The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 20 , ISSUE 5 ( May, 2019 ) > List of Articles


How do GTR and GBR Differ? A Periodontitis Case Treated Using an Equine-derived, Enzyme-deantigenic, Collagenpreserving Bone Graft, and Collagen Membranes

Riccardo Tizzoni, Marta Tizzoni

Keywords : Bone regeneration, Case report, Guided tissue regeneration, Periodontal diseases

Citation Information : Tizzoni R, Tizzoni M. How do GTR and GBR Differ? A Periodontitis Case Treated Using an Equine-derived, Enzyme-deantigenic, Collagenpreserving Bone Graft, and Collagen Membranes. J Contemp Dent Pract 2019; 20 (5):639-644.

DOI: 10.5005/jp-journals-10024-2571

License: CC BY-NC 4.0

Published Online: 01-08-2015

Copyright Statement:  Copyright © 2019; The Author(s).


Aim: The present case illustrates how a tooth, which had a highly questionable prognosis, was preserved by carrying out a periodontal regeneration surgery. Background: Treatment of periodontitis involves a careful consideration of all the factors that may allow the achievement of a favorable outcome; among those, the skillful use of guided tissue regeneration (GTR) membranes is of paramount importance. Case description: A 39-year-old patient presented with a mobile central upper incisor due to severe periodontitis and was treated according to GTR principles using a collagen membrane. A collagen-preserving bone graft was also used, as a scaffold for clot formation and cellular infiltration, which was covered with a second collagen membrane. The patient was contacted for follow-up assessment at 3, 6, 12, and 18 months after surgery. Follow-up radiographs showed that bone regeneration occurred around the involved tooth and very little tooth mobility was observed. The patient's masticatory function, appearance, and comfort were favorable. Conclusion: The use of two equine collagen membranes with the purpose of creating the best conditions to carry out periodontal regeneration according to GTR principles, in association with an equine, collagen-preserving, enzyme-deantigenic bone graft, allowed sufficient bone regeneration to salvage a tooth that was deemed otherwise lost because of periodontitis. Clinical significance: In cases of teeth that are severely compromised by periodontitis, the use of collagen membranes according to GTR principles can allow the regeneration of the periodontal tissues; the association with a bone substitute having well-known performance rates, covered with a collagen membrane (guided bone regeneration, GBR) can, in some cases, improve bone regeneration at the defect site.

