GTR Membrane Research Articles

Fabrication of drug loaded polylactic acid/keratin/polyethylene glycol GTR membrane for periodontal application

This study proposes the fabrication of, amoxicillin-loaded composite GTR membranes from polylactic acid (PLA), wool keratin (WK), and polyethylene glycol (PEG) for periodontal therapy. Deep eutectic solvents were employed for the extraction of keratin from wool fibers. For the preparation of the control (C), PLA and PEG were dissolved in a ratio of 60:40 in chloroform. While the experimental groups K2 and K3 were prepared by adding, 2% and 3% WK powder, respectively, to the control mixture. To prepare the experimental groups K2-D and K3-D, 1% AMOX-treated WK powder was mixed with the previously mentioned groups. The prepared GTR membrane was characterized using various analytical techniques. The treatment of sheep wool and the presence of AMOX in the experimental groups were confirmed using FTIR analysis. The Scanning electron microscope (SEM) images of the prepared GTR membranes showed voids and presented a conglomerated appearance. The K2 had the highest tensile strength, whereas K2-D and K3-D which contained drugs had lower tensile strengths but significant antibacterial activity. K2 experienced the greatest mass change after 1 h, while K2-D and K3-D experienced the least. Each membrane was found to be hydrophilic. The Alamar Blue Assay revealed good biocompatibility.

Preparation and optimization of an eggshell membrane-based biomaterial for GTR applications

ObjectivesGuided Tissue Regeneration (GTR) is a popular clinical procedure for periodontal tissue regeneration. However, its key component, the barrier membrane, is largely collagen-based and is still quite expensive, posing a financial burden to the patients as well as healthcare systems and negatively impacting the patient’s decision-making. Thus, our aim is to prepare a novel biomimetic GTR membrane utilizing a natural biomaterial, soluble eggshell membrane protein (SEP), which is economical as it comes from an abundant industrial waste from food and poultry industries, unlike collagen. Additive polymer, poly (lactic-co-glycolic acid) (PLGA), and a bioceramic, nano-hydroxyapatite (HAp), were added to improve its mechanical and biological properties. MethodsFor this barrier membrane preparation, we initially screened the significant factors affecting its mechanical properties using Taguchi orthogonal array design and further optimized the significant factors using response surface methodology. Furthermore, this membrane was characterized using SEM, EDAX, and ATR-FTIR, and tested for proliferation activity of human periodontal ligament fibroblasts (HPLFs). ResultsOptimization using response surface methodology predicted that the maximal tensile strength of 3.1 MPa and modulus of 39.9 MPa could be obtained at membrane composition of 8.9 wt% PLGA, 7.2 wt% of SEP, and 2 wt% HAp. Optimized PLGA/SEP/HAp membrane specimens that were electrospun on a static collector showed higher proliferation activity of HPLFs compared to tissue culture polystyrene and a commercial collagen membrane. SignificanceFrom the results observed, we can conclude that SEP-based nanofibrous GTR membrane could be a promising, environment-friendly, and cost-effective alternative for commercial collagen-based GTR membrane products.

Comparative evaluation of the auxiliary effect of different herbs to enhance the antibacterial efficacy of calcium hydroxide against Enterococcus faecalis biofilm – An in vitro study

Aim: The increase in potential side effects and safety concerns of conventional medicaments has led to the recent popularity of herbal alternative medications. The herbal products are known for their high antimicrobial activity, biocompatibility, anti-inflammatory, and antioxidant properties. The present study was designed to compare the effectiveness of calcium hydroxide (CH) in combination with various herbs as intracanal medicaments against Enterococcus faecalis biofilm. Methods: Forty extracted single-rooted maxillary teeth were decoronated and sectioned into two halves. They were later infected with E. faecalis to form a biofilm for 21 days. Subsequently, the root samples were divided into a control group and three experimental groups – the control group was treated with CH powder mixed with distilled water and the experimental Group 1 was treated with CH powder and aloe vera gel placed over PerioCol-guided tissue regeneration (GTR) membrane; Group 2 was treated with CH powder mixed with coronil, and incorporated with aloe vera gel; and Group 3 was treated with CH powder mixed with Ajmodadi Churna incorporated with aloe vera gel. At the end of 7 and 14 days, the antimicrobial efficacy of medicaments against E. faecalis biofilm was assessed at the depths of 200–400 μm. Kruskal–Wallis test and post hoc analysis – Mann–Whitney test were used for statistical analysis. Results: Ajmodadi Churna was most effective followed by coronil and CH placed over the PerioCol GTR membrane. Conclusion: Ajmodadi Churna exhibited superior results. Coronil displayed good efficacy against E. faecalis in long-term use and thus could be used as an effective intracanal medicament. Among the Ayurvedic preparations, both hold a promising future but to implement their use as sole intracanal medicaments clinically, further in vivo and long-term studies are warranted.

