Background:Many clinical studies have demonstrated that guided tissue regeneration (GTR) is a successful treatment modality of periodontal reconstructive surgery and it has become an accepted procedure in most periodontal practices. Rationale: The purpose of this structured review was to assess the efficacy of guided tissue regeneration (GTR) procedures in patients with periodontal osseous defects compared with surgical controls on clinical, radiographic, adverse, and patient-centered outcomes. It extends the scope of previous GTR systematic reviews, which were limited to randomized controlled studies, by the scope of outcome measures examined, and the duration of the study. Focused Question: In patients with periodontal osseous defects, what is the effect of physical barriers compared with surgical controls on clinical, radiographic, adverse, and patient-centered outcomes? Search Protocol:An electronic search of the Cochrane Oral Health Group Trials Register and MEDLINE databases was performed. Manual se...

Guided Tissue Regeneration for the Treatment of Periodontal Intrabony and Furcation Defects. A Systematic Review

Background: The significance of early membrane exposure on the regenerative outcome in guided tissue regeneration (GTR) and guided bone regeneration (GBR) procedures is somewhat controversial. Several clinical trials have shown better response when the membranes remained submerged (S) compared to those that have become exposed (E) during healing. Other studies have failed to show any such difference. Small sample size and/or large standard deviation of the changes might account for these discrepancies. The purpose of this meta-analysis is to critically combine the existing data in order to provide meaningful information based on a large database. Methods: Studies of GTR in Class II furcation and intrabony defects (IBD), together with GBR around dental implants, where the membrane became exposed during the postoperative period, were combined to form 3 separate databases. A meta-analysis was employed to compare the 2 subgroups (E versus S) in each of the databases. First, weighted mean changes and weighted ...

The effect of membrane exposure on the outcome of regenerative procedures in humans: a meta-analysis.

The purpose of this retrospective study was to determine factors affecting clinical outcome of guided tissue regeneration (GTR) in the treatment of intrabony periodontal defects. 38 patients each contributing 1 isolated intrabony defect treated with GTR were included in this analysis. Patient and defect characteristics, and defect-specific recordings relative to clinical outcome 6 months postsurgery were assessed. GTR treatment resulted in clinically and statistically significant improved probing depths (PD), clinical attachment levels (CAL), and probing bone levels (PBL). Presurgery PD and PBL were of predictive value for CAL gain and PBL gain, respectively. CAL and PBL gain did not correlate to defect depth or configuration. Cigarette smoking exhibited a highly significant negative correlation to parameters of clinical outcome.

Retrospective analysis of factors related to clinical outcome of guided tissue regeneration procedures in intrabony defects

The present clinical trial was designed to evaluate the effects of a bioactive glass, Perioglas, in the treatment of periodontal intrabony defects. 20 patients, 23-55 years of age (44 sites), with intrabony defects completed the 1-year study. Teeth with furcation involvement were excluded. After completion of initial therapy, defects were randomly assigned to either a test or control procedure. Following flap reflection, root planing and removal of chronic inflammatory tissue in both groups, the test defects were restored with the bioactive glass particulate material. Mucoperiosteal flaps were replaced, sutured and a periodontal dressing was used. All the patients received postoperative antibiotics and analgesics and were seen at 1 week for suture removal. Follow-up was then carried out weekly and at 3 months, 6 months, 9 months and 1 year post-surgery. Plaque score, bleeding score, probing pocket depth (PPD), probing attachment level (PAL) and gingival recession were recorded at baseline, 3 months and 1 year. Standardised radiographs for computer-assisted densitometric image analysis (CADIA) were taken at baseline, immediately post-operatively and at 1 year. The CADIA data showed a significant increase (F-ratio: 15.67, p < 0.001) in radiographic density and volume between the defects treated with the Perioglas when compared to those treated with surgical debridement only. PPD and PAL showed significant improvements in both experimental and control sites, with a greater trend to improvement in the experimental sites. It was concluded that this bioactive glass is effective as an adjunct to conventional surgery in the treatment of intrabony defects.

Particulate bioglass as a grafting material in the treatment of periodontal intrabony defects

Background: The longevity of the clinical benefits of guided tissue regeneration (GTR) has not been fully explored The aim of this investigation was to assess the long-term survival of GTR treated sites in terms of clinical attachment level (CAL) stability and tooth loss Methods: A total of 175 patients with one deep intrabony defect were selected for a retrospective investigation of tooth retention and CAL stability All sites had been treated with GTR more than 2 years previously and had received full periodontal examinations every 2 years for up to 16 years Definitions of events for survival analyses were tooth loss, loss of ≥2 mm compared with the CAL observed before GTR treatment, and loss of ≥2 mm compared with the CAL observed 1 year after completion of GTR Results: Teeth were severely compromised by the presence of CAL loss of 107 ± 24 mm, probing depths of 87 ± 23 mm and deep intrabony defects (average depth 66 ± 21 mm) After GTR, CAL gains were 46 ± 2 mm Average follow up was 8 ± 3

Long-Term Tooth Survival Following Regenerative Treatment of Intrabony Defects

The aim of the present study was to evaluate periodontal tissue alterations during the maintenance phase following GTR therapy. 18 patients (average age 54 years, range 39-79 years) with 19 local periodontal defects were monitored longitudinally using clinical periodontal parameters and radiographic assessments of bone level changes. 6 out of originally 24 patients were not available at the 4-year examination (2 patients were unwilling to participate and in 4 patients root amputations or tooth extractions had to be performed). Evaluations were performed at baseline, 3 months, 1 year and 4 years following GTR therapy (using non-resorbable Gore-Tex Periodontal Material). The changes observed at the deepest site of each tooth treated by GTR were compared to those encountered in the entire dentition. Supportive periodontal therapy was performed according to the patient's individual needs between 3 and 12 times between the 1 and 4 years examination. The plaque index and the gingival index at the 4 years examination were assessed and had increased to almost double the value of baseline, although the BOP remained lower compared to baseline data. Between the 1 and 4 years examinations, 1.27 mm of clinical attachment was lost as a mean. Regarding the site of each tooth treated with GTR with the initially deepest probing pocket depth, 1.42 mm of clinical attachment was lost during the maintenance phase. However, compared to baseline data, 1.37 mm of new attachment could be maintained. The clinical attachment level was maintained within +/- 1 mm in 12 out of 19 sites during the 4 years of maintenance.(ABSTRACT TRUNCATED AT 250 WORDS)

Maintenance of new attachment 1 and 4 years following guided tissue regeneration (GTR).

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Maintenance of new attachment 1 and 4 years following guided tissue regeneration (GTR).