Guided Tissue Regeneration Technique Research Articles

Utilising blood-derived products for guided tissue regeneration in periradicular surgery: a systematic review and meta-analysis

Background Since 1982, guided tissue regeneration (GTR) has become increasingly popular. The recent progress in GTR research focuses on the application of blood-derived products. However, no comprehensive systematic review has been conducted to assess its effectiveness specifically in periradicular surgery. Therefore, the aim of this review was to analyse the outcomes of periradicular with GTR using blood-derived products compared to standard periradicular surgery. Methods This review was based on randomised controlled trials comparing periradicular surgery in conjunction with GTR with blood-derived products and the standard periapical surgery. The databases searched included Embase, MEDLINE, Cochrane CENTRAL, and Dentistry and Oral Sciences Source, with the most recent search conducted on December 16th, 2022. Additionally, reference lists of similar systematic reviews were examined, while international trials registries and repositories were consulted for unpublished studies. Two blinded independent reviewers carried out the screening and the included studies underwent critical appraisal. The findings are reported in accordance with the PRISMA guidelines. Results A total of 261 publications were initially reviewed based on their title and abstract, resulting in seventeen studies that underwent full-text screening. At this stage, 14 studies were excluded, leaving three randomised controlled trials to be included. These trials involved a total of 85 patients. A meta-analysis was conducted for the outcome of healing. The overall treatment effect was 0.78 (95% CI 0.18 to 3.34), indicating a preference towards the control group. Conclusion Based on a meta-analysis of three studies, there was no statistically significant distinction observed in terms of healing between the GTR involving blood-derived products and standard procedure groups. However, critical appraisal revealed indirectness and imprecision, resulting in a certainty rating of 'low'. Thus, additional robust evidence is necessary to support the utilisation of blood-derived products in GTR techniques to enhance periradicular surgery outcomes. Systematic review registration number PROSPERO CRD42020222663.

Clinical outcomes of endodontic microsurgery in complicated cases with large or through-and-through lesions: a retrospective longitudinal study.

To investigate the clinical outcomes of endodontic microsurgery in complicated cases presenting with large or through-and-through lesions. We retrospectively collected and analyzed preoperative, intraoperative, and follow-up data from 143 complicated cases that underwent endodontic microsurgery. Clinical outcomes were assessed in terms of tooth survival and surgery success. Cox regression analysis was used to evaluate the survival rate and identify associated risk factors. Additionally, the success rate was compared across different postoperative periods, and potential factors contributing to surgical failure were identified through binary logistic regression. The overall survival and success rates were 93.0% and 91.7%, respectively. The Cox regression model identified four risk factors affecting tooth survival, including apicoectomy of four teeth (HR = 35.488; P = 0.0002), an open apex observed on preoperative radiographs (HR = 6.300; P = 0.025), the performance of guided tissue regeneration technique (HR = 8.846; P = 0.028), and a palatal surgical approach (HR = 8.685; P = 0.030). The success rate demonstrated an initial increase in the early postoperative period (from 0.5 to 2 years; P = 5.8124e-30), followed by stabilization (from 2 to 9 years; P = 0.298). Surgery success rate significantly declined when apicoectomy involved four teeth (OR = 109.412; P = 0.002). Endodontic microsurgery demonstrates satisfactory outcomes in complicated cases, maintaining a stable success rate after two years. However, tooth survival and surgery success are significantly compromised when apicoectomy involves four teeth. Factors such as guided tissue regeneration, an open apex, and the palatal surgical approach are associated with an increased risk of tooth extraction. Despite achieving acceptable outcomes in complicated cases, endodontic microsurgery is adversely affected by the apicoectomy of four teeth.

Clinical Approach of Extensive Periapical Lesion with Periradicular Regenerative Surgery: A Case Report with 7 Year Follow Up

The aim of this study is to report a case of two maxillary incisors with chronic apical abscess and through-and-through lesion submitted to periradicular regenerative surgery, with clinical follow-ups and evaluation through cone-beam computerized tomography for 7 years. In the presentation, there was a persistent sinus tract in the palate and sensibility to touch at the apical region of the central and left lateral maxillary incisors. The initial tomography revealed the presence of an extensive radiolucent area in the apical third of the referred teeth, with loss of the buccal and palatal cortic es. For the treatment, a periradicular regenerative surgery was performed, an association of endodontic surgery with Guided Tissue Regeneration technique, using bovine bone xenograft and bioabsorbable membrane. The clinical and radiographic evaluations, including cone-beam computerized tomography, at seven years postoperatively, showed absence of symptomatology and sinus tract, probing depth within normal standards and apical bone neoformation.

