3. Definition
Guided tissue regeneration : the method of the prevention of epithelial migration of
the cemental wall of the pocket that has gained wide attention and called GTR.
GTR procedures allowing the repopulation
of a periodontal defect by cells capable of
forming new connective tissue attachment
and alveolar bone.
4. History
Nyman et al. (1982) used a Millipore filter over a window created in the bone
and found the only hen cells from the PDL were allow to repopulate the
wound was total regeneration achieve.
Gottlow et al. (1984) used a Millipore filter and a Gore Tex membrane over
submerged roots in monkeys to demonstrate repopulation of the wound by
cells of PDL resulting in a considerably greater increase in new attachment
of the test teeth.
Karring et al. (1986) used a combination of tight and loose elastic about the
roots to prevent or permit cell repopulation from PDL.
5. Introduction
This method based on the assumption that only the periodontal ligament cells have the
potential for the regeneration of the attachment apparatus of tooth.
Non –bioresorbable membranes :-
Nucleopore Milipore PTFE membranes Commercially available
PTFE membranes for grafts
6. Bioresorbable membranes :- Provides initial barrier function during early stages of healing
( minimum of 6 weeks time ).
Collagen
Guidor Polyglycolic acid polymer
Vicryl mesh membrane
7. Objectives of an ideak barrier membrane
1. it should be bio compatible and allow tissue integration.
2. it should be non toxic and non-carcinogenic.
3. it should be chemically inert and non antigenic.
4. It should be easily sterilizable.
5. It should be easy to handle during surgery .
6. It should be sufficiently rigid so as to maintain a space b/w it and the root
surface.
7. It should be supplied indifferent design to suit the specific clinic situation .
8. It should be easily stored and should have a long self life.
9. It should be easily retrievable in case of complication .
10. it should not be too expensive.
9. Surgical procedures
Step 1: Raise full thickness flap utilizing vertical incisions, extending a
minimum of two teeth anteriorly and one tooth distally, to the tooth being
treated.
Step 2 : Debride the osseous defect and plan the root surfaces.
Step 3: Trim the membrane according to the size of the area being treated .
The membrane should extend approx. 2 to 3 mm on all the sides .
Step 4: Suture the membrane around the tooth with a sling suture .
Step 5: The flap is positioned back to its original position or slightly coronal
to it and is sutured using interrupted sutures , make sure the membranes
are covered completely, in case of non resorbable membranes, after 5 week
of the operation, it must be removed with a gentle tug.
