Use Of Guided Tissue Regeneration Research Articles

Effect of Guided Tissue Regeneration on the Success of Surgical Endodontic Treatment of Teeth with Endodontic-Periodontal Lesions: a Systematic Review.

Endodontic-periodontal lesions may need surgical approach and the application of guided tissue regeneration (GTR) to be treated by a combined approach. The aim of the present study was to evaluate the effects of GTR on the success (clinical and radiological healing) of teeth with endodontic-periodontal lesions treated by modern surgical endodontic treatment, by means of a systematic review of the literature. An exhaustive electronic (Medline, Embase and Scopus searched from inception to August 2020) and manual literature search combined with strict inclusion and exclusion criteria was undertaken to identify any clinical (prospective case series or comparative trials) studies that assessed the added benefit of GTR in modern surgical endodontic treatment of teeth with endodontic-periodontal lesions. The success of the treatment was assessed based on radiographic healing and clinical evaluations. The risk of bias of the identified studies was evaluated using the Cochrane's collaboration RoB 2.0 tool and the Joanna Briggs Institute (JBI) critical appraisal tools. A systematic literature search for eligible reports retrieved three randomized controlled trials (RCTs) and one prospective single arm study with a total of 125 teeth in 125 subjects. One of the RCTs has a low risk of bias, while the other two raised some concerns, using the RoB 2.0 tool. Due to the heterogeneity of the results, it was not possible to perform a comparative meta-analysis and the results are presented in a narrative manner and by calculating pooled outcomes. Pooling together the data from all the included studies, the reported outcome was of complete healing in 58.4% of all cases, of scar tissue formation / incomplete healing in 24% of cases, of uncertain healing in 12.8% of cases, and of failure in 4.8% of all analyzed teeth, with a follow-up ranging from 12 to 60 months. The scientific evidence about the use of GTR in modern surgical endodontic treatment of endodontic-periodontal lesion is sparse, and the available results are derived from very heterogeneous studies, thus not permitting to clarify which is the most effective treatment option in these cases, also due to the absence of studies comparing GTR versus no GTR.

3D-Printed Soft Membrane for Periodontal Guided Tissue Regeneration.

The current study aimed to perform an in vivo examination using a critical-size periodontal canine model to investigate the capability of a 3D-printed soft membrane for guided tissue regeneration (GTR). This membrane is made of a specific composition of gelatin, elastin, and sodium hyaluronate that was fine-tuned and fully characterized in vitro in our previous study. The value of this composition is its potential to be employed as a suitable replacement for collagen, which is the main component of conventional GTR membranes, to overcome the cost issue with collagen. Critical-size dehiscence defects were surgically created on the buccal surface of the roots of canine bilateral mandibular teeth. GTR treatment was performed with the 3D-printed membrane and two commercially available collagen membranes (Botiss Jason® and Smartbrane-Regedent membranes) and a group without any membrane placement was considered as the control group. The defects were submerged with tension-free closure of the gingival flaps. Histologic and histometric analyses were employed to assess the periodontal healing over an 8-week experimental period. Histometric evaluations confirmed higher levels of new bone formation in the 3D-printed membrane group. Moreover, in all defects treated with the membranes, the formation of periodontal tissues, bone, periodontal ligaments, and cementum was observed after 8 weeks, while in the control group, only connective tissue was found in the defect sites. There was no clinical sign of inflammation or recession of gingiva in any of the groups. The 3D-printed gelatin/elastin/sodium hyaluronate membrane can be safe and effective for use in GTR for periodontal tissue regeneration therapies, with better or comparable results to the commercial collagen membranes.