Efficacy of Guided Tissue Regeneration (GTR) membranes in the healing of apico-marginal defects: A prospective, controlled clinical trial

Background: There is still inadequate information available regarding the role of GTR techniques in such lesions with the presently available data suggesting that there is a possibility of healing of apico-marginal defects without use of GTR technique by using modern microsurgical procedures. Fewer randomized-clinical trials have evaluated the response of GTR membranes in the treatment of apico-marginal defects. Aim: The present prospective, controlled clinical trial was, therefore, planned to evaluate the role of collagen membrane as GTR material in the healing of apico-marginal defects. Subjects and Methods: Thirty patients meeting inclusion criteria were selected and allocated randomly to either the GTR membrane group or, the control group. Clinical and radiographic examination was done after one week for baseline measurements and then, during follow-ups at regular intervals of 3, 6, 9, and 12 months after the procedure. The criteria for success included the absence of clinical signs and symptoms and signs of radiographic healing. Statistical Analysis Used: The statistical analysis of the ordinal data was carried-out by using non-parametric methods. Mann-Whitney and Wilcoxon signed rank test were used for the unpaired and paired data respectively. Chi-square test was used to evaluate dichotomous data. Results: Significant reductions were observed in the periodontal pocket depth (PD), clinical attachment level (CAL), gingival margin position (GMP) and the size of the peri-apical lesion at 12-month follow-up (P < 0.05) in each treatment group except gingival margin position (GMP) in the GTR membrane group with the corresponding P value being 0.059. The results for the reduction in the size of the peri-apical lesion were, also, found to be statistically significant with the corresponding P value being <0.05. Furthermore, 83.33% of the patients showed complete healing in case of GTR membrane group while the same was found to be 90.9% in case of the control group although the difference in the percentage reduction in the size of the peri-apical lesion at different time intervals after surgery was found to be statistically insignificant between the two groups. Conclusion: The results of the present study indicated that there might not be any additional clinical advantage obtained from GTR membrane barriers in the surgical management of isolated apico-marginal defects of primary endodontic origin with absent or, minimal proximal bone loss.

Guided tissue regeneration in peri-radicular surgery

Guided tissue regeneration techniques have been available in dentistry for decades. Primarily used for periodontal surgery and implant placement, their usefulness in periapical surgery has been getting increased attention. From the currently available evidence, guided tissue regeneration can improve patient outcomes. As a result, this technique might become more common in the future. Therefore, this review outlines the main uses of guided tissue regeneration and provides a brief summary of evidence surrounding it, with particular focus on periapical surgery.

Management of External Cervical Resorption in Mandibular Molar Furcation Area - A Case Series

<p>External cervical resorption (ECR) is an aggressive form of root resorption causing loss of tooth structure and sometimes leading to destruction of adjacent alveolar bone. In the advanced extent of ECR lesion, surgical intervention is inevitable. Several studies presented favorable treatment outcomes on advanced ECR lesions at single teeth. In the light of these studies, this article reports on surgical management of two ECR cases. Materials and Methods: Two cases had ECR combined with bony defect in left mandibular first molar. Case 1 had ECR lesion over buccal furcation area combined with buccal bone plate loss. Following root canal treatment, the resorptive defect was restored by mineral trioxide aggregate and the bony defect was treated with guided tissue regeneration (GTR). Case 2 had class II furcation defect with ECR over furcal surfaces of mesial and distal roots. The resorptive defect was restored with bioceramic putty and class II furcation bony defect was treated by GTR. Root canal treatment of tooth 36 was done later after case 2 suffered from symptomatic irreversible pulpitis of tooth 36. Result: At one-year follow-up of case 1, no inflammatory signs with probing pocket depth (PPD) less than 3mm clinically and regeneration of buccal bone plate radiographically were found of tooth 36. At half year follow-up of case 2, there was a healthy gingiva with PPD less than 3mm clinically and the furcation area has been partially filled with regenerated bone radiographically of tooth 36. Conclusion: These case series presented an interdisciplinary surgical management of two cases with external cervical resorption combined with bony defect over lower molar furcation area which were successfully treated with biocompatible restorative material in combination with GTR technique in short-term follow-up.</p> <p> </p>

Influence of Guided Tissue Regeneration Techniques on the Success Rate of Healing of Surgical Endodontic Treatment: A Systematic Review and Network Meta-Analysis.

