What Is Guided Tissue Regeneration?

Guided Tissue Regeneration (GTR) is a surgical method to place a physical barrier to selectively separate different periodontal tissues to prevent gingival epithelium and gingival connective tissue from growing to the root surface, creating space and inducing periodontal The periodontal ligament cells of tissue regeneration potential move toward the crown and grow and differentiate, realizing the regeneration of periodontal ligament, alveolar bone, and cementum, forming new periodontal attachment.

Guided tissue regeneration

Guided Tissue Regeneration (GTR) is a surgical method to place a physical barrier to selectively separate different periodontal tissues and prevent

During periodontal healing, four different tissue-derived cells participate, competing with each other to occupy the root surface, resulting in different healing:

Gum epithelium-Gum epithelial cells grow fastest, first occupying the root surface, forming a long-bonded epithelium for healing.

Gingival connective tissueGingival connective tissue cells grow faster than gingival epithelial cells. If they attach to the root surface first, it will cause root absorption.

Alveolar bone-Bone marrow cells derived from alveolar bone have the slowest growth rate. If they occupy the root surface first, osseointegration will form.

Periodontal ligament-Periodontal ligament-derived cells grow more slowly than gingival epithelium and connective tissue cells. However, if the root surface is occupied first, new cementum and alveolar bone can be generated, and periodontal ligament fibers are embedded therein, that is, new functional periodontal support tissue is generated, and new adherent healing is formed. This is the most important Ideal way to heal.

Bone defects formed by vertical bone resorption.

Bifurcation lesions.

Localized gum withdrawal.

Plaque control is not good, and the plaque control index is greater than 20%.

Local inflammation and etiology were not eliminated.

Those with systemic diseases who cannot undergo surgery. Such as heart disease patients who had an acute attack within six months, rheumatic heart disease patients, blood disease patients, uncontrolled diabetes patients.

Since Nyman S has applied the Guided Tissue Regeneration (GTR) principle to the physiological regeneration of newly attached periodontal tissues, more and more scholars have devoted themselves to applying the GTR principle to clinical practice. However, due to the choice of cases, surgical methods, and the performance of the applied barrier membranes, various studies often report wound healing, and the degree of tissue regeneration varies. ^[1]

Postoperative complications include pain, swelling, bleeding, and infection. In addition, there may be sensitive roots, temporary increase in tooth looseness, alveolar parietal bone resorption, tissue flap necrosis or perforation, gingival or periodontal abscesses, irregular gum shape, root absorption or ossification, and drug reactions. If postoperative complications occur, they should be promptly and appropriately managed, including hemostasis, adequate analgesia, and local or systemic use of antibiotics.

Root canal therapy is a common method for the treatment of pulp disease and pulp-derived periapical disease. The follow-up success rate for 2 to 10 years is 86% to 93%; pulp-derived periapical lesions can also be cured. Effective treatment was achieved through apical surgery, especially after the concept of "modern apical surgery" was proposed, and its success rate also increased from 59% to 94% of traditional apical surgery. However, for periodontal-endodontic lesions, large periapical lesions, and buccal-lingual perforation lesions, conventional apical surgery heals slowly, and most of the periapical tissue is healed by repair, not regeneration. In recent years, guided tissue regeneration (GTR) has been widely used in this type of disease, which has significantly improved the success rate of apical surgery. In 2011, Naylor et al. Surveyed 1 129 American endodontic doctors and found that more than 40% of them had used GTR in apical surgery. This article reviews the application of guided tissue regeneration in apical surgery in recent years. ^[9]

Postoperative care should be taken: There may be discomfort and complications such as pain, swelling, soft teeth, temporary increase in looseness, but these symptoms will gradually decrease and disappear. If the dentin is allergic due to the exposure of the roots after surgery, desensitization treatment can be revisited; Do not brush your teeth for 24 hours, and use mouthwash. Teeth can be brushed in the non-surgical area after 24 hours, but care must be taken to prevent the periodontal plugging agent from falling off. Generally, after 2 weeks of follow-up, remove the plugging agent and sutures, use a soft-bristled toothbrush to brush the operation area; enter semi-liquid food or soft food within 24 hours after surgery, and chew on the non-operative side to avoid eating hot or irritating food And drinks.

Do not explore periodontal pockets for 6 weeks after GTR. Postoperative tissue healed in the form of long-binding epithelium, and no new connective tissue attachment could be formed. However, long-binding epithelium has been proven to maintain long-term stable clinical efficacy under the control of plaque.

Guiding the clinical application of periodontal tissue regeneration can reduce the depth of periodontal pockets, increase the periodontal attachment level, promote alveolar bone regeneration, thereby improving the function of teeth and extending the life of teeth. However, for clinicians, only by understanding the influencing factors of the clinical efficacy of GTR technology, and controlling or utilizing it, can it ensure a stable clinical treatment effect. ^{[1] [10] [2] [3] [4] [5] [6] [7] [8]}