Buccal plate thickness as a predictor for endodontic microsurgery outcomes: A retrospective cohort study

The aim of the study was to determine the relationship between preoperative buccal plate thickness (BPT) and radiographic healing at the osteotomy site after endodontic microsurgery (EMS) with and without guided tissue regeneration (GTR) using cone beam computed tomography (CBCT) imaging. The retrospective sample of 143 individuals who had EMS with pre- and postoperative CBCT scans availablewere divided into 2 groups: group 1 (GTR) and group 2 (no GTR), which were further divided into teeth where BPT was >1.0 mm or ≤1.0 mm. Bone healing was assessed by subjective evaluation of bone formation attheresected root surface (I1), periapical bone formation (I2), cortical plate formation (I3), and a derived index (Author2-Author1 Indices) (I4), calculated by a composite score of I1 and I2. There was no significant impact on surgical healing with the use of GTR when BPT is >1.0 mm. The GTR had a significant impact on surgical healing when the BPT was ≤1.0 mm. This study supported the use of CBCT to evaluate three-dimensional healing after EMS. The Author2-Author1 index was found to be a clinically relevant method for assessing healing. To improve healing rate, the EMS cases with a preoperative BPT of ≤1.0 mm may benefit from GTR.

The effect of platelet-rich plasma on clinical outcomes of the surgical treatment of periodontal intrabony defects: A systematic review and meta-analysis.

BackgroundStudies investigating the use of platelet–rich plasma (PRP) in the treatment of intrabony defects have yielded mixed results. The aim of our study was to evaluate the efficacy of PRP by comparing clinical attachment level (CAL) and pocket depth (PD) for patients who received PRP as an adjunct to periodontal intrabony defect therapy with those for patients who did not. We also analyzed the influence of guided tissue regeneration (GTR) and different study designs (parallel and split–mouth studies) on the clinical outcomes of intrabony defects.MethodsWe performed a systematic review of articles published in any language up to June 7, 2015 by searching PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. We included only randomized controlled clinical trials (RCTs) that compared clinical outcomes between patients who received PRP as an adjunct to periodontal intrabony defect therapy and patients who did not. We combined data from randomized trials to assess clinical outcomes using a random–effects model.ResultsOf the 307 abstracts that were initially identified, 12 RCTs related to the treatment of periodontal intrabony defects were included in the final analysis. Clinically and significantly greater CAL gains and PD reductions were observed in subjects who received PRP as an adjunct to periodontal intrabony defect therapy than in subjects who did not (CAL: WMD 0.76 mm, 95 % CI = 0.34 to 1.18 mm, P = 0.0004; PD: WMD 0.53 mm, 95 % CI = 0.21 to 0.85 mm, P = 0.001). Subgroup meta-analyses of patients who underwent GTR demonstrated that this approach did not significantly affect treatment outcomes (CAL: WMD 0.08 mm, 95 % CI = −0.30 to 0.46 mm, P = 0.67), as indicated by a comparison with patients who did not undergo GTR (CAL: WMD 1.22 mm, 95 % CI = 0.88 to 1.57 mm, P < 0.00001). Univariate meta-regression analyses revealed that the use of GTR explained the heterogeneity among the included studies (P < 0.05).ConclusionsWithin its limitations, this review suggests that PRP may be beneficial as an adjunct to graft materials for the treatment of periodontal intrabony defects, except in cases involving the use of GTR.

Influence of keratinized tissue on spontaneous exposure of submerged implants: classification and clinical observations

Aim The reasons for spontaneous early exposure (SEE) of dental implants during healing have not been established yet. The objective of this study was to assess whether the width of keratinized tissue (KT) and other site-related conditions could be associated with implants’ SEE. Materials and methods Data from 500 implants placed in 138 non-smoking patients, between September 2009 and June 2010, were evaluated. Implants were submerged and allowed to heal for 3 to 6 months. At baseline, the following conditions were documented: the presence of keratinized tissue width > 2 mm; the type of implant site (i.e. fresh extraction socket or edentulous alveolar ridge); concomitant use of guided tissue regeneration. During the healing period, the occurrence of partial or total implants SEE was recorded; thus, a mixed-effects logistic regression analysis was performed to investigate the association between implant site conditions and implant exposure. Results One hundred and eighty-five implants (37.0%) remained submerged after healing and were classified as Class I, whereas 215 (43.0%) showed partial spontaneous early exposure (SEE) at the first week after implant placement (Class II), and 100 implants (20.0%) developed more extensive exposures (Class III). The variables, baseline width of KT (p = 0.18), fresh extraction socket (p = 0.88) and guided tissue regeneration (GTR) plus bone substitutes (p = 0.42), were not found to be correlated with implants` SEE, with an odds ratio (OR) of 1.29 (95% confidence interval: -0.12–0.63), 1.03 (95% confidence interval: -0.46–0.53) and 1.22 (95% confidence interval: -0.29–0.68), respectively. Conclusion It was not possible to establish an association between SEE and some implant-related factors; therefore, further investigations focused on the reasons associated to implants’ SEE are needed.

