• Journal of Periodontal and Implant Science
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• 제32권3호
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• pp.475-488
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• 2002

The purpose of this study is to evaluate histologically the resorption and tissue response of various resorbable collagen membranes used for guided tissue regeneration and guided bone regeneration, using a subcutaneous model on the dorsal surface of the rat. In this study, 10 Sprague-Dawley male rats (mean BW 150gm) were used and the commercially available materials included acellular dermal matrix allograft, porcine collagen membrane, freeze-dried bovine dura mater. Animals were sacrificed at 2,6 and 8 weeks after implantation of various resorbable collagen membranes. Specimens were prepared with Hematoxylin-Eosin stain for light microscopic evaluation. The results of this study were as follows: 1. Resorption : Inner portion of porcine collagen membrane was resorbed a lot at 6 weeks, but its function was being kept for infiltration of another tissues were not observed. Freeze-dried bovine dura mater and acellular dermal allograft were rarely resorbed and kept their structure of outer portion for 8 weeks. 2. Inflammatory reactions : Inflammatory reaction was so mild and foreign body reaction didn't happen in all of resorbable collagen membranes, which showed their biocompatibility. 3. In all of resorbable collagen membranes, multinuclcated giant cells by foreign body reactions were not observed. Barrier membranes have to maintain their function for 4-6 weeks in guided tissue regeneration and at least 8 weeks in guided bone regeneration. According to present study, we can find all of the resorbable collagen membranes kept their function and structure for 8 weeks and were rarely resorbed. Foreign body reaction didn't happen and inflammatory reaction was so mild histologically. Therefore, all of collagen membranes used in this experiment were considered proper resorbable membranes for guided tissue regeneration and guided bone regeneration.

• Restorative Dentistry and Endodontics
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• 제47권4호
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• pp.35.1-35.9
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• 2022

Although the success rates of microsurgery and micro-resurgery are very high, the influence of a recurrent perforation combined with radicular cyst remains unclear. A 21-year-old white female patient had a history of root perforation in a previously treated right maxillary lateral incisor. Analysis using cone-beam computed tomography (CBCT) revealed an extensive and well-defined periapical radiolucency, involving the buccal and palatal bone plate. The perforation was sealed with bioceramic material (Biodentine) in the pre-surgical phase. In the surgical phase, guided tissue regeneration (GTR) was performed by combining xenograft (lyophilized bovine bone) and autologous platelet-rich fibrin applied to the bone defect. The root-end preparation was done using an ultrasonic tip. The retrograde filling was performed using a bioceramic material (Biodentine). Histopathological analysis confirmed a radicular cyst. The patient returned to her referring practitioner to continue the restorative procedures. CBCT analysis after 1-year recall revealed another perforation in the same place as the first intervention, ultimately treated by micro-resurgery using the same protocol with GTR, and a bioceramic material (MTA Angelus). The 2-year recall showed healing and bone neoformation. In conclusion, endodontic micro-resurgery with GTR showed long-term favorable results when a radicular cyst and a recurrent perforation compromised the success.

• Journal of Periodontal and Implant Science
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• 제26권2호
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• pp.356-364
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• 1996

The present study was done to evaluate the antibacterial effects of $Minoclin^R$ which was localally delivered on the $Gore-tex^R$ barrier membrane in the guided tissue regeneration(GTR) therapy for treatment of human furcal defects. Beneath the membranes. the antibiotics were applied for 1 week and then changed with new one. The $Minoclin^R$ was removed out one week later. 6 weeks after the GTR therapy. No systemic antibiotics were administered except for oral mouthrinses with chlorhexidines. 2 weeks and 6 weeks following the membrane therapy, the bacterial samples were examined for periodontopathic microorganisms. The results indicated that the locally delivered $Minoclin^R$ successfully inhibited the growth of periodontopathic organisms. This results might be further applied in the subgingival plaque control regimen in the GTR procedure, especialy in patients who is contraindicated for oral administration of systemic antibiotics

• 대한치과의사협회지
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• 제39권10호통권389호
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• pp.819-824
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• 2001

충분한 골양이 존재해야 한다는 것은 임프란트를 식립하는데 있어서 중요힌 선결조건이므로, 임프란트를 식립하기 전이나 식립하는 도중에 치조제의 높이와 고경을 증대시키기 위하여 조직유도재생술 (Guided Tissue Regeneration, GTR)의 생물학적 원리에 기초를 둔 골유도재생술(Guided Bone Regeneration, GBR)이 필요하다. 이 장에서는 임프란트치료시 골유도재생술을 이용하여 임프란트 주위의 골결손부에 대한 치료로서 현재 이용되고 있는 이식재의 종류와 그 임상적 응용, 그리고 결손부 주위에서 골 생성을 향상시크는 방법에 대하여 살펴보고자 한다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제18권2호
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• pp.224-235
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• 1996

