University of Minnesota Tissue GTR Regeneration in

Tissue

Regeneration in

Periodontics

• Bone Grafts

• Guided Tissue Regeneration

GTRProcedures allowing the

repopulation of a periodontal

defect by cells capable of

forming new connective tissue

attachment and alveolar bone.

Race to Repopulate• Epithelium

• Gingival Connective Tissue

• Cementum/PeriodontalLigament

• Alveolar Bone

GTR

1st Generation - Non Resorbable

2nd Generation - Resorbable

3rd Generation - Resorbable &

Antimicrobial

Dr. Larry WolffPeriodontology III

Spring Semester, 2009School of Dentistry

University of Minnesota

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GTR Materials1st: Non-Resorbable

* Gore-Tex

2nd: Resorbable

* Biomend * Resolute

* Capset * Atrisorb

3rd: Resorbable & Antimicrobial

* Atrisorb - D

Ideal Membrane for GTR

Procedures• Absorbable

• Bio Compatible

• Cell Occlusive

• Space Maintenance

• Tissue Integration

• Clinically Manageable

Indications for Guided

Tissue Regeneration

• Class II furcations

• 2 or 3 wall vertical defects

• Recession

• Alveolar ridge preservation

Class II Furcations

Vertical Defects Insufficient Bone Height/Width

Normal Deficient




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Indications for Guided

Tissue Regeneration

• Augment bone in sinus

• Augment bone for implant

• Sinus perforation after extraction

• Augment bone after infection

Dehiscence Defect

Before GTAM After GTAM removal

Treatment 2 months

Types of GTR

Non-Resorbable

• Gore-Tex

Resorbable• ATRISORB

• Biomend

• CAPSET

• Emdogain

• Resolut

Gore - Tex

Gore-Tex• Polytetrafluoroethylene

• Non-resorbable

• Second stage surgical

procedure required




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Evaluating Results

Before Gore-Tex®

Periodontal Material

Treatment

After Gore-Tex®

Periodontal Material

Treatment

Infrabony

Defects




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GORE-TEX Removal

• Remove 4 - 6 weeks post op

• Use small incision

• Do not disturb tissue

• Cover new tissue with flap

GTR in

Treatment of

Recession

Defects




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GORE-TEX Regenerative Material

Titanium Reinforced (TR)

Configurations

Transgingival and Submerged Configurations

For applications where shapeability can

contribute to better spacemaking in non-

spacemaking defects.




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Types of GTR

Non-Resorbable

• Gore-Tex

Resorbable

• ATRISORB

• Biomend

• CAPSET

• Resolut

ATRISORB




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Atrisorb - D

Free Flow

• 4 % Doxycycline

• Bioabsorbable




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Guidor• Polylactic acid + citric acid ester

• Resorbable

• One stage surgery

• Degradation: 4-6 weeks




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BioMendBiomend

• Collagen

• Hemostatic

• Chemotactic for fibroblast

• Easily manipulated


• Degradation: 4 weeks




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Autologous

Platelet

Concentrate




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• Concentrated platelets (10X)

• Concentrated Growth Factors

• ! Cell Recruitment

• ! Cell Division

• Accelerate Wound Healing




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CAPSETCAPSET

• Calcium sulfate

• Resorbable


• Degradation: 3-4 weeks




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Periodontal

Treatment:

Bone Grafting




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Resolut RESOLUT• Polyglycolic acid and poly

(lactic acid-co-glycolic acid)

• Resorbable


• Degradation: 8 weeks

RESOLUT™

Regenerative Material Defect at surgery

Dr. Bill Becker, unpublished




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Material placement


Re-entry


Emdogain

Gel

Emdogain®

• Enamel matrix protein

• Amelogenins - Porcine

• Resorbable

• Surface-cementum forming cells

• Prevent epithelial downgrowth

• User friendly




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Deep

Periodontal

Pocket

Final

debridement

of root

surface-

cleaning

Root surface

conditioning

with PrefGel™

Application of

EMDOGAIN®

Regain of clinical

attachment and

alveolar bone

following

Emdogain® Gel

Treatment




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Female, 68 years, Non-Smoker

BL(Courtesy Dr. David H. Yu, San Antonio, TX)

12 Months

Surgical Guidelines for GTR

• Full-thickness flaps

• Primary coverage for membranes

• Chlorhexidine rinse - 4-6 weeks

• Antibiotic coverage - 14 days

• Gentle brushing - 3 weeks

GTR

Factors Affecting Success

• Systemic factors

• Level of oral hygiene

• Technical factors

• Smoking

• Membrane exposure

• Post-operative infection

Conclusions - GTR

• Bioabsorbable = Non-resorbable

• Class II furcations - Successful

• Infrabony defects - Successful

• Technique sensitive

• Oral hygiene important

• Smoking - Adverse effect

• > 8 years - stable




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Documents

University of Minnesota Tissue GTR Regeneration in