Materials and prognostic factors of bone regeneration in periapical surgery: A systematic review

Objectives: Analyse the effectiveness of different materials and techniques used in guided tissue regeneration (GTR) applied in periapical surgery, comparing the success rate obtained in 4-wall defects and in through-and-through bone lesions as well as to establish prognostic factors. Material and Methods: A Cochrane, PubMed-MEDLINE and Scopus database search (October 2012 to March 2013) was conducted with the search terms “periapical surgery”, “surgical endodontic treatment”, “guided tissue regeneration”, “bone regeneration”, “bone grafts”, “barrier membranes” and “periapical lesions” individually and next, using the Boolean operator “AND”. The inclusion criteria were the use of GTR (bone graft and/or membrane barrier), clinical studies including at least 10 patients, 10 years aged articles published in English or French. The exclusion criteria were case reports and nonhuman studies. Results: 34 publications were selected from a total of 483. 9 of the 34 were excluded. Finally, the systematic review included 25 articles: 2 metaanalysis, 8 reviews, 13 prospective studies and 2 retrospective studies. They were stratified according to their level of scientific evidence using the SORT criteria. The 4-wall periapical and through-and-through lesions improve more their prognosis by combining bone grafts and barrier membranes than using these materials exclusively, respect to the control groups. The results show lower failure rates in 4-wall lesions than in through-and-through lesions using GTR. Conclusions: The combined GTR technique (filling material and membranes) obtains a greater success rate both in 4-wall lesions and in through-and-through lesions, respect to the control groups. The use of regeneration materials seems to be more necessary in through-and-through lesions,> 5mm lesions, lower teeth and apicomarginal lesions as they have the worst healing prognosis. In function of the articles scientific quality, a type B recommendation is given in favour to the use of GTR in association of periapical surgery in case of 4-wall and through-and-through lesions. Key words:Periapical surgery, surgical endodontic treatment, guided tissue regeneration, bone regeneration, bone grafts, barrier membranes.

Periodontal healing following reconstructive surgery: effect of guided tissue regeneration using a bioresorbable barrier device when combined with autogenous bone grafting. A randomized‐controlled trial 10‐year follow‐up

The objective of this 10-year randomized-controlled trial follow-up was to evaluate the stability of treatment outcomes following the implantation of autogenous bone graft with or without guided tissue regeneration (GTR) in the treatment of deep intra-bony periodontal defects. Forty patients exhibiting deep intra-bony periodontal defects were included in a randomized-controlled trial evaluating the adjunctive effect of GTR to autogenous bone graft. Twenty-six of 39 patients completing the original study were available for follow-up 10 years post-treatment. The patients had been included in a structured maintenance programme and were evaluated using the criteria of the original study by the same investigators. Significant improvements in the probing depth and clinical attachment level were observed for both groups between baseline and 9 months. Whereas the autogenous bone graft+GTR group showed significant improvements in probing bone levels and increased gingival recession at 9 months, no significant differences were observed for the autogenous bone graft group. Nine-month within-group results were maintained throughout the 10-year follow-up. Nevertheless, between-group comparisons at 10 years showed that the autogenous bone graft+GTR group exhibited significantly greater probing depth reduction (mean +/- SE: 4.2 +/- 0.5 versus 2.7 +/- 0.5 mm, p=0.023) and probing bone-level gain (3.9 +/- 0.8 versus 1.3 +/- 0.9 mm, p=0.034) than the autogenous bone graft group. Borderline significant differences between the autogenous bone graft+GTR and the autogenous bone graft groups were observed for clinical attachment level gain at 10 years (3.8 +/- 0.5 versus 2.2 +/- 0.7 mm, p=0.067), whereas no significant differences were observed for gingival recession (0.7 +/- 0.3 versus 0.6 +/- 0.5 mm, p>0.05). The results of this randomized study suggest that statistically significant differences were found with the adjunct use of GTR to an autogenous bone graft at 10 years. Nevertheless, these results should be interpreted with caution in light of its clinical relevance and biological rationale. Importantly, resolution of deep intra-bony periodontal defects can be maintained in the presence of a structured maintenance programme emphasizing high oral hygiene standards.

