|What is guided tissue regeneration?
Note: Severe vertical bone loss in the facial of
#7 and #8 and a periapical cyst on #9 (upper left central
of Biogran (synthetic bone graft)
Placement of BioOss(Bovine
Placement of Bioguide Membrane
and Resorbable Tack from BioHorizon
Flap Released, Closure, and
Case treated by Dr. Bui at Cosmetic Dentist of Katy
Dinh X. Bui, D.D.S., M.S.
is guided tissue regeneration?
Guided tissue regeneration is the term refer to the concept
of using barriers of different types in periodontal surgery
to promote regeneration of attachment apparatus of the tooth,
i.e. alveolar bone, cementum, and periodontal limament. The
barrier is constructed of biocompatible material, exhibits
occlusive properties to prevent fibrous connective tissue
invasion of the space, provides some degree of protection
from bacterial invasion should the membrane become exposed
to the oral environment, provides suitable space which osseous
regeneration can occur, and finally, is capable of tissue
integration to help stabilize the healing wound, creating
a seal between bone and material to prevent connective tissue
leakage into the defect, and retards the migration of epithelium
around the material.
Noted that regeneration is different
from repair, as achieved in scaling and root planing in treatment
of periodontitis. Repair represents the invasion of connective
tissue into the defect space, and result in the establishment
of long junctional epithelium. Attachment is a type of connective
What is required for a successful
guided tissue regeneration surgery?
The prognosis for guided tissue regenerative surgery
is very good. As with any treatment, the local and systemic
etiology must be identified. It is not as important that how
extensive is the defect but what cause the defect to occur.
Identify the cause of the periodontal lesion is the key for
preventing the recurrence of the defect after the surgery
has been deemed successful. The key to achieve predictable
- Use of an appropriate barrier membrane. Membrane selection
should be base on biocompatibility, ease of adaptation to
the defect, tissue integration, creation of space for bone
regeneration, and bioavailability during the crucial regenerative
- Surgical technique in flap reflection, debridement
of defect, and adaptation.
- The use of bone graft with osteoinductive and osteoconductive
property to further stimulation of migration, differentiation,
and maturation of new bone.
- Stabilization and close adaptaion of membrane to the
surrounding bone can be aided with bone screw or tack (resorbable
- Primary flap closure
- Eliminate of all the systemic and local etiology which
may lead to surgical complication (autoimmune disease, diabetes,
occlusal trauma, poor oral hygiene)
- The use of adjunctive therapy postoperatively such
as periostat may help in regeneration result.
If we control all the factors above, the outcome should
be very successful in regeneration of new attachment apparatus.
When do we need to use
guided tissue regeneration procedure in treating periodontal
Today, in my opinion, guided tissue regeneration should
always be evaluated in every periodontal surgery in treating
periodontitis. With all the advances in adjunctive therapy
using localized delivery of antimicrobial therapy (arrestin,
periostat, periochip, attridox,etc...), the use of flap
surgery for debridement is gradually becoming very limited.
Guided tissue regeneration, when done correctly, almost
always delivered a very predictable result, i.e., regeneration
of new alveolar bone, new cemental attachment, and periodontal
The same principle of guided tissue regeneration applied
to regeneration of bone in the edentulous area for implant
placement or ridge augmentation. This phenomena is referred
to as guided bone regeneration.
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On the right hand column is an example of a
case using guided tissue regeneration to treat the severe
bone loss in the maxillary anterior region. Patient was diagnosed
of localized severe periodontitis in the maxillary anterior
region. Occlusal trauma, poor oral hygiene are the etiology.
Patient treatment included scaling and root planing, followed
by guided tissue regeneration. Tooth #9 (upper left central
incisor) is treated with root canal therapy. Finally, Orthodontic
therapy is used to eliminate occlusal trauma due to anterior
crowding (upper right canine, lateral, and premolar pushed
For full presentation of this case
done in Flash, please browse our porfolio section, under "Treatmet
of Furcation Involvement using Guided Tissue Regeneration"