Early implantation before sufficient ossification has taken place usually results in osseointegartion failure due to reduced bone-fixture interface area. However, various studies have shown successful osseointegration results following immediate implants concurrently with GTR. The clinical trends have been to shorten the patients' edentulous state by immediate implantation, and reduce the alveolar bone resorption. However, it may be difficult to attain the complete soft tissue coverage of the sites, increasing the chance of infection. Furthermore, there may be more studies needed on the clinical behaviors of e-PTFE membranes, various modofications in the membrane materials and bone graft materials. Various animal and clinical studies have been reported on the successful osseointagration following immediate implantation, but the long-term follow-up studies are limited. The present study investigated 16 immediately-implanted implants with GTR therapy with or without calcium carbonate grafting on 11 patients 3 years after installation and 24-30 months after functional loading. Based on the clinical, radiographic and histologic findings, the following results have been attained. 1. Clinically, stability has been shown on all 16 implants throughout the investigated periods. 2. Radiologically, the alveolar bone loss has progressed up to the polished neck portion but not beyond it, suggesting the progressive osseointegration from the GTR therapy. 3. The GTR method used in the present study is easy to use clinically, and may be appied in the regeneration of ossoeous defects around implants and in the immediate implantation. 4. The difficulty in complete tissue coverage may be avoided by delaying the installation for 2 to 3 weeks after the extraction allowing certain degree of soft tissue healing.

• Journal of Periodontal and Implant Science
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• 제26권4호
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• pp.967-987
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• 1996

The present study was to evaluate the healing patterns of guided tissue regeneration( GTR) using resorbable $Vicryl^{(R)}$(polyglactin 910) mesh and nonresorbable expanded polytetrafluoroethylene(ePTFE) membrane with or without bone grafting using autogeneous bone and demineralized freeze-dried bone allograft(DFDBA) in the grade II furcation defects. Mucoperiosteal flaps were reflected buccally in the mandibular 2nd, 3rd and 4th premolar areas and furcation defects were created surgically by removing $5{\times}6mm$ alveolar bone in 4 dogs. Root surfaces were thoroughly debrided of periodontal ligament and cementum, and notches were placed on root surface at the most apical bone level. In the right and left mandibular quadrant, each tooth was received $Vicryl^{(R)}$ mesh(ACE Surgical Supply Co., USA) only, $Vicryl^{(R)}$ mesh with DFDBA, $Vicryl^{(R)}$ mesh with autogeneous bone grafts, ePTFE membrane($Core-tex^{(R)}$ membrane, W.L. Gore & Associates Inc., USA) only, ePTFE membrane with DFDBA or ePTFE membrane with autogeneous bone grafts. For the fluorescent microscopic examination, fluorescent agents were injected at 2, 4 and 8 weeks after surgery. Four weeks after surgery, 2 dogs were sacrificed and ePTFE membranes were removed from remaining 2 dogs, which were sacrificed at 12 weeks after surgery. Undecalcified tissues were embedded in methylmethacrylate and $10{\mu}m$ thick sections were cut in a buccolingual direction. These sections were stained with hematoxylin-eosin stain and Masson's trichrome stain, and evaluated by descriptive histology and linear measurements. The results were as follows : 1) $Vicryl^{(R)}$ mesh group showed less connective tissue attachment than ePTFE membrane group. 2) The combination of GTR using $Vicryl^{(R)}$ mesh and osseous grafts resulted in new attachment and new bone formation more than GTR using $Vicryl^{(R)}$ mesh only. 3) GTR using ePTFE membrane, with or without osseous grafts, enhanced periodontal regeneration. 4) Root resorption and dentoalveolar ankylosis were observed in the areas treated with the combination of GTR and DFDBA. It was suggested that the effect of adjunctive bone grafting in GTR procedure depends on the materials and the physical properties of barrier membranes. $Vicryl^{(R)}$ mesh performed a barrier function and the use of adjunctive bone grafting may enhance the periodontal regeneration.

• Journal of Periodontal and Implant Science
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• 제30권1호
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• pp.167-180
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• 2000