Efficacy of Xenogeneic Bone Grafting With Guided Tissue Regeneration in the Management of Bone Defects After Surgical Endodontics

The purpose of this prospective clinical trial was to monitor the outcomes of periradicular surgery in large periapical lesions with or without guided tissue regeneration (GTR) and anorganic bovine bone. All teeth in the study revealed a periradicular lesion measuring at least 10 mm. A total of 63 teeth in 44 patients were included according to specific selection criteria. In the test group, after root end filling was completed, the defect was filled with anorganic bovine bone and was covered with a resorbable collagen membrane. In the control group, neither graft nor membrane was used. A total of 59 teeth in 41 patients were evaluable at 1-year follow-up. Of these, 24 teeth belonged to the test group and 35 to the control group. Overall, 46 teeth (78%) had successfully healed, 10 (16.9%) demonstrated uncertain healing, and 3 exhibited treatment failure. Investigators found no statistically significant differences in outcome between test and control groups. The present study showed that the use of GTR in association with anorganic bovine bone in the treatment of patients with large periradicular lesions of strictly endodontic origin has no beneficial effect on outcome.

GTR may have no added value over connective tissue grafts for gingival recession defects

Question: What is the efficacy of guided tissue regeneration (GTR) for recession defects and how does it compare to connective tissue grafts (CTG)? Objective To summarise the efficacy of GTR for recession defects and compare this with connective tissue grafts (CTG). Data sources Medline 1985–2000 (search terms not given). Study selection English-language papers evaluating gingival recession in humans were included. Other criteria were not described and no details of independent evaluation decisions on study eligibility. Data extraction Tables were constructed separately for GTR resorbable and nonresorbable barriers and for studies comparing GTR with CTG. Although no true meta-analyses were attempted, arithmetic means of outcomes were calculated pooling different study designs together. Results Thirty studies were identified. From a mainly qualitative assessment, GTR appeared to offer no advantage over CTG with respect to clinical outcomes of root coverage. Technical difficulties of GTR were also highlighted including achieving primary flap closure and membrane exposure. Differences in study design and reporting hampered efforts to formally pool the data. Conclusion The authors conclude that the use of GTR does not result in greater benefits than CTG alone. Danesh-Meyer MJ, Wikesjo UME. Gingival recession defects and guided tissue regeneration: a review. J Periodont Res 2001; 36:341–354

Histological evaluation of a biodegradable polyactive ®/ hydroxyapatite membrane

Guided tissue regeneration (GTR) is a technique which is used for the treatment of bone defects associated with periodontal disease or enossal dental implants. In most experimental studies on GTR, non-degradable membranes are used. A drawback inherent to such devices is that at the end or in the course of the wound healing they have to be removed. Therefore, the aim of the present study was to investigate a new biodegradable membrane material for use in GTR, which also has excellent mechanical properties and is biocompatible. The material is a composite consisting of poly(ethyleneglycol terephthalate) and poly(butylene terephthalate) segmented copolymer (PEG/PBT), which for the experiments was used in pure form and also mixed with hydroxyapatite (HA) grains. Subcutaneous and subgingival implantation studies in goats were performed to determine the biocompatibility and biodegradability characteristics of several of these materials. Differences between materials were introduced in the production process, PEG PBT ratio, material thickness and presence of HA. Implantation periods were 3, 6 and 12 wk. The histological results indicated that all investigated materials were biocompatible with the surrounding tissue. Degradation of the membranes was attended by a mild cellular reaction. The degradation process was mainly influenced by the PEG PBT ratio. A higher PBT content resulted in a decreased degradation.