Several regeneration techniques and materials have been proposed for the healing of bone defects after surgical endodontic treatment; however, the existing literature does not provide evidence on the most recommended techniques or materials. The aim of the present systematic review and network meta-analysis (NMA) is to summarize the clinical evidence on the efficacy of guided tissue regeneration techniques (GRTs). The PRISMA recommendations were followed. Four databases were searched up to December 2021. Randomized clinical trials (RCTs) with a minimum follow-up of 6 months were included. The risk of bias was assessed using the Cochrane Collaboration tool. A fixed effects model and frequentist approach were used in the NMA. Direct GRT technique comparisons were combined to estimate indirect comparisons, and the estimated effect size of the comparisons was analyzed using the odds ratio (OR). Inconsistency was assessed with the Q test, with a significance level of p < 0.01, and a net heat plot. A total of 274 articles was identified, and 11 RCTs (6 direct comparisons of 15 techniques) were included in the NMA, which examined 6 GRT techniques: control, Os, PL, MB, MB + Os, and MB + PL. The MB + Os group compared to the control (OR = 3.67, 95% CI: 1.36–9.90) and to the MB group (OR = 3.47, 95% CI: 1.07–11.3) showed statistically significant ORs (p ˂ 0.05). The MB + Os group presented the highest degree of certainly (P-score = 0.93).

Management of iatrogenic root perforation with grade II furcation involvement through guided tissue regeneration technique: A case with comprehensive review of clinical literature

The aim of this case report was to describe a successful repair of a long-standing furcal and coronal root perforation with grade II furcation involvement in the mesiolingual canal of a lower first molar. A 41-year-old male patient reported with the chief complaint of mild intermittent pain and pus discharge from mandibular left first molar for 1 year. Upon clinical and radiographic examination, a pulpal diagnosis of previously initiated therapy with root perforation was made. In addition, the tooth had a periapical diagnosis of chronic apical abscess, as well as a primary endodontic and secondary periodontal lesion with grade II furcation involvement. Root canal treatment and surgical repair of the perforation and furcation involvement with Mineral Trioxide Aggregate and bone graft was done. Recall examination after 2 years showed no evidence of periodontal breakdown. The patient was asymptomatic, and favorable bone regeneration and periodontal healing were seen on the radiograph. A literature review was also conducted to assess the factors affecting the prognosis of perforation repair in molars. Long-standing cervical root and furcal perforations readily lead to persistent endo-perio lesions and have been found to have the worst prognosis. A biocompatible sealing of the perforation site along with periodontal regeneration effectively enhances the longevity of such teeth. Though there are very few case reports that advocated the use of guided tissue regeneration for periodontal regeneration, nevertheless it has proven to be a reliable technique to improve the prognosis for crestal level and furcal root perforations.

Multiple gingival recessions treated with subepithelial connective tissue graft in vista technique: A case report

Recession of gingiva presents a common challenge for the clinicians. Many different periodontal plastic surgeries have been recommended for root coverage, like coronally advanced flap, pedicle graft, free gingival graft, connective tissue graft, guided tissue regeneration technique, pouch and tunnel technique etc. among which ‘vestibular incision sub-periosteal tunnel access (VISTA)’, proposed by Zadeh HH, offers a predictable and long lasting results with a minimally invasive surgical approach. This article presents a case report on management of multiple gingival recession in anterior maxilla with VISTA technique in combination with sub-epithelial connective tissue graft (SCTG).

Guided tissue regeneration techniques involving blood-derived products in periradicular surgery: a systematic review and meta-analysis protocol.

