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At least 19 recordsLinked to original sources
PubMed1992

Development of the principle of guided tissue regeneration.

Guided tissue regeneration (GTR) is a new treatment principle in surgical therapy, developed from the result of studies in experimental animals. It implies that only those types of cells with the capacity of producing regeneration are allowed to invade the surgically treated lesion during healing. This is accomplished by the placement of a physical barrier with excludes undesirable types of tissue. Healing of periodontal bony lesions can be obtained predictably by treatment according to the principle of guided tissue regeneration but several studies have suggested that the same principle can also be applied successfully in other fields of dentistry. In implantology, the method has been used for immediate placement of implants into extraction sockets, for healing of peri-implant bony defects and for augmentation of atrophic alveolar ridges.

Alveolar Bone Loss↗
PubMed1991

Principles and techniques of guided tissue regeneration.

Guided tissue regeneration is an accepted technique to promote new attachment in periodontal therapy. It is supported by sound basic research indicating that the definitive factor in the obtainment of regeneration is the source from which the cells repopulating the exposed root surface originate. These studies have indicated that cells proliferating from the periodontal ligament have the greatest potential for achieving new attachment. The use of barriers during periodontal surgery permits the possibility of periodontal ligament proliferation toward the exposed root at the same time that epithelial and gingival connective tissue proliferation is blocked. Studies in which Gore-Tex periodontal material has been used as a barrier have shown positive results in animal and clinical studies. Histologically, the formation of new cementum, bone, and periodontal ligament has been demonstrated. Clinically, beneficial results have been documented in the treatment of intrabony defects with three-wall, two- to three-wall, or funnel-shaped topography. Also, Class II furcations with or without a vertical component have been treated successfully by guided tissue regeneration.

Animals↗
PubMed1999

Adjuncts used to enhance the results of guided tissue regeneration.

Guided Tissue Regeneration involves procedures designed to regenerate lost periodontal structures. There are several adjunctive procedures used in conjunction with barrier membranes. This review article discusses the most commonly used adjuncts and the benefits and limitations of each. A brief synopsis of possible future directions is also discussed.

Anti-Bacterial Agents↗
PubMed1996

Protease repertoires of cells adherent to membranes recovered after guided tissue regeneration.

Guided tissue regeneration is a clinical procedure used to restore mineralized tissue that has been lost to periodontal disease or after tooth extraction. The procedure makes use of Gore-tex membranes or Gore-tex augmentation membranes (GTAM) to prevent migration of keratinocytes and gingival fibroblasts into healing wounds. To begin to characterize the regenerative cells associated with these membranes, human cells have been rescued from membranes retrieved after bone-inductive procedures. Cell lines were established from tissue adherent to Gore-tex membranes used to regenerate bone around periodontally compromised teeth, and from tissue adherent to GTAM used in edentulous ridge augmentation procedures or in conjunction with implant placement. Cell lines were screened for mineralized nodule formation in vitro prior to their subsequent analysis. All but one of the lines selected for this study formed mineralized nodules in vitro with cells from GTAM tending to form nodules more quickly than cells from Gore-tex. Zymograms and Western blots were used to compare protease profiles of these cells with those of human gingival fibroblasts, keratinocytes and periodontal ligament (PDL) cells. All cell types except for keratinocytes produced a 72 kD protease. In contrast, keratinocytes were the only cells that produced 92 kD gelatinase. In some cell lines, notably those removed from patients after short periods of regeneration, collagenase was the major protease detected on gelatin substrate gels. Some of these cell lines also produced additional proteases including a low molecular weight protease (30 kD) not seen in gingival fibroblasts, PDL cells or keratinocytes.

Adult↗
PubMed1999

[Trauma of the peripheral nervous system: experimental assessments with guided tissue regeneration].

Guided tissue regeneration open interesting perspectives in reconstructive surgery of peripheral nerves. Artificial conduits for nerve repair can be obtained with biodegradable polymers. Lactic and caproic acid copolimers and poliphosphazenes are biocompatible materials and have a slow reabsorption rate. Two types of conduits obtained with Poli[L-lactide-co-6-caprolactone] and poli [bis (etilalanate) phosphazene] were evaluAted as guides for nerve regeneration in an experimental model on two groups of six Wistar rats. Under general anesthesia and with microsurgical technique, the ischiatic nerve was bilaterally isolated. On the right side a segment of the nerve was removed to create a 10 mm gap. The defect was then repaired using the conduit. On the controlateral limb after the creation of the same defect, the nerve continuity was restored using as an autograft the segment removed from the right side. Control were performed at 30, 90, 180 days and consisted in histological and electron microscopy investigations. They showed the gradual degradation of both the conduits without signs of local toxicity. The regeneration of the nerve fibers in the lumen was not significantly different from that observed in the autologous grafts. Both the conduits may be considered effective for guided nerve regeneration, but polyphosphazenes allow the possibility of use the polymer as a carrier for neurite-promoting factors.

