Membranes for Guided Tissue Regeneration - an Update

2016

Periodontal regeneration has become one of the primary objectives of periodontal therapy. The resulting scientific endeavours have elucidated modes of periodontal wound healing, the growth of periodontal cells and their association with the surrounding matrix, and growth-promoting factors. The periodontal regeneration industry is producing better and more expensive devices, but the criteria for evaluating their success have not progressed to the same extent. Although clinical measurements of attachment level and probing depths, along with radiography, are good methods of evaluating tooth survival and prognosis, they do not indicate true biological regeneration. The goals of periodontal therapy include not only the arrest of periodontal disease progression, but also the regeneration of structures lost to disease, where appropriate. Conventional surgical approaches (e.g., flap debridement) continue to offer time-tested and reliable methods to access root surfaces, reduce periodontal p...

Journal of Membrane and Separation Technology, 2013

Periodontal regeneration is the restoration of lost periodontium or supporting tissues and includes the formation of new alveolar bone, new cementum and new periodontal ligament. The concept of GTR is based on the exclusion of gingival connective tissue cells and prevention of epithelial down growth into the wound, thereby allowing cells with regenerative potential (PDL and bone cells) to enter the wound first. GTR consists of placing barriers of different types to cover the bone and periodontal ligament thus temporarily separating them from gingival epithelium. Excluding the epithelium and gingival connective tissue from the root surface during the post-surgical healing phase not only prevent epithelial migration into the wound but also favors repopulation of the area by cells from the periodontal ligament and bone. Purpose and Scope-This review discusses the rationale for using guided tissue regeneration therapy. The review not only attempts to clarify the concept of selective tissue regeneration using non-resorbable and resorbable barriers, but to discuss differences in healing events after treatment with the two types of barriers together with their significance in periodontal therapy. At present, barrier membranes have potential clinical use in promoting periodontal tissue regeneration if patients to be so treated are selected appropriately. Research is still necessary to determine the critical period for guiding the ingrowth of new attachment forming cells and also to further clarify the concept of GTR involving the "wrong cell type" which inhibits periodontal tissue regeneration.

Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine, 2010

Periodontitis affects around 15 per cent of human adult populations. While periodontal treatment aimed at removing the bacterial cause of the disease is generally very successful, the ability predictably to regenerate the damaged tissues remains a major unmet objective for new treatment strategies. Existing treatments include the use of space-maintaining barrier membranes (guided tissue regeneration), use of graft materials, and application of bioactive molecules to induce regeneration, but their overall effects are relatively modest and restricted in application. The periodontal ligament is rich in mesenchymal stem cells, and the understanding of the signalling molecules that may regulate their differentation has increased enormously in recent years. Applying these principles for the development of new tissue engineering strategies for periodontal regeneration will require further work to determine the efficacy of current experimental preclinical treatments, including pharmacologic...

Dental Clinics of North America, 2005

2005

2015

Periodontitis is an infectious disease that causes destruction of the attachment apparatus of the tooth. Regeneration has been defined as the reproduction or reconstitution of lost or injured part of the body in a way that the function and architecture of the lost tissue is restored. In terms of periodontal regeneration, the structure and function of the gingiva, alveolar bone, root cementum and periodontal ligament must be restored. There are a broad range of treatment options which bring about regeneration, bone grafts, root biomodification, guided tissue regeneration to name a few. This review paper gives an insight to the various options available for periodontal regeneration and the clinical effectiveness of each of them.

Periodontology 2000, 2019

The periodontium is a complex organ comprised of four mesenchymal tissue components (gingiva, cementum, alveolar bone, and periodontal ligament [PDL]) that behave as a functional unit, providing the tooth with an attachment apparatus to the jawbone capable of withstanding masticatory forces and maintaining homeostasis in the oral cavity. 1 Among these components, the PDL is the key structural element that bridges the cementum and the alveolar bone. It is a highly cellular and vascularized tissue mainly comprised of thick collagen fiber bundles that insert within the external layers of the cementum and the alveolar bone (bundle bone) forming the so-called Sharpey fibers. Many cell types can be found in the healthy PDL, including fibroblasts and endothelial, epithelial, neural, and undifferentiated mesenchymal cells. The latter ones are responsible for maintaining the homeostasis of all periodontal tissues, since upon the appropriate signaling mechanisms they can differentiate to cementoblasts (leading to cementum deposition), to osteoblasts (leading to bone deposition), or to fibroblasts (leading to new connective tissue formation). The PDL is a highly vascular tissue, containing a very rich arteriolar plexus, and is also rich in nervous receptors and terminals that are responsive to proprioception and sensory stimulation.

Journal of periodontology, 2005

Untreated periodontal disease leads to tooth loss through destruction of the attachment apparatus and tooth-supporting structures. The goals of periodontal therapy include not only the arrest of periodontal disease progression,but also the regeneration of structures lost to disease where appropriate. Conventional surgical approaches (e.g., flap debridement) continue to offer time-tested and reliable methods to access root surfaces,reduce periodontal pockets, and attain improved periodontal form/architecture. However, these techniques offer only limited potential towards recovering tissues destroyed during earlier disease phases. Recently, surgical procedures aimed at greater and more predictable regeneration of periodontal tissues and functional attachment close to their original level have been developed, analyzed, and employed in clinical practice. This paper provides a review of the current understanding of the mechanisms, cells, and factors required for regeneration of the perio...

Periodontology 2000, 2000