The objective of this review is to evaluate the clinical outcomes of standard periradicular surgery versus periradicular surgery with the use of guided tissue regeneration techniques involving blood-derived products in patients undergoing periradicular surgery. Guided tissue regeneration techniques have been available in dentistry for decades. Primarily used during periodontal surgery and implant placement, their usefulness in periapical surgery has been garnering increased attention. According to current available evidence, guided tissue regeneration can improve clinical patient outcomes. No systematic reviews have been carried out to investigate guided tissue regeneration techniques involving blood-derived products in periradicular surgery. Randomized controlled trials that investigate the outcomes of guided tissue regeneration techniques involving blood-derived products versus standard periradicular surgery technique, will be included for review. Studies will be excluded if they contain patients who have previously undergone periradicular surgery or the treatment was carried out on unrestorable teeth (ie, due to periodontal disease or root fractures). The databases MEDLINE, Embase, Dentistry and Oral Sciences Source, and Cochrane CENTRAL will be used to locate published reports of studies. Reference lists of relevant past systematic reviews will be used to identify further studies. Unpublished studies will be sought using international trials registries and repositories. Two reviewers will carry out independent screening of records for inclusion and the selected studies will be critically appraised prior to data extraction and synthesis. Meta-analysis will be performed if appropriate. PROSPERO CRD42020222663.

Management of upper central incisor with large periapical inflammatory cyst and persistent fistula: Case report

The objective of this case report was to describe the retreatment of an immature upper right central incisor in a 20-year-old female patient after unsuccessful endodontic treatment, who had probable clinical-radiographic diagnosis of a large periapical inflammatory cyst and persistent fistula. After removing the root canal filling material, disinfection of the root canal system, and successive intracanal medication changes over 60 days, the fistula remained active. Therefore, parendodontic surgery was performed. The root canal system was obturated, the periapical cyst was surgically enucleated, and retro-obturation with mineral trioxide aggregate was performed. We used the guided tissue regeneration technique with a xenograft and resorbable membrane. On histopathological examination, we observed bacterial colonies present in the lumen of the cystic lesion. Clinical evaluation, periapical radiograph, and cone-beam tomography confirmed complete healing of the periapical area of the affected tooth. The treatment success was verified by periapical healing over a follow-up period of 21 months.

Multifunctional chitin-based barrier membrane with antibacterial and osteogenic activities for the treatment of periodontal disease

The guided tissue regeneration technique is an effective approach to repair periodontal defect. However, collagen barrier membranes used clinically lose stability easily, leading to soft tissue invasion, surgical site infection, and failure of osteogenesis. An ideal barrier membrane should possess proper antibacterial, osteoconductive activities, and favorable biodegradation. In this study, zinc oxide nanoparticles were homogeneously incorporated into the chitin hydrogel (ChT-1%ZnO) through one-step dissolution and regeneration method from alkaline/urea solution the first time. The remaining weights of ChT-1%ZnO in 150 μg/mL lysozyme solution was 52% after 5 weeks soaking. ChT-1%ZnO showed statistical antibacterial activities for P. gingivalis and S. aureus at 6 h, 12 h, and 24 h. Moreover, ChT-1%ZnO exhibits osteogenesis promotion in vitro, and it was further evaluated with rat periodontal defect model in vivo. The cemento-enamel junction value in ChT-1%ZnO group is 1.608 mm, presenting a statistical difference compared with no-membrane (1.825 mm) and ChT group (1.685 mm) after 8 weeks postoperatively.

Platelet-Rich Fibrin for Hard- and Soft-Tissue Healing in Mandibular Third Molar Extraction Socket.

Background:Successful management of patients reporting with extreme sensitivity in second molar after surgical extraction of deeply impacted mandibular third molar poses a big challenge to oral surgeons and periodontists worldwide. A variety of grafts, barrier membranes, and guided tissue regeneration techniques have been used postsurgically for soft- and hard-tissue formation. In the current study, platelet-rich fibrin (PRF), a second-generation platelet aggregate, was assessed for its effectiveness in promoting hard- and soft-tissue healing.Objective:The aim of the study was to evaluate the efficacy of PRF in hard- and soft-tissue healing after extraction of mandibular third molar.Materials and Methods:Bilateral surgical disimpaction of mandibular third molar was done on 25 patients. In every patient, randomly allocated test side received PRF and the other side acted as control. Pain, edema, tenderness, sensitivity, Sulcus Bleeding Index (SBI), Plaque Index, clinical attachment level (CAL), probing depth, and bone height were measured at different intervals for a maximum period of 6 months.Results:There was a statistically significant improvement in patients' signs and symptoms of pain, tenderness, edema, and sensitivity with the use of PRF. A statistically significant improvement was seen in SBI, Plaque Index, and probing depths, while CALs and bone height were not influenced by PRF use.Conclusion:PRF is a very viable and useful biomaterial for soft-tissue healing and relieving patient symptoms, however, it does not help in hard-tissue healing with respect to cortical bone.