Animals↗
PubMed2000

Using absorbable collagen membranes for guided tissue regeneration, guided bone regeneration, and to treat gingival recession.

This article reviews the role of barrier membranes in guided tissue regeneration (GTR) and guided bone regeneration (GBR), including the advantages of using absorbable barrier membranes in GTR and GBR and the unique properties of collagen membranes. The indications and contraindications for using collagen membranes for these procedures are examined, and successful cases are presented. Finally, the role of collagen membranes in the future of regenerative therapy is considered.

Absorbable Implants↗
PubMed2004

Prognostic factors for alveolar regeneration: effect of tissue occlusion on alveolar bone regeneration with guided tissue regeneration.

OBJECTIVES: Design criteria for guided tissue regeneration (GTR) devices include biocompatibility, cell occlusion, space-provision, tissue integration, and ease of use. The objective of this study was to evaluate the effect of cell occlusion and space-provision on alveolar bone regeneration in conjunction with GTR. METHODS: Routine, critical-size, 6 mm, supra-alveolar, periodontal defects were created in 6 young adult Beagle dogs. Space-providing ePTFE devices, with or without 300-microm laser-drilled pores were implanted to provide for GTR. Treatments were alternated between left and right jaw quadrants in subsequent animals. The gingival flaps were advanced for primary intention healing. The animals were euthanized at week 8 post surgery. The histometric analysis assessed regeneration of alveolar bone relative to space-provision by the ePTFE device. RESULTS: A significant relationship was observed between bone regeneration and space-provision for defect sites receiving the occlusive (beta = 0.194; p < 0.02) and porous (beta = 0.229; p < 0.0004) GTR devices irrespective of treatment (p = 0.14). The bivariate analysis showed that both space-provision and device occlusivity significantly enhanced bone regeneration. Hence, sites receiving the occlusive GTR device and sites with enhanced space-provision showed significantly greater bone regeneration compared to sites receiving the porous GTR device (p = 0.03) or more limited space-provision (p = 0.0002). CONCLUSIONS: Cell occlusion and space-provision may significantly influence the magnitude of alveolar bone regeneration in conjunction with guided tissue regeneration.

Alveolar Bone Loss↗
PubMed1994

The role of guided tissue regeneration and guided bone regeneration.

The goal of periodontal therapy includes not only the halting of the progressive loss of connective tissue attachment but also the restitution of those parts of the supporting apparatus which have been destroyed. The cells which repopulate this area may originate from any number of the different tissue components of the periodontium: the dentogingival epithelium, the gingival connective tissue, the alveolar bone, and the periodontal ligament (PDL). The size and shape of the wound and the potential of the different types of tissues cells to migrate, determines the type of healing. Previous studies have revealed that root resorption was found to occur when granulation tissue derived from the gingival connective tissue or alveolar bone was proliferating into contact with the root surface, while re-epithelialization of the surface prevented both connective tissue attachment and root resorption. The only cells which appear to have the capacity to form a new attachment were cells originating from the PDL. Based on this knowledge of the biological behaviour of the different periodontal tissues during wound healing, the principle of Guided Tissue Regeneration (GTR) was introduced and tested. A membrane section was placed over the debrided root surface in such a way that all periodontal tissues except the PDL cells were prevented from reaching contact with the root. Healing resulted in extensive amounts of new connective tissue attachment, that is, the formation of new cementum with inserting collagen fibres. The objective was, and is, assessment of how predictably new attachment may form when treatment included GTR.(ABSTRACT TRUNCATED AT 250 WORDS)

Alveolar Bone Loss↗
PubMed1999

Polylactide bioabsorbable polymers for guided tissue regeneration.