The present study evaluated the effects of guided tissue regeneration using biodegradable membrane, with and without calcium-phosphate thin film coated deproteinated bone powder in beagle dogs. Contralateral fenestration defects(6 × 4 mm) were created 4 mm apical to the buccal alveolar crest on maxillary canine teeth in 5 beagle dogs. Ca-P thin film coated deproteinated bone powder was implanted into one randomly selected fenestration defect(experimental group). Biodegradable membranes were used to provide bilateral GTR. Tissue blocks including defects with overlying membranes and soft tissues were harvested following a four- & eight-week healing interval and prepared for histologic analysis. The results of this study were as follows. 1.......The regeneration of new bone, new periodontal ligament, and new cementum was occurred in experimental group more than control group. 2.......The collapse of biodegradable membranes into defects were showed in control group and the space for regeneration was diminished. In experimental group, the space was maintained without collapse by graft materials. 3........In experimental group, the graft materials were resorbed at 4 weeks after surgery and regeneration of bone surrounding graft materials was occurred at 8 weeks after surgery. 4.......Biodegradable membranes were not resorbed at 4 weeks and partial resorption was occurred at 8 weeks but the framework and the shape of membranes were maintained. No inflammation was showed at resorption. In conclusion, the results of the present study suggest that Ca-P thin film coated deproteinated bone powder has adjunctive effect to GTR in periodontal fenestration defects. Because it has osteoconductive property and prohibit collapse of membrane into defect, can promote regeneration of much new attachment apparatus.

• Journal of Periodontal and Implant Science
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• 제25권3호
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• pp.518-528
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• 1995

The immunohistochemical study has been performed on the distribution of receptors for various growth factors in the newly forming granulation tissues following the guided tissue regeneration procedures. Two specimens from 2 different patients were collected from the newly forming granulation tissues at 2 weeks following GTR procedures using Gore-tex menbrane and rubber dam, respectively. For immunohistochemical localization of each recptor, anti-platelet-derived growth factor $receptor-{\alpha}$, anti-platelet-derived growth factor $receptor-{\beta}$. anti-insulin-like growth factor receptor, anti-basic fibroblast growth factor receptor, anti-transforming growth $factor-{\beta}$ receptor and anti-fibronectin receptor were incubated onto the specimens as primary antibodies. After the reaction, FITC-conjugated second antibodies have been applied. When the total numbers of immunoreactive cells and the true positive cells were counted, there were high variability among receptors tested in the present study. The mean number of immunoreactive cells were highest in the case for anti-IFG-1 receptor. However the number of true positive cells were highest in the case for $TGF-{\beta}$ receptor. The present investigation indicated that the receptor for $TGF-{\beta}$ were stongly expressed in the newly forming granulation tissues following the guided tissue regeneration therapy.

• Journal of Periodontal and Implant Science
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• 제38권sup2호
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• pp.405-412
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• 2008

Purpose: Pathologic tooth migration (PTM) commonly occurs in the anterior region and is associated with periodontal disease. The treatment of PTM of anterior teeth can be complex and time consuming, and a multidisciplinary approach is often required. Materials and Methods: The patient was a 38-year-old woman with a chief complaint of saving and realigning her elongated maxillary left central incisor. This paper describes the successful combined periodontal regenerative (guided tissue regeneration) and prosthetic treatment and a 2-year follow-up of maxillary central incisor with pathologic tooth migration, deep intrabony defect, and poor prognosis. Results: The right maxillary central incisor was restored by laminate veneer and the left by all-ceramic crown. The patient had no pain and discomfort and was satisfied with the outcomes of her treatment for 2 years. She has maintained her recall program at the Department of Periodontology at 3 months interval. Conclusion: The key step in the successful treatment of PTM in anterior region is to obtain a high level of cooperation from the patient. Maintenance of the treatment result of PTM is dependent on the continuous preservation of periodontal health.

• Journal of Periodontal and Implant Science
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• 제31권2호
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• pp.345-356
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• 2001

The purpose of the present study was to evaluate the clinical efficacy of guided tissue regeneration(GTR) using resorbable polylactic/polyglycolic copolymer(PLA/PGA) membrane in mandibular class II furcation involvement and to compare it to the clinical efficacy of only flap operation. Both procedures were conducted in 5 patients with class II furcation involvements. After 6 months of follow up, the probing pocket depth, clincial attachment level, bone probing depth, and radiographic changes were compared, and the following results were obtained: 1. GTR using PLA/PGA demonstrated a statistically significant reduction in probing pocket depth and bone probing depth, and the control group demonstrated a statistically significant reduction in bone probing depth. 2. The comparison between the experimental and control group failed to demonstrate statistically significant difference in clinical improvement, but more reduction in probing pocket depth and bone probing depth were observed in the experimental group. The probing pocket depth and the bone probing depth were $2.2{\pm}1.6mm$ and $2.4{\pm}1.1mm$ respectively in the control group, while they were $2.4{\pm}1.3mm$ and $3.0{\pm}1.2mm$ respectively in the experimental group. 3. Radiographic change was not detectable for the both groups during the 6 months of follow up. 4. Sites with deeper probing pocket depth at baseline examination showed greater amount of clinical improvement in both groups. Other clinical factors didn't have any significant effect on the treatment results. It is concluded that though there are some limitations, PLA/PGA membrane is effective for the treatment of mandibular class II furcation involvement.