For years, guided bone regeneration (GBR) has been used to replace missing bone: Now, using the same principles, guided tissue regeneration (GTR) allows for the growth of the periodontal ligament (PDL) and cementum. The PDL and cementum provide tooth stability.
The Difference Between Regeneration and Repair
Periodontal therapy aims to predictably regenerate a functional attachment apparatus that was destroyed by periodontitis. Regeneration refers to a healing process designed to completely replicate the function and original design of a missing part. Guided tissue regeneration involves the creation of a replacement PDL and cementum. Creating new alveolar bone can be accomplished through the use of guided bone regeneration.
Repair refers to using scar tissue as a means to replace the missing apparatus. The abilities of scar tissue are extremely limited. Scar tissue can only repair the missing part by establishing a long junctional epithelium attachment. This attachment is established at the interface of the tooth and the tissue.
What is Guided Tissue Regeneration?
Regeneration refers to the growth and differentiation of intercellular substances and new cells as a means to develop replacement parts or tissues. Whereas, traditional modalities typically failed in its attempts to regenerate the tissue lost during the disease process, applying the principles of GTR may lead to restitution of a functional periodontal apparatus.
Guided tissue regeneration is a technique that is used to prevent epithelial migration down the cementum, which is located between the tooth root surface and the bone. This process is called guided tissue regeneration because the surgeon literally ‘guides the growth’ of particular tissues. With GTR, periodontal regeneration can be accomplished by recognizing and then addressing the biologic principles of differential tissue response.
Indications for the Use of Guided Regeneration
Procedures that benefit from guided regeneration methods involve end results requiring the total regeneration of a periodontal structure (that was lost as a result of periodontal disease), procedures used to treat recession defects and bone loss as well as those with the objective of augmenting the ridge to allow for the placement of an osseointegrated implant.
Guided regeneration is implemented during the post-surgical healing phase. Performing guided tissue and guided bone regeneration entails strategically placing a variety of barriers to separate the periodontal ligament and bone from the gingival epithelium. Inhibiting the ability of the gingival connective tissue and the epithelium to migrate into the wound and down the cementum wall promotes repopulation of the cells responsible for healing the PDL, cementum and the bone.
What Happens if the Epithelial Cells Migrate Down the Cementum Wall?
The epithelial cells are responsible for healing the gingival tissue: These cells grow faster than the cells necessary to reform the periodontal ligament and the cementum. The PDL attaches to and forms a strong bond with the root of the tooth; thus, increasing the tooth’s stability. Although the epithelial cells will attach to the root, this attachment is not nearly as strong as the attachment created by the periodontal ligament. If the epithelial cells are able to enter the existing pocket, migrate down the wall and attach to the root, it is not uncommon for these cells to eventually detach from the root. Once detached, the pocket reopens. Therefore, inhibiting the ability of the epithelial cells to migrate down the cementum wall so as to allow for the growth of the periodontal ligament and cementum is essential.
The GTR Process
Allowing time for the growth of the new cementum and periodontal ligament fibers requires the use of a barrier membrane. The application of this barrier membrane allows the slower PDL fiber and cementum cells to establish themselves, while the faster-moving epithelial cells are blocked from entering the wound.
Dr. Jeffrey Brown creates a gingival flap to access the bone. After removing damaged tissue beneath the elevated gingival flap, he places a collar of thin barriers around the tooth being treated. Once the barriers are in place, the gingival tissue is placed on top of the barrier and stitched together. Some barriers are resorbable, which means they will disintegrate on their own at some point within six and eight weeks. In the event that a nonresorbable barrier must be used, an additional surgical procedure is necessary to remove the barrier. This second surgery usually takes place several weeks after the first.
If you are looking for a compassionate and experienced, board-certified periodontist, contact Vero Implants and Periodontics (VIP) today. We offer two convenient locations (Vero Beach and Melbourne, Fla.). To schedule your initial consultation with Dr. Jeffrey Brown, call VIP today at 772.569.9700.