OBJECTIVE: Guided tissue regeneration is a procedure to improve tissue repair, which creates an optimal environment for the intrinsic growth ability of tissues. METHODS: A prerequisite for guided tissue regeneration is the availability of materials with suitable physicochemical and biocompatibility properties for the preparation of the devices. We investigated bone and peripheral nerve guided tissue regeneration, making two conduits from poly[L-lactide-co-6-caprolactone] (PLLC--peripheral nerve) and with poly [DL-lactide] (PDLLA--bone) with different features. After the polymer synthesis and chemical characterization, the conduits were evaluated in vivo in rat sciatic nerve gaps and in rabbit radius defects. RESULTS: The results demonstrated good biocompatibility of both polymeric conduits. A good axonal regeneration and the restoration of the nerve trunk continuity, similar to that observed with autologous grafts has been obtained with PLLC conduits, that slowly degrade in about 6 months. PDLLA conduits protected the bone defect against the invasion of surrounding soft tissues; an effective bone growth bridging the defect was observed in their lumen. CONCLUSION: These results confirm the versatility of polylactides as biomaterials and will encourage further investigations on hard and soft tissues.

Absorption↗
PubMed2002

Effect of polylactide/glycolide (PLGA) membranes loaded with metronidazole on periodontal regeneration following guided tissue regeneration in dogs.

BACKGROUND: Bioabsorbable membranes have been successfully used for guided tissue regeneration (GTR) and local delivery systems because they are biocompatible and do not require second surgery for removal. Several studies have demonstrated that metronidazole, when applied topically, produced immediate effects on microbiological and clinical parameters, most notably a reduction in probing depth and loss of attachment. The purpose of this study was to evaluate the regenerative potential of a metronidazole-loaded biodegradable (polylactide/glycolide) (PLGA) GTR membrane in dogs. METHODS: Six male adult dogs with 36 created osseous defects were enrolled. Bilateral dehiscence type defects in 5 mm diameter were created at buccal aspect of the alveolar bone in maxillary premolar teeth. After full thickness flap elevation, exposed root surfaces were thoroughly planed. In the experimental sites, PLGA membranes with or without metronidazole were fitted and placed over the defects. On the control defects only root planing was performed. Gingival flaps were replaced slightly coronal to the cemento-enamel junction. Animals were sacrificed at 60 days. The histometric analysis was evaluated with the following parameters: defect height (DH), apical extension of junctional epithelium (AEJE), new cementum height (NCH), new bone height (NBH), and new gingival connective tissue height (NCTH). RESULTS: Postoperative clinical healing was similar in the 3 groups. There were no statistically significant differences between the 2 experimental groups in any parameters. Statistically significant differences were observed for AEJE, NCH, NBH, and NCTH in experimental groups when compared with the controls. Statistically significantly greater NCH, NBH, and NCTH were seen in the experimental groups than the controls and control defects showed longer AEJE than the experimental defects. CONCLUSIONS: These results suggest that PLGA membranes with and without metronidazole may have a beneficial effect on periodontal regeneration.

Absorbable Implants↗
PubMed1993

Healing patterns associated with an Atrisorb barrier in guided tissue regeneration.

The current guided tissue regeneration clinical technique uses synthetic membranes at the time of the surgical procedure to separate the gingival and periodontal tissue components. These membranes are tied to the tooth surface and have to be ++removed during a second surgical procedure. The material Atrisorb is currently under development as a guided tissue regeneration barrier in Class II furcation defects. This material is applied directly over the furcation defect and is not tied to the tooth surface. Because of its biodegradability, Atrisorb does not have to be removed. A case study is presented.

Aged↗
PubMedDate not supplied

Guided tissue regeneration: the new frontier in periodontics.

The ideal goal of periodontal therapy is the reestablishment and regeneration of the lost periodontal tissues. Many different treatment regimens have been suggested to achieve this dream; however, most are unpredictable and highly debated in the periodontal literature. This paper discusses the most current philosophy in periodontal regeneration--guided tissue regeneration. A brief review of the literature, surgical technique, and case presentations pertaining to this procedure are provided.

Adult↗
PubMed1996

Guided tissue regeneration in dentistry.

Guided tissue regeneration (GTR) is a technique currently used in dentistry for periodontal surgery, oral surgery, implant dentistry and reconstruction of maxillomandibular defects. The basic premise for this technique is to allow for osseous regeneration prior to soft tissue migration into the area of interest. This is accomplished with the use of membranes that prevent the migration of the soft tissue element into the bony defect. This paper discusses current uses for GTR techniques and reviews some of the materials now available for this purpose.