PDF Share
  1. Bhat M, Roberts-Thomson K, et al. Clustering of risk indicators for periodontal disease: a population-based study. Community Dent Health 2015 Sep;32(3):158–162.
  2. Devi P, Pradeep AR. Classification of periodontal diseases: the dilemma continues. N Y State Dent J 2009 Jun–Jul;75(4):30–34.
  3. Meynardi F, Pasqualini ME, et al. Correlation between dysfunctional occlusion and periodontal bacterial profile. J Biol Regul Homeost Agents 2016 Apr–Jun;30(2 Suppl 1):115–121.
  4. Cortellini P, Tonetti MS. Focus on intrabony defects: guided tissue regeneration. Periodontol 2000 2000 Feb;22:104–132.
  5. Pretzl B, Eickholz P, et al. Endodontic status and retention of molars in periodontally treated patients: results after 10 or more years of supportive periodontal therapy. J Clin Periodontol 2016 Dec;43(12):1116–1123. DOI: 10.1111/jcpe.12621.
  6. Gottlow J, Nyman S, et al. New attachment formation as the result of controlled tissue regeneration. J Clin Periodontol 1984 Sep;11(8): 494–503.
  7. de Jong T, Bakker AD, et al. The intricate anatomy of the periodontal ligament and its development: lessons for periodontal regeneration. J Periodontal Res 2017 Dec;52(6):965–974. DOI: 10.1111/jre.12477.
  8. Yamamoto T, Ugawa Y, et al. Modulation of microenvironment for controlling the fate of periodontal ligament cells: the role of Rho/ROCK signaling and cytoskeletal dynamics. J Cell Commun Signal. 2018 Mar;12(1):369–378. DOI: 10.1007/s12079-017-0425-3.
  9. Nyman S, Karring T, et al. Healing following implantation of periodontitis-affected roots into gingival connective tissue. J Clin Periodontol 1980 Oct;7(5):394–401.
  10. Karring T, Nyman S, et al. Potentials for root resorption during periodontal wound healing. J Clin Periodontol 1984 Jan;11(1):41–52.
  11. Caton J, Zander HA. Osseous repair of an infrabony pocket without new attachment of connective tissue. J Clin Periodontol 1976 Feb;3(1):54–58.
  12. AlGhamdi AS, Ciancio SG. Guided tissue regeneration membranes for periodontal regeneration—a literature review. J Int Acad Periodontol 2009 Jul;11(3):226–231.
  13. Miller SC. Textbook of Periodontia. 3rd ed. Philadelphia, PA: Blakiston; 1950.
  14. Löe H. The Gingival Index, the Plaque Index and the Retention Index Systems. J Periodontol 1967 Nov–Dec;38(6):Suppl:610–616.
  15. Ramfjord SP. The Periodontal Disease Index (PDI). J Periodontol 1967 Nov–Dec;38(6):Suppl:602–610.
  16. López NJ, Belvederessi M. Healing following implantation of healthy roots, with and without periodontal ligament tissue, in the oral mucosa. J Periodontol 1983 May;54(5):283–290. DOI: 10.1902/jop.1983.54.5.283.
  17. Chen FM, Sun HH, et al. Stem cell-delivery therapeutics for periodontal tissue regeneration. Biomaterials 2012 Sep;33(27):6320–6344.
  18. Dominici M, Le Blanc K, et al. Minimal criteria for defining multipotent mesenchymal stromal cells. The International Society for Cellular Therapy position statement. Cytotherapy 2006;8(4):315–317.
  19. Morrison SJ, Kimble J. Asymmetric and symmetric stem-cell divisions in development and cancer. Nature 2006 Jun 29;441(7097):1068–1074. DOI: 10.1038/nature04956.
  20. Miura M, Gronthos S, et al. SHED: stem cells from human exfoliated deciduous teeth. Proc Natl Acad Sci U S A 2003 May 13;100(10): 5807–5812. DOI: 10.1073/pnas.0937635100.
  21. Sonoyama W, Liu Y, et al. Characterization of the apical papilla and its residing stem cells from human immature permanent teeth: a pilot study. J Endod 2008 Feb;34(2):166–171. DOI: 10.1016/j.joen.2007.11.021.
  22. Seo BM, Miura M, et al. Investigation of multipotent postnatal stem cells from human periodontal ligament. Lancet 2004 Jul 10–16;364(9429): 149–155. DOI: 10.1016/S0140-6736(04)16627-0.
  23. Hernández-Monjaraz B, Santiago-Osorio E, et al. Mesenchymal Stem Cells of Dental Origin for Inducing Tissue Regeneration in Periodontitis: A Mini-Review. Int J Mol Sci 2018 Mar 22;19(4):1–17. DOI: 10.3390/ijms19040944.
  24. Pellegrini G, Pagni G, et al. Surgical Approaches Based on Biological Objectives: GTR vs GBR Techniques. Int J Dent 2013;2013:521547. DOI: 10.1155/2013/521547.
  25. Moskow BS, Karsh F, et al. Histological assessment of autogenous bone graft. A case report and critical evaluation. J Periodontol 1979 Jun;50(6):291–300. DOI: 10.1902/jop.1979.50.6.291.
  26. Listgarten MA, Rosenberg MM. Histological study of repair following new attachment procedures in human periodontal lesions. J Periodontol 1979 Jul;50(7):333–344. DOI: 10.1902/jop.1979.50.7.333.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.