Interdisciplinary management of horizontal root fracture in middle third with osseous bone defect – A clinical report

Dental trauma are the main cause of emergencies in dental practice. Amongst these, root fractures are relatively uncommon but comprises about 0.5 to 7% of all injuries affecting permanent dentition. Most commonly, root fracture occurs from a horizontal impact mostly in oblique direction. The incidence is more common at the mid-third of the root rather at the apical and cervical thirds. Such hideous injury must be restored to normal as early as possible to retain the dental health and appearance. This report records the case of horizontal root fracture of upper anterior tooth, treated with Mineral Trioxide Aggregate (MTA) and fractured root fragments were unified with the aid of a stainless steel reamer after an endodontic treatment. Alloplastic bone graft and GTR membrane were used for osseous bone defect. Mineral trioxide aggregate (MTA) has several impending & forthcomin clinical applications owing to its grander sealing property and biocompatibility. A 12 months follow-up revealed a well stabilized assembly of the root fragments and periodontal healing.

Fabrication of polymeric composite GTR membrane from eggshell powder, polylactic acid and polyethylene glycol for periodontal application: in vitro evaluation

This study aims to fabricate, characterize and evaluate Guided tissue regeneration (GTR) membrane containing eggshell (ES), chlorhexidine (CHX) and polymeric matrix for periodontal application. ES powder ground to size 74 µm was mixed in Polylactic Acid (PLA) and Polyethylene Glycol (70:30 ratios) mixture in 10% and 30% wt to fabricate the membrane and named groups C-10 and C-30. Along with this, 0.25% and 0.5% CHX powder were adsorbed on ES powder and incorporated in PLA and PEG mixture to fabricate drug containing groups C-10CHX and C-30CHX respectively. UTM was used to measure tensile strength, Young’s Modulus, and percent elongation of the prepared GTR membrane. Experimental groups containing 10% ES powder (C-10 and C-30) had adequate tensile properties. The percent mass change of the samples was calculated by the change in weight of the samples (Wd) from the weight of samples after immersion in phosphate-buffered saline PBS (Wt). Contact angle measurement showed that all membranes were found to be hydrophilic (contact angle<90). Groups containing the drug CHX (C-10CHX and C-30CHX) had significant disc diffusion antibacterial activity. Cell viability assay was carried out by Alamar Blue Assay using mouse fibroblasts NIH3T3 and pre-osteoblasts that indicated very good biocompatibility of the groups (C, C-10, C-30, and C-10CHX) while experimental group C-30CHX showed slight cytotoxicity (Cell Viability >70%).

Treatment of mandibular Grade II furcation defects using demineralized freeze-dried bone allograft alone or in combination with guided tissue regeneration membrane – A randomized controlled clinical trial.

Background– Periodontal disease, if not interfered, will headway further with attachment loss involving the bifurcation or trifurcation of multirooted teeth. Furcation involved molar teeth respond less favorably to conventional periodontal therapy alone resulting into tooth loss. Combining osseous grafting with guided tissue regeneration membrane may enhance the response to treatment as compared to graft – only therapy by achieving mechanical stabilization and preventing micromovement of the bone graft material.
 
 Aim & Objective – To compare the efficacy of demineralized freeze-dried bone allograft alone or in combination with guided tissue regeneration membrane in the treatment of mandibular Grade II furcation defects.
 
