GUIDED TISSUE REGENERATION !

Dental: Guided Tissue Regeneration Membrane

Surgical procedures can be an intimidating for many patients and this is why we hope to offer our patients a

good insight into the type of injury, some possible solutions and how Inion® implants and technologies can

help.

It is always extremely important for you to find out as many details as possible about your problem, the

available methods of treatment for that condition, and any particular surgical method your dentist may

recommend for you.

The gum versus bone race:

Soft tissue, such as gum tissue, grows very fast while bone grows more slowly. When a hole is created in the

bone, for example when a tooth is removed or because of an infection, soft tissue grows into the space very

quickly and prevents bone from forming there. When bone is needed to support a tooth or dental implants,

uncontrolled gum tissue growth can be a problem.

A Membrane can be used to cover the hole and act as a barrier to block out the gum tissue from growing into

the area. This allows the more slowly growing bone to fill the hole without any competition.

Guided Tissue Regeneration (GTR) for treatment of Periodontal disease

Periodontal Disease, or Gum disease, is an infection of the gums caused by bacteria. If left

untreated, pockets of infection form between the gums and the roots of the teeth. Eventually, the

tissue connecting the teeth and the gums begins to break down, causing the teeth to loosen.

Treatment usually involves thorough cleaning and, in more advanced cases, surgery may be

required. This can include cutting and peeling back the gums to allow the bacteria and plaque to be

scraped off the root surfaces.

Treatment usually involves thorough cleaning and, in more advanced cases, surgery may be required. This

can include cutting and peeling back the gums to allow the bacteria and plaque to be scraped off the root

surfaces.

Membranes can then be used to regenerate lost periodontal tissue and supporting bone. With guided tissue

regeneration, the faster growing connective tissue and epithelial cells are prevented from migrating into the

wound, and space is maintained between the membrane and bone, allowing time for periodontal ligament

and bone to repopulate and mature in the defect area. A membrane can be used alone or with a bone graft

or bone substitute.

Guided Bone Regeneration (GBR)

Guided Bone Regeneration (GBR) refers to procedures that attempt to regenerate bone, often prior to the

placement of dental implants. This is accomplished using membranes to keep out soft tissue and allow the

bone to grow in bony defects and extraction sockets.

Whenever a tooth is lost or extracted a lot of the bone that once surrounded the tooth root can disappear.

This bone loss is described as ‘bone resorption’ . For some people, bone loss after the removal or loss of

teeth leaves them without enough to secure an implant.

Guided bone regeneration can be used to create additional bone in deficient areas before placing dental

implants or to repair defects around previously placed dental implants. The surgical hole can be filled with

several different types of materials before covering the area with a protective membrane barrier, i.e.:

Autograft – Bone can be harvested from the patient’s own body by scraping the jaw bone, removing cores or

blocks of bone from different places, or even getting bone from the patient’s hip.

Allograft bone – bone from a deceased donor.

Other materials – such as treated bone from animals, synthetic bone, coral and biocompatible polymers can

also be used.

The Inion GTR membrane acts as a

barrier between the gum and the

defect(space). This enables a slower

growing periodontal ligament and

formation of bone cells to repair the

area.

Complete healing of the area occurs

when the periodontal ligament and

bone cells have regenerated(grown

back) and the Inion GTR membrane

has completely degraded(absorbed).

 

Surgical Technique -What to expect?

The theory of GTR proposes that placing a barrier between the overlying gingival (gum)tissues and the gap

will stop the faster-moving epithelium and gingival connective tissue from migrating into the wound space,

allowing time for the periodontal ligament, and bone to repopulate the area.

This membrane will usually be placed during periodontal or bone graft surgery as part of

the overall treatment, Your dentist, surgeon or periodontist will explain what to exepct.

 

Biomaterial Advantage

Inion’s biodegradable materials are safe and synthetic, without any of the potential risks associated with

materials from human or animal origin.

The need for membrane removal surgery is eliminated by using Inion GTRTM membranes. The polymers

used in the Inion membranes and tacks biodegrade in the body and are then metabolized(processed) by the

body into carbon dioxide and water.

Membrane

TMC Trimethylene Carbonate

LPLA L-lactide

PGA Polyglycolide

Tack

TMC Trimethylene Carbonate

DLPLA D, L-lactide

The biocompatibility of the materials has been well documented and the same polymers have been clinically

used for more than 30 years in biodegradable sutures and orthopaedic fixation devices.

What is the difference between Inion GTRTM membrane and other

biodegradable membranes?

The key difference is that the membrane becomes stiff when implanted. This allows the space under the

membrane to be maintained so that more bone volume can be generated.

What is the degradation time of the Inion GTRTM membrane?

The Inion GTRTM membranes are tailored to fully biodegrade within one to two years. The barrier function of

the membrane to exclude gingival cells from the defect site is maintained for 8-12 weeks, thereafter the

membrane starts to break down and biodegrade

What happens to the membrane? What does it degrade into?