Biocompatible Materials↗
PubMed2002

A systematic review of guided tissue regeneration for periodontal furcation defects. What is the effect of guided tissue regeneration compared with surgical debridement in the treatment of furcation defects?

OBJECTIVES: To systematically review the evidence of effectiveness of guided tissue regeneration (GTR) for furcation defects. BACKGROUND: The evidence for the effectiveness of GTR in furcation defects has not yet been systematically appraised. METHODS: We searched for randomized controlled trials with at least 6 months' follow-up comparing GTR with surgical debridement (open flap debridement, OFD). Data sources included electronic databases, hand-searched journals and contact with experts. Screening, data abstraction and quality assessment were conducted independently by multiple reviewers. The primary outcome measure was reduction in open horizontal furcation depth, secondary outcomes were frequency of furcation closure, gain in horizontal and vertical probing attachment and reduction of vertical probing depth. RESULTS: For the primary outcome, reduction in horizontal furcation depth assessed during re-entry, the weighted mean difference between GTR and control was 1.51 mm (95% CI [0.39-2.62], chi-square for heterogeneity 67.6 (df = 3), P < 0.001) in mandibular class II furcations, 1.05 mm (95% CI [0.46-1.64, chi-square for heterogeneity 34.9 (df = 3), P < 0.001) in maxillary class II furcations, and 0.87 mm (95% CI [-0.08-1.82], chi-square for heterogeneity 0.1 (df = 4), P = 0.991) in studies that had combined mandibular and maxillary class II furcations. For the secondary outcomes, GTR treatment led to significantly better results than open flap debridement. No meta-analysis could be performed for frequency of furcation closure because of sparse data. CONCLUSIONS: Overall, GTR was consistently more effective than OFD in reducing open horizontal furcation depths, horizontal and vertical attachment levels and pocket depths for mandibular or maxillary class II furcation defects. However, these improvements were modest, variable and there was only a limited number of studies available to appraise the effects, thus limiting general conclusions about the clinical benefit of GTR. Future studies should aim to identify factors associated with achieving consistent and more pronounced benefits over open flap debridement.

Furcation Defects↗
PubMed1998

A review of guided tissue regeneration.

Developments in guided tissue regeneration mean that in certain circumstances it is possible, with predictable success, to create new connective tissue attachment to periodontally affected sites. Continuing development promises even greater progress in the future.

Absorption↗
PubMed1998

[A 3-year experience with guided tissue regeneration procedures].

The Guided Tissue Regeneration (GTR) procedures are promoting a clinically and radiologically as well as histologically verifiably periodontal attachment gain. The objective of the study was to evaluate the clinical efficacy of these GTR techniques. In the past four years different barrier membranes (Gore-tex, Resolut and Guidor) were used around 318 teeth of 196 patients. 169 periodontal defects of 140 patients were followed up at least for two years. 54 patient had chronic adult type periodontitis, 67 suffered with rapidly progressing periodontitis and 15 had different severe mucogingival lesions. 111 vertical bony defects, 43 Class II-III furcation lesions and 15 mucogingival lesions were surgically corrected. The average preoperative probing depth (PD) and the clinical attachment loss (CAL) of the vertical bony defects were 5.3 +/- 1.7 mm and 6.2 +/- 1.9 mm respectively. The PD of the deepest Class III furcation lesion was 11 mm. The average gingival recession of the mucogingival lesions was 4.5 +/- 1.1 mm. The GTR technique provided the best results in the Class II-III furcation lesions, where an average 2.4 +/- 0.9 clinical attachment gain was observed one year postoperatively. The GTR techniques provided an average 1.8 +/- 1.2 mm attachment gain in the vertical bony crater cases. In both groups of cases a marked gingival recession followed the healing and the periodontal regeneration. In this way the average reduction in the probing depth exceeded the average attachment gain by more that 1.5 mm. 1 year after the operation the average radiologic bone fill was about 0.9-1.2 mm. The resorbable barrier membranes resulted in clinically significant root coverage and an average 3.5 +/- 1.7 mm gain in the width of keratinized gingiva. The success or failure of our cases were mainly determined by the patient's compliance, the level of the postoperative professional and individual oral hygiene and the number of periodontal recalls. These findings are also underlining the importance of the high standard of oral hygiene in the postoperative periodontal regeneration.

Adult↗