 Materials & method - In this study a total number of 20 patients with 20 mandibular sites (buccal grade II furcation involvement) were evaluated. They were divided into two groups: Control group (bone graft only) and test group (bone graft + GTR). The clinical parameters assessed were vertical probing depth, horizontal probing depth and relative clinical attachment level.
 
 Results – In this study the statistical analyses comparing test and control sites at baseline revealed no significant differences between the two groups for any of the clinical parameters considered. At 6 month evaluation, significant difference was found between two groups regarding VPD, HPD and rCAL.
 
 Conclusion – It was concluded that there is a significant enhanced effect of using DFDBA bone graft in combination with GTR membrane over bone graft alone for the treatment of mandibular Grade II furcation defects.

Treatment of Periapical Infected Site and Bony Defect in the Maxillary Esthetic Zone by Extraction & Immediate Implant Placement Particulate Equine Xenograft & Equine Pericardial GTR Membrane: A Case Report

Immediate placement and restoration of the implant is a widely used protocol, but loading of implants in the site which is periapically infected is still not very popular. Very few studies have been conducted and it’s still in debate. The conventional protocol of placing implant and waiting for it to osseointegrate is time consuming and compromises patient’s esthetics and psychological comfort

Comparative evaluation of the physical properties of membranes for periodontal regeneration: An In vitro Study

Introduction: Barrier membranes are the devices used in guided tissue regeneration procedures to promote the repopulation of the wound space by periodontal ligament cells. Commercially available membranes have been used widely for periodontal regeneration. The aim of the present study is to compare and evaluate the physical properties of membranes used for periodontal regeneration. Materials and Methods: The tensile strength and surface topography using scanning electron microscope were analysed of three commercially available membranes: chorion membrane, Healiguide™ membrane and PerioCol®-GTR membrane were analysed. Results: The tensile strength of the PerioCol®-GTR membrane was the highest, while that of the Chorion membrane was the least. Variations in the surface topography were observed in all three membranes groups. Conclusion: The study demonstrated variation in surface topography and tensile strength of the resorbable periodontal membranes, suggestive of differences in the time of resorption during regenerative periodontal procedures.

Management of an endo-perio lesion: A multidisciplinary approach

The presence of pulpal pathosis and inflammatory periodontal disease concomitantly can complicate diagnosis and treatment planning of any tooth. It requires a combined treatment approach involving endodontic, periodontic and prosthodontic intervention. Often, the periodontal and prosthodontic aspects are neglected by the clinicians after successful endodontic treatment resulting in failure. The present case report describes a multidisciplinary approach for the treatment of a tooth that presented with an endo-perio lesion; using non-surgical root canal treatment and periodontal regenerative surgery (non-incised papillae surgical approach, {NIPSA} long with GTR membrane and an alloplastic bone graft) which were then followed by the placement of a conservative tooth coverage restoration (endocrown). A significant gain in clinical attachment level was seen 6 months postoperatively. Radiographically also a significant amount of bone fill was observed.

An Insight into Nano Silver Fluoride-Coated Silk Fibroin Bioinspired Membrane Properties for Guided Tissue Regeneration.

The current work focuses on the development of a novel electrospun silk fibroin (SF) nonwoven mat as a GTR membrane with antibacterial, biomineralization and biocompatible properties. The γ-poly glutamic acid (γ-PGA)-capped nano silver fluoride (NSF) and silver diamine fluoride (SDF) were first synthesized, which were dip-coated onto electrospun silk fibroin mats (NSF-SF and SDF-SF). UV-Vis spectroscopy and TEM depicted the formation of silver nanoparticles. NSF-SF and SDF-SF demonstrated antibacterial properties (against Porphyromonas gingivalis) with 3.1 and 6.7 folds higher relative to SF, respectively. Post-mineralization in simulated body fluid, the NSF-SF effectively promoted apatite precipitation (Ca/P ~1.67), while the SDF-SF depicted deposition of silver nanoparticles, assessed by SEM-EDS. According to the FTIR-ATR deconvolution analysis, NSF-SF portrayed ~75% estimated hydroxyapatite crystallinity index (CI), whereas pure SF and SDF-SF demonstrated ~60%. The biocompatibility of NSF-SF was ~82% when compared to the control, while SDF-coated samples revealed in vitro cytotoxicity, further needing in vivo studies for a definite conclusion. Furthermore, the NSF-SF revealed the highest tensile strength of 0.32 N/mm and 1.76% elongation at break. Therefore, it is substantiated that the novel bioactive and antibacterial NSF-SF membranes can serve as a potential candidate, shedding light on further in-depth analysis for GTR applications.