Endodontic Surgery Associated with Guided Tissue Regeneration Technique: Case Report

AbstractNon-surgical endodontic retreatment should always be the first option for reintervention when the initial endodontic treatment fails. The surgical treatment, called periradicular surgery, will be the procedure of choice when there is no success after the conventional endodontic retreatment. The purpose of this article is to describe clinical case of endodontic surgery, associated with guided tissue regeneration (GTR). A male patient, 24 years old, was referred for endodontic surgery on tooth 12 after two unsuccessful endodontic interventions. During the surgery, osteotomy, lesion curettage, apicectomy, retrograde obturation with Mineral Trioxide Aggregate (MTA), and filling of the bone failure with lyophilized bone and reabsorbable collagen membrane were performed. After six months of follow-up, the patient did not present any type of painful symptomatology. The endodontic surgery, associated with a technique of guided tissue regeneration, was efficient to solve this clinical case. Keywords: Endodontics. Apicoectomy. Guided Tissue Regeneration. Resumo O retratamento endodôntico não cirúrgico deve sempre ser a primeira opção de reintervenção quando o tratamento endodôntico inicial falha. Já o tratamento cirúrgico, ou cirurgia parendodôntica, será o procedimento de escolha quando não há sucesso após o retratamento endodôntico convencional. O objetivo deste artigo é descrever um caso clínico de cirurgia parendodôntica, associada à regeneração tecidual guiada (RTG). O paciente, gênero masculino, 24 anos, foi encaminhado para cirurgia parendodôntica no dente 12 após duas intervenções endodônticas sem sucesso. Durante a cirurgia foram realizadas manobras de osteotomia, curetagem da lesão, apicectomia, obturação retrógrada com Mineral Trióxido Agregado (MTA), além de preenchimento da falha óssea com osso liofilizado e membrana de colágeno reabsorvível. Após seis meses de acompanhamento do caso, o paciente não apresentou nenhum tipo de sintomatologia dolorosa. A cirurgia parendodôntica, associada à técnica de regeneração tecidual guiada, foi eficiente para solucionar este caso clínico. Palavras-chave: Endodontia. Apicectomia. Regeneração Tecidual Guiada.

Cover Image

The cover image is based on the Case Report Surgical management of a large radicular cyst using modified guided tissue regeneration techniques: a case report with 4 years follow-up by J.M.P. Camargo et al., https://doi.org/10.1111/ors.12424. Cover Image © José Maurício Camargo Images

Fabrication and Characterization of Chitosan-Collagen Membrane from Barramundi (Lates Calcarifer) Scales for Guided Tissue Regeneration.

Objectives The aim of this study was to evaluate the synthesis, mechanical strength, and morphology of chitosan–collagen membranes from barramundi scales for guided tissue regeneration technique. Materials and Methods Collagen was extracted from barramundi scales by immersion in acetic acid. The resulting wet collagen was later dried. The membrane was fabricated by mixing chitosan with collagen from barramundi scales. Membrane characterization parameters were measured using Fourier transform infrared (FTIR), scanning electron microscopy (SEM) and mechanical property. Results The FTIR spectrum showed the typical peak of the mixture of chitosan and collagen. The tensile strength and elongation at break of the membrane in dry condition were 0.28 MPa and 8.53%, respectively, while in the wet condition these were 0.12 MPa and 25.6%. The membrane porosity test result was 38.85%; SEM result showed a porous membrane surface with size varying around 16 to 100 µm. Conclusion The chitosan-collagen membrane from the barramundi scale showed the fibrous membrane surface that has ideal porous size as guided tissue regeneration membrane and the lower mechanical strength.

