Abstract
Chronic periodontitis is the most common disease which induces oral tissue destruction. The goal of periodontal treatment is to reduce inflammation and regenerate the defects. As the structure of periodontium is composed of four types of different tissue (cementum, alveolar bone periodontal ligament, and gingiva), the regeneration should allow different cell proliferation in the separated spaces. Guided tissue regeneration (GTR) and guided bone regeneration (GBR) were introduced to prevent epithelial growth into the alveolar bone space. In the past, non-absorbable membranes with basic functions such as space maintenance were used with bone graft materials. Due to several limitations of the non-absorbable membranes, membranes of the second and third generation equipped with controlled absorbability, and a functional layer releasing growth factors or antimicrobials were introduced. Moreover, tissue engineering using biomaterials enabled faster and more stable tissue regeneration. The scaffold with three-dimensional structures manufactured by computer-aided design and manufacturing (CAD/CAM) showed high biocompatibility, and promoted cell infiltration and revascularization. In the future, using the cell sheath, pre-vascularizing and bioprinting techniques will be applied to the membrane to mimic the original tissue itself. The aim of the review was not only to understand the past and the present trends of GTR and GBR, but also to be used as a guide for a proper future of regeneration therapy in the oral region.
Highlights
The health of oral and periodontal tissue significantly affects the quality of life [1]
The barrier membranes used in Guided tissue regeneration (GTR) and guided bone regeneration (GBR) are usually divided based on their degradation characteristics: absorbable and non-absorbable membranes
In order to eliminate the necessity for secondary surgery, an absorbable membrane was suggested as a barrier membrane for GTR and GBR
Summary
The health of oral and periodontal tissue significantly affects the quality of life [1]. The cells including cementoblast, osteoblast, osteoclast, and mesenchymal cells from PDL are activated to rebuild their missing tissues [5,6,7,8,9] For successful regeneration, both GTR and GBR procedures are used to achieve stability of blood clot, wound site healing, and isolation of the bone healing site from soft tissues, and to provide adequate space for bone healing [10]. The “PASS principle” suggests four biological principles necessary for the bone regeneration, which are (1) primary wound closure to ensure uninterrupted healing; (2) angiogenesis to provide blood and nutrient supply, as well as delivery of pro-healing cell types; (3) space maintenance for new bone growth while preventing soft tissue in-growth; and (4). There are many advances in regeneration therapy in periodontal tissues, but only the developments of membranes and grafting materials are reviewed in this article
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