Development of biodegradable silkworm cocoon derived silk membrane for GTR in the treatment of grade II furcation

This was a preliminary study to develop a biodegradable membrane from silkworm Bombyx.mori. The silk fibroin membrane prepared was analyzed for tensile strength and used in patients with grade II furcation defects, which was compared with collagen membrane. Though collagen is the gold standard, it has disadvantages, one of them being slow biodegradability. Hence this research was carried out to see if silk fibroin was good as a regenerative material in providing bone fill in the furcal area. As it is commonly accepted that treatment in the furcal area is better with bone graft and GTR membrane compared with just bone graft and flap surgery, this clinical trial with a common bone graft was carried out in addition to barrier membrane, which were of different sources. The patients fulfilling the inclusion criteria were randomized into test and control sites. The test sites received bone graft(colocast) and silk fibroin membrane while the control site received bone graft(colocast) and collagen membrane(cologide). The bone fill was analyzed radiographically using AUTOCAD software 2017. The results of the study showed that both the sites did not show any adverse effects, but improvement were noted clinically and radiographically. Radiographically significant improvement was seen in silk fibroin sites indicating that silk fibroin with bone graft would be better as a regenerative material.

Assessment of Modified Polycaprolactone Membrane in Horizontal Ridge Augmentation of Atrophic Ridge

Aim : The aim of the study was to assess the modified polycaprolactone resorbable membrane in horizontal ridge augmentation of atrophic ridge. Subjects and Methods: Twenty Patients with alveolar bone resorption in the anterior maxilla that require alveolar ridge augmentation to allow rehabilitation with fixed implant-supported prosthesis were included in this study. Patients were divided randomly into two main groups; Group (A) to whom collagen resorbable membrane has been used. Group (B) to whom modified (PCL) resorbable membrane has been used. Results: In the present study, At 1 week, after 1 as well as 3 months; there was no statistically significant difference between Local infections, wound healing, and membrane exposures in the two groups. Immediately; there was no statistically significant difference between bone density measurements in the two groups. After 6 months, group (B)showed statistically significant higher mean bone density and ridge width than group(A) due to the flexibility present in the nature of the product used in group (B) that was not available in the product used in group (A). Conclusion: PCL has been introduced as candidate materials for bioactive GTR membrane due to its biocompatibility and simple fabrication procedure. PCL-membrane promote tissue formation.

Histomorphometric analysis of bone interphase

Background: Different surgical techniques have been advocated for esthetic rehabilitation of deficient alveolar ridges with implant placement: Guided bone regeneration (GBR), Alveolar distraction osteogenesis, Onlay block graft (autogenous and allograft); However, autogenous block graft still provides with predictable outcome since being the gold standard for regeneration and augmentation. Objective: The aim of the present study was to compare histomorphometrically the bone interphase of augmented site with and without GTR (guided bone regeneration) membrane before implant placement. Material and Methods: In this study, a total of 16 patients with missing incisor with Siberts Class 1 alveolar defects were selected, parasymphysial block graft were harvested and stabilized with miniscrews, DFDBA graft material around the block graft were placed, and 8 were covered with GTR resorbable membrane. Miniscrews were removed after 6 months. Bone core biopsy of interphase were retrieved by 2.9 mm diameter trephine bur and sent for histologic and histomorphometric analysis using histometry software. Results: Data were evaluated using paired sample t-test and Shapiro-Wilk test. Histological evidence of fibrous tissue interphase was observes in specimen without GTR group. Though there were no statistically significant difference between the two groups in terms of amount of new bone 31.47 versus 30.6% (P = 0.5362), while there was a statistically significant difference in percentage of residual grafted material higher in non GTR augmented site (t value= 4.501 P = 0.0003) and marrow space in GTR group with statistical significance (t = 2.887 P = 0.0098). Conclusion: Only few studies have tested histomorphometrically to see the exact uptake of the augmented site, comparing interpositioning of fibrous tissue, newly formed bone at site, residual graft material and marrow space. It is most appropriate to use an evidenced-based approach when a treatment plan is being developed for bone augmentation cases. This study will add to the evidence of use of autogenous block graft with GTR membrane thus providing a connective tissue interphase free augmentation.

