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
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.
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.
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.
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.
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.
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.
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.
Karring T, Nyman S, et al. Potentials for root resorption during periodontal wound healing. J Clin Periodontol 1984 Jan;11(1):41–52.
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.
AlGhamdi AS, Ciancio SG. Guided tissue regeneration membranes for periodontal regeneration—a literature review. J Int Acad Periodontol 2009 Jul;11(3):226–231.
Miller SC. Textbook of Periodontia. 3rd ed. Philadelphia, PA: Blakiston; 1950.
Löe H. The Gingival Index, the Plaque Index and the Retention Index Systems. J Periodontol 1967 Nov–Dec;38(6):Suppl:610–616.
Ramfjord SP. The Periodontal Disease Index (PDI). J Periodontol 1967 Nov–Dec;38(6):Suppl:602–610.
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.19220.127.116.113.
Chen FM, Sun HH, et al. Stem cell-delivery therapeutics for periodontal tissue regeneration. Biomaterials 2012 Sep;33(27):6320–6344.
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.
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.
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.
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.
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.
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.
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.
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.1918.104.22.1681.
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.1922.214.171.1243.