cells stained positively for alkaline phosphatase and osteopontin, whereas mononuclear cells stained positively for CD4. Interleukin-4-producing cells could be detected in adjacent sections. However, interferon-y-producing cells could not be detected. These findings suggest that interleukin-4-producing cells may be one of the elements associated with success in the human bone regeneration process in vivo.

Adult↗
PubMed1994

Periodontal tissue response to a new bioresorbable guided tissue regeneration device: a longitudinal study in monkeys.

This study evaluated periodontal tissue response to a new bioresorbable guided tissue regeneration barrier material following guided tissue regeneration treatment of dehiscence-type defects at 45 teeth in 15 monkeys. The results were clinically and histologically evaluated 6 weeks and 3,6, 12, and 24 months posttreatment. Healing was uneventful and without inflammation or other adverse tissue reactions. Following 6 weeks of healing, the matrix barrier was completely integrated with the surrounding tissues, preventing epithelial downgrowth along the device. There were no inflammatory cell infiltrates adjacent to the material. New attachment (ie, new cementum with inserting collagen fibers) and new supporting bone were found after 6 weeks of healing. The matrix barrier maintained its functional stability for a minimum of 6 weeks. The subsequent slow resorption process of the material occurred without detrimental effects on the surrounding tissues, demonstrating the biocompatibility of the material. The material was completely resorbed after 6 to 12 months. At the final stages of the resorption process, macrophages and multinuclear cells were present within the tissue that replaced the material. The design and the resorption pattern of the matrix barrier are discussed in relation to the regenerative wound healing process.

Animals↗
PubMed1995

The importance of periodontal pathogens in guided periodontal tissue regeneration and guided bone regeneration.

Although guided tissue regeneration (GTR) procedures in periodontitis lesions and around endosseous dental implants represent exciting new therapeutic modalities in periodontics, these treatments can fail because of shortcomings in surgical techniques, restriction in the size and shape of the defect, anatomic features interfering with surgery, or infectious complications. Our studies show that optimal tissue regeneration cannot be expected for a nonbioabsorbable barrier membrane placed in a site infected by periodontopathic microorganisms. Our data also indicate that treatment failure is most frequent in patients who harbor high levels of periodontal pathogens and show evidence of severe periodontitis in numerous teeth. To decrease the risk of infection and to ensure proper healing, periodontal therapy should precede insertion of the barrier membrane for GTR. Recently, we have studied the effect of the pathogens on periodontal GTR and guided bone regeneration around dental implants and the results are reviewed in this article.

Biofilms↗
PubMed1990

Bone regeneration adjacent to titanium dental implants using guided tissue regeneration: a report of two cases.

The biologic principle of guided tissue regeneration was applied to regenerate alveolar bone in conjunction with the placement of titanium dental implants. In one case, complete osseointegration of an implant was achieved by the placement of a Teflon membrane over an implant that had been inserted into an alveolus immediately following tooth extraction. In a second case, the same biologic principle was used to increase the volume (height and width) of a resorbed, edentulous alveolar ridge to provide adequate bone dimensions for implant installation. In both cases, the membranes appear to have prevented the repopulation of the wound area by cells other than those derived from surrounding bone tissue. These two different applications of the principle of guided tissue regeneration open new avenues for reconstructive osseous surgery.

Adult↗
PubMed1995

Bone formation following guided tissue regeneration (GTR).

The principle of guided tissue regeneration using barrier membranes has become an accepted method for the treatment of teeth with severe osseous defects and furcation involvement. A technique was developed using an expanded polytetrafluoroethylene soft-tissue patch, 1 mm thick (W.L. Core and Assoc., Flagstaff, AZ), in conjunction with an alloplast hydroxyapatite bone substitute (HA-500, 40-60 mesh) (Orthomatrix, Minneapolis, MN), for space maintenance in severe osseous defects. A case report is presented which demonstrates the successful use of this method, and includes a fourth-year re-entry procedure that illustrates the complete bone fill and obturation of a severe vertical defect and Class II furcation of a mandibular first molar.

Aged↗
PubMed1993

1982-1992: a decade of technology development for guided tissue regeneration.

In the last decade guided tissue regeneration (GTR) therapy has evolved in both surgical technique and membrane technology. Given new applications and membrane materials, not only must new surgical techniques be critiqued, but membrane designs must be critically examined as well. A review of historical membrane development suggests that 5 design criteria are essential: 1) tissue integration; 2) cell-occlusivity; 3) clinical manageability; 4) spacemaking; and 5) biocompatibility. These criteria may be applied to select appropriate materials and designs for specific GTR applications.