Comparative evaluation of demineralized bone matrix and type II collagen membrane versus eggshell powder as a graft material and membrane in rat model.

The regeneration of supportive periodontal tissues after destructive periodontal disease has become one of the primary objectives of periodontal therapy. Demineralized bone matrix (Osseograft), when used, has shown osteoinductive potential and collagen membrane (GTR) prevents the migration of epithelium into it. The literature showed that eggshell which consists of hydroxyapatite and calcium carbonate shows osteoconductive as well as inductive properties. Eggshell membrane which is made of type X collagen matrix can be used as a barrier membrane. Hence, the aim of the study was to compare the demineralized bone matrix with GTR membrane to eggshell constituents and its membrane as a regenerative material in Wistar rats. A critical size periodontal defect of 1.5 × 6 mm was created on either side adjacent to mandibular incisors after raising the full thickness flap. Osseograft and collagen membrane covered the defect on one side and the eggshell components and its membrane filled the defects. The animals were sacrificed on the 45th day. Histological evaluation showed intensive new bone formation on both sides of the defect. Inflammation has resolved completely with no signs of eosinophils. Complete defect healing was noted in both the defects. A minimal amount of epithelial entrapment was noted in both the sites. There was no significant difference observed between the comparisons. More connective tissue was found in the test group. Within the limits, it can be concluded that eggshell powder along with membrane can be used as a potential graft material.

Cortical Bone Graft and GTR Membrane as "Ceiling Effect" in Alveolar Bone Grafting.

In orofacial cleft deformity cases, bone grafting is a very essential step in reconstruction of the residual alveolar cleft defect. Though various authors have put forth different techniques and graft sources for alveolar bone grafting, at our center, we have used iliac crest as the graft source and cortical bone graft with GTR membrane as "ceiling effect". We have evaluated a series of cases of secondary alveolar bone grafting done with this technique by same surgeon at our center and have found great success. In this clinical paper, we describe our surgical technique and also the key points from surgeons experience to ensure a better result.

English

Collagen is the most abundant protein that holds the whole body together in humans. It is found in the skin, bones, muscles and tendons and provides a scaffold to give strength and structure. These are proteins of unique structure and function with wide distribution throughout the animal kingdom ranging from insects to man. They are the major fibrous protein of the connective tissue which constitute about 1/3rd of the total protein in the body. Collagen is a highly versatile material and extensively used in the field of medicine for the management of severe burns, non-healing ulcers, traumatic, surgical wounds and various cosmetic procedures. In dentistry collagen is found to have a good scope of improvement, as materials which are biocompatible and easily absorbed by the tissues are more acceptable than synthetic one’s. It has a proven rate of success in the field of dentistry as GTR membrane, Root conditioning agent, Haemostatic agent and wound dressing agent. This paper aims to present an overview of collagen, its structure, biocompatibility and also focuses on the applications in the field of dentistry.