The Inion GTR™ membrane degrades by hydrolysis and over time is metabolised through natural processes

in the body into carbon dioxide and water, which are then exhaled and excreted.

Can the Inion membrane be used to prepare dental implant sites?

The Inion GTRTM Membrane System is also indicated for bone augmentation around dental implants. Due to

its outstanding space maintenance properties excellent bone volume gain may be achieved.

How fast can I expect bone to regenerate underneath the membrane?

You can expect bone to grow at least as fast as with other membranes. However, ultimate results depend on

a variety of factors which need to be assessed prior to surgery. Early animal study results indicate an

acceleration of bone growth due to specific formulation of the membrane. Further research hereto is ongoing.

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HOW IMPORTANT IS DENTAL CLEANING !!

Dental Cleaning

Prophylaxis and Periodontal Health

The dental profession refers to the dental cleaning appointment as a dental prophylaxis, or prophy. It’s most significant functions are prevention of dental disease and patient education. It is likely the most important and valuable visit a patient may ever make to the dentist.

The routine dental cleaning is anything but routine, and should include:

  • ·        Personal oral hygiene evaluation, home care review and recommendations.
  • ·        Toothbrushing and flossing instructions.
  • ·        Supra gingival (above the gum) scaling to remove plaque and tartar from all visible tooth surfaces.
  • ·        Debridement of tartar beneath the gum, as conditions warrant.
  • ·        Topical fluoride treatment to the age of thirteen.
  • ·        Polishing the teeth.
  • ·        Nutrition assessment, if needed
  • ·        Periodontal charting, and scheduling of additional periodontal care as indicated.
  • ·        The dental prophylaxis is the cornerstone for a lifetime of dental health.

 

Ultrasonic and Hand Scaling

 

Plaque is the colonization of natural oral bacteria on food debris that remains on the surface and in the crevices of the teeth and gums. Combing with minerals in the saliva, it ultimately forms a hard, rough sediment known as dental tartar or calculus which attracts further plaque buildup. Calculus must be removed by a dental professional for the prevention of periodontal disease.

Removal of calculus may be performed by a licensed dentist, either by manual scaling of the teeth, or with an ultrasonic device. The choice of technique is a personal preference by the hygienist or wishes of the patient. Most states permit trained dental hygienists to administer local anesthetic and nitrous oxide (laughing gas), often necessary for deep periodontal scaling and root planing.

Light or moderate tartar buildup is commonly removed by manual scaling instruments of various shapes and sizes The skills of the hygienist are especially important for this procedure.

The ultrasonic scaler, commonly called by the brand name, is often indicated for the efficient removal of heavy, tenacious tartar and stain The hygienists may follow its use with hand scaling for a more finite smoothing of tooth and root surfaces.

Caution is warranted for people who wear pacemakers, as the ultrasonic sounds may interfere with the function of the pacemaker.

Root Planing

Accumulation of plaque causes inflammation of the gums and an ensuing breakdown of the periodontal attachment (the fibrous connection of the teeth to the supporting structures). Pockets between the teeth and soft tissue become deeper, and the underlying bone recedes Increased pocket depth encourages the formation of more calculus, plaque and further tissue breakdown The ongoing bacterial colonization byproducts perpetuate the disease process.

Root planing is a procedure to treat periodontal conditions (moderate to advanced gum disease) by thoroughly scaling the roots of teeth to establish a smooth, calculus free surface The process may be performed by a dental hygienist, dentist or periodontist (gum specialist), and usually requires local anesthesia to prevent pain Thorough periodontal scaling customarily involves several dental visits

More advanced conditions may necessitate periodontal surgery for complete debridement of the roots and recontouring of the hard and soft tissue to arrest the disease process or to restore, in select situations, lost bone.

Polishing

The dental prophylaxis is refined by a final polishing of the teeth to remove stain and create a sensation of fresh breath and a clean mouth It may be accomplished by spraying high pressured water mixed with baking soda paste onto the surface of the teeth, or a rubber cup and polishing paste.

The Dental Recall Appointment

Patients should schedule their recall appointments on a regular basis for the early diagnoses of dental disease The hygienist or dentist may recommend a prophylaxis visit every two to six months. Recall frequency depends on many factors and should be determined on an individual basis. Some people tend to have more buildup of calculus than others and some may be more prone to periodontal inflammation or the development of tooth decay. Patients with inadequate oral hygiene practices will require more frequent cleanings.

Dental Cleaning for Children

The dental prophylaxis is especially important for children to establish good oral hygiene practice and to appreciate the importance of dental health. Easy dental prophy appointments help create self esteem and will lessen anxiety should dental restorative care become necessary in the future.

The regular application of topical fluoride, early detection of orthodontic (bite) problems, and an evaluation for pit and fissure sealants are part of preventive dental health.