WHAT IS GUIDED TISSUE REGENERATION

AND WHERE CAN IT BE USED?

Your teeth are at risk because of periodontal disease. It began with the buildup of plaque and tartar on your teeth, which may have resulted from insufficient brushing and flossing. Over time, the plaque and tartar have caused loss of the supporting tissue around some of your teeth.

When plaque builds up on a tooth, bacteria in the plaque attack the bone around the tooth as well as the fibers which connect the tooth to the bone. As the fibers and bone are destroyed, a pocket or space forms between the gum and the tooth- an ideal site for more plaque to build up.  Without proper hygiene the process may continue, sometimes without symptoms, until the tooth is endangered.

Guided Tissue Regeneration (GTR) is a procedure that enables bone and tissue to regrow around an endangered tooth OR IF THE TOOTH IS LOST, to increase bone for implant placement either pior to or at time of placement. This is different from other periodontal therapies where regrowth of the bone and the tissue is often limited or highly unpredictable. Conventional therapies for periodontal treatment have often involve removal of soft (gum) tissue to reduce pocket depths. This would leave a greater portion of the tooth exposed, resulting in a less pleasing appearance.

In GTR therapy for teeth, the soft (gum) tissue is surgically separated from the endangered tooth and the tooth surface is thoroughly cleaned.  Infected tissues are removed from the area. Next a small piece of material called a GTR membrane is placed against the tooth.  If the tooth is to be removed and an implant placed, the soft tissue is then sutured back into place, covering the implant if placed and the membrane.  Platelet Rich Plasma, PRP can also be used and within a few days, the healing process is proceeding.

EXTRACTION, PRP, AND GTR WITH IMMEDIATE IMPLANT PLACEMENT

Photographs of CLINICAL CASE

          1) Unhealthy supporting bone structure for tooth.

RADIOGRAPHS OF CLINICAL CASE

Healthy, regeneration of new bone and supporting tissue with implants in place.

This type of treatment is appropriate for many types of problems. The type and severity of bone and soft tissue loss, your willingness to maintain appropriate oral hygiene, and whether or not you smoke, are factors considered by your dental professional when choosing an appropriate therapy. GTR can improve the condition caused by periodontal disease within six to eight weeks, although complete healing may not be achieved for six months. During this time, the healing wound must be protected from trauma for several weeks.

Photographs of CLINICAL COMPLETED CASE

RADIOGRAPHS OF COMPLETED CLINICAL CASE

     Healthy, regeneration of new bone and supporting tissue with implants,custom abutments & crowns in place.

This is how GTR works: the GTR membrane serves as a barrier that separates fast-growing soft (gum) tissue from the newly cleaned surface of the tooth root. This enables slower-growing fibers and bone cells to migrate into the protected area. 

Absorbable collagen membrane can be used and removal of the membrane is unnecessary. It will be completely and naturally dissolved in approximately eight weeks following surgery.  Incases of bone regeneration with an extraction site, a nonresorbable membrane will be needed during the time of regeneration

Collagen is a natural material that has been used for many years in medical products. Collagen is the most abundant protein in the animal kingdom and is made of bovine Achilles tendon, one of the purest sources of Type I collagen available.

1) Unhealthy supporting structure for a tooth.

2) Placement of the barrier to promote the regeneration process.

3) New formation of bone and healing tissue.

4) Healthy, regenerated gums.

 

 

Prior to GTR therapy, your dental professional will recommend an appropriate oral hygiene program. It is essential that you follow this program, otherwise, GTR therapy has less chance of success and may be ruled out as a treatment option.

The surgeon draws approximately 50cc of your blood at the time of surgery. The blood is placed in a specialized centrifuge that spins and automatically separates the red blood cells from the plasma. The plasma is then further centrifuged to concentrate the autologous platelets and hence your natural growth factors. The Platelet Rich Plasma (PRP) is then available for your surgeon to use as needed. The entire process takes less than 5 minutes and adds no extra time to the surgical procedure.

Platelet Rich Plasma (PRP) is composed of platelets and plasma. Platelets are tiny cells that are partially responsible for causing blood to clot. Platelets also contain large reservoirs of natural growth factors. While a normal concentration of platelet circulating in your blood is 200,000 per micro liter, the platelet count in PRP can exceed 2 million platelets per micro liter.

Platelets contain potent growth factors necessary to begin tissue repair and regeneration at the wound site. Growth factors derived from platelets initiate connective tissue healing, bone regeneration and repair, promote development of new blood vessels, and stimulate the wound healing process.

The use of PRP enriched with growth factors is considered by many to be a "new frontier" of clinical therapy. Since PRP can he used in so many types of procedures and for so many types of patients, you should discuss your specific surgery with your doctor.

Following GTR therapy

Following GTR therapy, your doctor will provide specific instructions for proper oral hygiene and care of the area under treatment. These may include the following:

• It is important not to disturb the GTR membrane or the tissue that covers it. Your doctor may ask you to refrain from brushing or flossing the treated area for some time following the procedure to avoid damage to healing tissues.

• Specific mouthwashes may be recommended to reduce plaque buildup.

• Your doctor may prescribe an antibiotic to reduce the possibility of a bacterial infection in the surgical area.

• You will be scheduled for postoperative visits.

These appointments are important as they allow your doctor to evaluate wound healing and professionally clean the treated area, if necessary.

• If the GTR membrane becomes exposed, or if other problems occur, consult your doctor for additional instructions.

• Some discomfort should be expected following surgery. This is normal for any form of periodontal surgery. When PRP is used, there is no second surgery or additional discomfort.

When your doctor determines that treatment and healing are complete, you may return to a normal hygiene regimen.

It is important to keep in mind that proper hygiene is essential to prevent a serious recurrence of periodontal disease. For many patients, this means adhering more stringently to hygiene practices than in the past since inadequate hygiene was probably a primary factor in the onset of the disease.

For these reasons, you should review your brushing and flossing practices with your doctor and make a long-term commitment to following your doctor’s prescribed regimen.

If you have any questions regarding the GTR procedure, do not hesitate to discuss it with your doctor.

[Top]