Surgical management of a large radicular cyst using modified guided tissue regeneration techniques: a case report with 4 years follow‐up

AbstractThis case report discusses the management of a large radicular cyst using current periapical surgery techniques associated with the use of modified guided tissue regeneration (GTR) techniques. The cyst involved several anterior teeth and measured 40 mm in its widest dimension, involving both cortical plates, and extending into the floor of the nose. The surgical endodontics techniques used here included the use of enhanced magnification, minimal root resection, ultrasonic root‐end preparation and retrograde obturation with a bioceramic root repair material. The large bone defect was reconstructed with the use of a mixture of autogenous bone harvested from the mandibular ramus, Bio‐oss® and platelet‐rich fibrin (PRF), covered with a thin PRF membrane acting as a modified GTR. The combination of these techniques ensured successful clinical, radiographic and tomographic outcomes after 4 years of follow‐up.

Electrospun F18 Bioactive Glass/PCL-Poly (ε-caprolactone)-Membrane for Guided Tissue Regeneration.

Barrier membranes that are used for guided tissue regeneration (GTR) therapy usually lack bioactivity and the capability to promote new bone tissue formation. However, the incorporation of an osteogenic agent into polymeric membranes seems to be the most assertive strategy to enhance their regenerative potential. Here, the manufacturing of composite electrospun membranes made of poly (ε-caprolactone) (PCL) and particles of a novel bioactive glass composition (F18) is described. The membranes were mechanically and biologically tested with tensile strength tests and tissue culture with MG-63 osteoblast-like cell line, respectively. The PCL-F18 composite membranes demonstrated no increased cytotoxicity and an enhanced osteogenic potential when compared to pure PCL membranes. Moreover, the addition of the bioactive phase increased the membrane tensile strength. These preliminary results suggested that these new membranes can be a strong candidate for small bone injuries treatment by GTR technique.

Treatment of periodontal disease with guided tissue regeneration technique using a hydroxyapatite and polycaprolactone membrane

ABSTRACT The aim of this study was to evaluate the use of a malleable membrane composed of hydroxyapatite (60%) and polycaprolactone (40%) as treatment of periodontal disease experimentally induced in dogs. A bone defect of standardized dimensions was created between the roots of the third and fourth premolar of 12 dogs for periodontal disease induction. Six dogs had the defect covered by the membrane and six dogs received only standard treatment for periodontal disease, also applied to dogs in the treated group. The animals were clinically monitored during the experiment. Radiographs were taken after surgery and at 60 days after treatment initiation. Clinical attachment level was also assessed in those moments. On the 60th day, dental sample of all animals, containing tooth, defect and periodontal tissues, were harvested, fixed in formalin and analyzed by microtomography and histology. During the experimental period, the animals showed no pain and purulent discharge, however, there was dehiscence in 50% of animals and membrane exposure in five out of six animals in the treated group. Clinical attachment level showed no difference between groups. Radiographs showed radiopacity equal to the alveolar bone in both groups. The microtomography revealed that the control group had higher bone volume in the defect compared to the treated group; however, the furcation was not filled by new alveolar bone in any animal. Histological analysis revealed that junctional epithelium invasion was lighter in the control group. New bone was only observed in the apical edge of the defect in both groups. Although the composite is biocompatible and able to keep the space of the defect, it did not promote periodontal tissue regeneration within 60 days of observation.

Conservative Socket Regeneration with Buccal Wall Defect Using Guided Tissue.

Progressive alveolar bone resorption after tooth extraction may lead to surgical and prosthetic-driven difficulties, especially when deciding to use a dental implant to replace the extracted tooth. This case report discusses an irreparable lower left second premolar tooth with a periodontal lesion on the buccal side. A preservative tooth extraction was performed. Then, the socket was grafted with bovine bone, a collagen membrane was placed between the buccal bone and the attached gingiva, covering the bone dehiscence buccally, and the socket without a flap was raised. After a 6-month healing period, there was minimal socket width resorption and a shallow buccal vestibule. The implant was placed with high primary stability and sufficient buccal plate thickness. In conclusion, this guided tissue regeneration technique can minimize alveolar bone resorption in a socket with buccal dehiscence, but technical difficulties and shallowing of the buccal vestibule still exist.