Guided tissue regeneration

Guided tissue regeneration ( A TECHNIQUE OF NON GRAFT-ASSOCIATED NEW ATTACHMENT )

RAJASHREE DHAR , 64

Contents Definition History Classification Objectives Surgical procedure Conclusion

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.

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.

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 membranesCommercially available PTFE membranes for

grafts

Bioresorbable membranes :- Provides initial barrier function during early stages of healing ( minimum of 6 weeks time ).

Collagen

Guidor Polyglycolic acid polymer

Vicryl mesh membrane

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.

Collagen Vicryl mesh membrane

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.

Conclusion