Animals↗
PubMed1996

Guided tissue regeneration associated with orthodontic therapy.

Guided tissue regeneration (GTR) to enhance genuine new periodontal attachment may improve preorthodontic conditions for moving teeth into infrabony defects or for vertical movements of teeth with reduced bone support. The possible benefits of GTR for combined periodontal/orthodontic therapy are discussed and substantiated with preliminary experimental findings.

Alveolar Bone Loss↗
PubMed2001

Poly(L-lactide)acid/alginate composite membranes for guided tissue regeneration.

The barrier membranes for guided tissue regeneration (GTR) to treat bone defects have to satisfy the criteria of biocompatibility, cell-occlusiveness, space-making, tissue integration and clinical manageability. In this study a system constituted of a poly(L-lactide) acid (PLLA) asymmetric membrane combined with an alginate film was prepared. The PLLA membrane functions to both support the alginate film and separate the soft tissue; the alginate film is intended to act as potential vehicle for the growth factors to promote osteogenesis. The structural, morphological, and mechanical properties of the bilamellar membrane and its stability in culture medium were evaluated. Moreover, the feasibility of using the alginate membranes as controlled-release delivery vehicles of TGF-beta was monitored. Finally, the bacterial adhesion and permeability of Streptococcus mutans, selected for the high adhesive affinity, were monitored. The results showed that the surfaces of the alginate side, to be used in contact with the bone defect, were rougher than PLLA ones. When in contact with complete culture medium, the PLLA-alginate membrane retained its mechanical and structural properties for more than 100 days. Then, the degradation processes occurred but the membrane continued to be stable and manageable for 6 months. Growth factors such as TGF-beta can be incorporated into alginate membranes functioning as drug delivery vehicle, and retain the biological activity when tested in an in vitro model system. The obtained membrane acted as a barrier to the passage of S. mutans bacteria and showed to promote a lower bacterial adhesion with respect to commercial GTR membranes.

Alginates↗
PubMed1995

Osseointegration of subperiosteal implant via guided tissue regeneration. A pilot study.

The principle of guided tissue regeneration was applied in an attempt to generate bone to cover a subperiosteal implant. Titanium frame works, casted on individual impressions of the anterior surface of the tibia of 4 Copenhagen White rabbits, were stabilized to the tibia by microscrews, and half of them were covered by an expanded polytetrafluoroethylene augmentation membrane. The observation period was 12 weeks. Guided bone regeneration partly covering the implants was seen at all experimental sides; on the control sides the implants were mainly embedded in fibrous tissue. Studies are in progress with the aim of reducing marked marrow space formation observed in all the regenerated areas.

Animals↗
PubMed1993

Long-term assessment of combined osseous composite grafting, root conditioning, and guided tissue regeneration.

Although the short-term success of guided tissue regeneration has been widely reported, few studies on the long-term success of treatment have been published. The present investigation assessed the 5-year results of guided tissue regeneration procedures used alone or in combination with root conditioning and osseous composite grafts. Results indicated that the long-term success of guided tissue regeneration was significantly enhanced by the addition of root conditioning and grafting procedures.

Acid Etching, Dental↗
PubMed1997

A comparative study of root coverage obtained with guided tissue regeneration utilizing a bioabsorbable membrane versus the connective tissue with partial-thickness double pedicle graft.

Obtaining predictable root coverage has become an important part of periodontal therapy. The purpose of this study was to compare two techniques of obtaining root coverage. The two techniques were the connective tissue with partial-thickness double pedicle graft and guided tissue regeneration with a bioabsorbable polylactic acid softened with citric acid ester membrane. The connective tissue with partial-thickness double pedicle graft had a mean root coverage of 97.1%, and the guided tissue regeneration procedure produced a mean root coverage of 75.1%. This difference was not statistically significant. Additionally, it was the goal of this study to determine if the thickness of the tissue near the defect was a factor in root coverage. Thickness of the tissue was not a factor with the connective tissue with partial-thickness double pedicle graft. The thin areas had a mean root coverage of 100%, while the others had a mean root coverage of 95.9%. This difference was not statistically significant; however, the thickness of the tissue was a factor in root coverage success in the guided tissue regeneration procedure. The thin areas treated with guided tissue regeneration had a mean root coverage of 26.7%, while the others had a mean root coverage of 95.9%. This difference was statistically significant. The results of this study demonstrate that root coverage is possible with both procedures. However, when the tissue in the area of the defect is relatively thin, the connective tissue with partial-thickness double pedicle graft will produce greater root coverage. When treating defects with tissue that is not thin, similar amounts of root coverage can be obtained with both procedures.

Absorption↗