DENT461– BDS4

Guided Tissue Regeneration

GTR
Getulio Nogueira
 Learning Outcomes

1 2 3
To describe
the concepts of
To understand
the biological
To cite
the best
periodontal principles of GTR indications of GTR
wound healing
¡ Preserve natural dentition, periodontium and periimplant tissues
¡ Maintain and improve periodontal and peri-implant health
¡ Maintain patients’ comfort, aesthetics and function
AAP Guidelines for Periodontal Therapy. J Periodontol 72:1624-1628, 2001
 BoP+

?
PPD 10mm
REC -2mm
CAL 8mm

BoP-
PPD 2mm
REC 0mm
CAL 0mm
 Outline

1 2 3
To describe
the concepts of
To understand
the biological
To cite
the best
periodontal principles of GTR indications of GTR
wound healing
 ¡ Epithelial Cells

¡ Connective Cells

¡ Bone Cells

¡ PDL cells

GTR principle!
PDL
*
Subgingival biofilm

Inflammation CT

Destruction of
Bone and PDL

Apical migration JE
 Bone + Dentin (resorption)

Ankyloses

Caton & Greenstein, 1993

 Biofilm/calculus elimination

Partial bone formation

Inflammation resolution

Long Junctional Epithelium

Caton & Greenstein, 1993
 Lack of new
cementum

Resorption

CT adaptation

Caton & Greenstein, 1993

 New cementum

New Sharpey fibres

New CT
attachment

Yukna & Mellonig, 2000

 New cementum

New PDL

New bone

Regeneration

Yukna & Mellonig, 2000

 + New bone + New cementum

Carranza, 2015
 Outline

1 2 3
To describe
the concepts of
To understand
the biological
To cite
the best
periodontal principles of GTR indications of GTR
wound healing
¡ Derived from the classic studies of Nyman (1982), Lindhe (1984),
Karring (1986) and Gottlow (1986), GTR is based on the potential of
periodontal cells for regeneration of the attachment apparatus of
the tooth (Melcher, 1976).
¡ Regenerative surgeries do not intend to treat PD
¡ RS treat anatomic defects left by the progression of PD

Carranza, 2015
¡ Selective cell repopulation (epithelial exclusion)
¡ Use of physical barriers (membranes) + or - grafts
¡ Clot stabilization
¡ Wound protection
¡ Space making
 JE

CTA

New ATT
LJE

Regeneration

CTA

Regeneration
JE

Membrane (barrier)

Regeneration
CRITERIA TYPES
¡ Biocompatible ¡ Resorbable
¡ Cell occlusive ¡ Non resorbable
¡ Space-making ¡ Emdogain*
¡ Tissue integration ¡ PRF*

¡ Clinical flexibility
 Outline

1 2 3
To describe
the concepts of
To understand
the biological
To cite
the best
periodontal principles of GTR indications of GTR
wound healing
1. Infrabony defects (1, 2, 3 walls= intrabony), crater

2. Furcation lesions (class II)

1. Poor OH
2. Medical conditions, heavy smoking (>20 cig/day)
3. Horizontal bony defects
4. PD <4mm
5. Tooth mobility (>1)
6. Furcation lesions - grade I and III, short root trunk

Miron et al, 2015

Goldman & Cohen, 1958
Ustaoglu et al, 2020
Gorski et al, 2020
Carranza, 2015
Re-entry at 6 WEEKS
2 YEARS
1 year FU
Horizontal infrabony defects Vertical infrabony defects

1-wall 2-wall 3-wall

Furcation class III Furcation class I Furcation class II

Regenerative Potential
EMDOGAIN PRF
 Conclusions for GTR

1 2 3
Periodontal healing: Biological principles: Indications:

¡ Epithelial exclusion ¡ Infrabony defects

¡ Repair ¡ Cell selection ¡ Class II Furcations
¡ Regeneration ¡ Clot protection