The factors related with the failure in GBR and GTR technique

Yeom, Hey Ri; Ku, Young; Chung, Chong Pyung

Abstract

Using barrier membrane, guided bone regeneration(GBR) and guided tissue regeneration(GTR) of periodontal tissue are now widely studied and good results were reported. In bone regeneration, not all cases gained good results and in some cases using GTR, bone were less regenerated than that of control. The purpose of this study is to search for the method to improve the success rate of GBR and GTR by examination of the cause of the failure. For these study, rats and beagle dogs were used. In rat study, 5mm diameter round hole was made on parietal bone of the rat and 10mm diameter of bioresorbable membrane was placed on the bone defects and sutured. In 1, 2, 4 weeks later, the rats were sacrificed and Masson-Trichrome staining was done and inspected under light microscope for guided bone regeneration. In dog study, 3x4mm2 Grade III furcation defect was made at the 3rd and 4th premolar on mandible of 6 beagle dogs. The defects were covered by bioresorbable membrane extending 2-3mm from the defect margin. The membrane was sutured and buccal flap was covered the defect perfectly. In 2, 4, 8 weeks later, the animals were sacrificed and undecalcified specimens were made and stained by multiple staining method. In rats, there was much amount of new bone formation at 2 weeks, and in 4 weeks specimen, bony defect was perfectly closed and plenty amount of new bone marrow was developed. In some cases, there were failures of guided bone regeneration. In beagle dogs, guided tissue regeneration was incomplete when the defect was collapsed by the membrane itself and when the rate of resorption was so rapid than expected. The cause of the failure in GBR and GTR procedure is that 1) the membrane was not tightly seal the bony defects. If the sealing was not perfect, fibrous connective tissue infiltrate into the defect and inhibit the new bone formation and regeneration. 2) the membrane was too tightly attached to the tissue and then there was no space to be regenerated. In conclusion, the requirements of the membrane for periodontal tissue and bone regeneration are the biocompatibility, degree of sealingness, malleability, space making and manipulation. In this animal study, space making for new bone and periodontal ligament, and sealing the space might be the most important point for successful accomplishment of GBR and GTR.