Guided bone and tissue regeneration

Guided bone and tissue regeneration
Intervention
MeSH D048091

Guided bone regeneration or GBR, and guided tissue regeneration or GTR are dental surgical procedures that utilize barrier membranes to direct the growth of new bone and gingival tissue at sites having insufficient volumes or dimensions of bone or gingiva for proper function, esthetics or prosthetic restoration.

GBR is similar to guided tissue regeneration (GTR) but is focused on development of hard tissues in addition to the soft tissues of the periodontal attachment. At present, guided bone regeneration is predominantly applied in the oral cavity to support new hard tissue growth on an alveolar ridge to allow stable placement of dental implants. Used in conjunction with sound surgical technique, GBR is a reliable and validated procedure.[1]

Contents

History

Use of barrier membranes to direct bone regeneration was first described in the context of orthopaedic research 1959.[2] The theoretical principles basic to guided tissue regeneration were developed by Melcher in 1976, who outlined the necessity of excluding unwanted cell lines from healing sites to allow growth of desired tissues.[3] Based on positive clinical results of regeneration in periodontology research in the 1980s, research began to focus on the potential for re-building alveolar bone defects using guided bone regeneration. The theory of Guided tissue regeneration has been challenged in dentistry. Most frequently by Hessam Nowzari and Jorgen Slots <ref.[1]</ref>.

Overview

Four stages are used to successfully regenerate bone and other tissues, abbreviated with the acronym PASS:[4]

  1. Primary closure of the wound to promote undisturbed and uninterrupted healing
  2. Angiogenesis to provided necessary blood supply and undifferentiated mesenchymal cells
  3. Space creation and maintenance to facilitate space for bone in-growth
  4. Stability of the wound to induce blood clot formation and allow uneventful healing

In dentistry

The first application of barrier membranes in the mouth occurred in 1982[5][6][7] in the context of regeneration of periodontal tissues via GTR, as an alternative to resective surgical procedures to reduce pocket depths.[4][8]

Indications

There are several uses of bone regeneration:

References

  1. ^ PLarsen, Peter; G. E. Ghali (2004). Peterson's Principals of Oral and Maxillofacial Surgery. Hamilton, Ont: B.C. Decker. ISBN 1-55009-234-0. 
  2. ^ Hurley LA, Stinchfield FE, Bassett AL, Lyon WH (October 1959). "The role of soft tissues in osteogenesis. An experimental study of canine spine fusions". J Bone Joint Surg Am 41-A: 1243–54. PMID 13852565. 
  3. ^ Melcher AH (May 1976). "On the repair potential of periodontal tissues". J. Periodontol. 47 (5): 256–60. doi:10.1902/jop.1976.47.5.256. PMID 775048. 
  4. ^ a b Wang HL, Boyapati L (March 2006). ""PASS" principles for predictable bone regeneration". Implant Dent 15 (1): 8–17. doi:10.1097/01.id.0000204762.39826.0f. PMID 16569956. 
  5. ^ Nyman S, Lindhe J, Karring T, Rylander H (July 1982). "New attachment following surgical treatment of human periodontal disease". J. Clin. Periodontol. 9 (4): 290–6. doi:10.1111/j.1600-051X.1982.tb02095.x. PMID 6964676. 
  6. ^ Gottlow J, Nyman S, Karring T, Lindhe J (September 1984). "New attachment formation as the result of controlled tissue regeneration". J. Clin. Periodontol. 11 (8): 494–503. doi:10.1111/j.1600-051X.1984.tb00901.x. PMID 6384274. 
  7. ^ Gottlow J, Nyman S, Lindhe J, Karring T, Wennström J (July 1986). "New attachment formation in the human periodontium by guided tissue regeneration. Case reports". J. Clin. Periodontol. 13 (6): 604–16. doi:10.1111/j.1600-051X.1986.tb00854.x. PMID 3462208. 
  8. ^ Perry R. Klokkevold; Newman, Michael C.; Henry H. Takei (2006). Carranza's Clinical Periodontology. Philadelphia: Saunders. ISBN 1-4160-2400-X. 
Tissues of the periodontium
and their physiologic entities
Diagnoses
Pathogenesis
Pathologic entities
Diagnosis, treatment planning,
prevention and
chemotherapeutic agents
Periodontal armamentarium
Conventional therapy
Surgical therapy and
periodontal surgery
Important personalities
Other specialties
Endodontology · Orthodontology · Prosthodontology

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