Palatoradicular Groove Associated Defect Resolved with GIC, Alloplastic Graft and GTR Membrane

ABSTRACT The region of maxillary lateral incisor is an area of embryological importance with major and minor malformations like, gemination, fusion, cysts, dens in dente, peg-shaped laterals, talon cusps, supernumerary roots, and palatogingival groove (PGG). Palatogingival groove is a developmental groove usually found on the lingual aspect of maxillary incisors. It can be simple or complex on the basis of its connection to the pulp. These grooves act as a nidus for plaque accumulation which destroys the sulcular epithelium and later deeper parts of the periodontium. Since proper cleaning of this region is difficult by patient himself, it can lead to serious localized periodontal lesion or can communicate with endodontic lesion. Suggested treatment modalities are curettage of the affected tissues, elimination of the groove by grinding (saucerization), or by sealing with a variety of filling materials. If the groove extends beyond the middle-third of the root apex, surgical procedures are required, including use of barriers and intraosseous alloplastic graft to correct the defect. How to cite this article Devaraj CG, Yadav A, Sharma S, Meena M, Mishra P, Godara S, Kapoor R. PalatoRadicular Groove Associated Defect Resolved with GIC, Alloplastic Graft and GTR Membrane. J Mahatma Gandhi Univ Med Sci Tech 2016;1(2):75-78.

A novel porcine collagen GTR membrane for treatment of Class II molar furcation involvement

Abstract Guided tissue regeneration (GTR) in the management of the periodontal furcation invasion is effective. Recent studies showed significant clinical improvement with different materials. The purpose of this study is to provide clinical evaluations of the bone repair potential of GTR combined with a novel porcine collagen membrane in the treatment of human molar Class II furcations. Fifty-one patients, 33 males and 18 females, with no systemic disease and a mean age of 49.1 years, participated in this study after phase I periodontal therapy. Probing depth, attachment loss and radiographic examination were recorded and analyzed before and after GTR therapy with collagen membrane. In the soft tissue measurement, the periodontal pocket (PD) depth was 5.283±0.283 mm before the surgery and improved to 2.631±0.147 mm at 9 months after surgery (p<0.05). Attachment loss also showed similar results. The attachment level was 5.547±0.3 mm before the surgery, and 2.911±0.188 mm at 9 months after surgery (p<0.05). According to the measurements the attachment gain was 2.636±0.168 mm after GTR surgery with porcine collagen membrane. According to this study, the porcine collagen membrane can perform with exceptional results in attachment level gain for the Class II periodontal furcation involvement.

Clinical and Radiographic Evaluation of Regenerative Potential of GTR Membrane (Biomesh®) along with Alloplastic Bone Graft (Biograft®) in the Treatment of Periodontal Intrabony Defects

The primary goal of periodontal therapy is to restore the tooth supporting tissues lost due to periodontal disease. The aim of the present study was to compare the efficacy of combination of GTR membrane and alloplastc bone graft with open flap debridement (OFD) in treatment of periodontal intrabony defects. Twenty paired intrabony defects were surgically treated using split mouth design. The defects were randomly assigned to treatment with OFD, GTR membrane+bone graft (test) or OFD alone (control). The clinical efficacy of two treatment modalities was evaluated at 6 months postoperatively by clinical, radiographical parameters. The measurements included probing pocket depth (PD), clinical attachment level (CAL), gingival recession (GR), bone fill (BF), bone density (BD). The mean reduction in PD at 0 to 6 months was 3.20±0.82 mm and CAL gain of 3.10±1.51 mm occurred in the GTR membrane+bone graft (test) group; corresponding values for OFD (control) were 2.10±0.63 mm and 1.90±0.57 mm. Similar pattern of improvement was observed when radiographically postoperative evaluation was made. All improvement in different parameters was statistically significant (p<0.01). Treatment with a combination of collagen membrane and bone graft led to a significantly more favorable clinical outcome in intrabony defects as compared to open flap debridement alone.

Zucchellie&amp;#39;s Technique with GTR Membrane for Multiple Gingival Recession Coverage

5 ABSTRACT: Gingival recession associated with dentinal hypersensitivity is one of the commonest issues addressed by the periodontist. The treatment choice for these cases should address biological as well as patient chief complaint. Coronally advanced flaps for root coverage are the most commonly used technique for multiple teeth recessions. This case report describes a case of Class I gingival recession due to faulty brushing technique associate with dentinal hy- persensitivity treated with Zucchelli's modification of conventional coronally advanced flap with GTR membrane.