Beruflich Dokumente
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The membranes used during this procedure are most commonly made of materials such as expanded polytetrafluoroethylene (ePTFE), polyglactic acid, polylactic acid, and
collagen. Pini-Prato et al. (1992) and Tinti & Vincenzi
(1994) reported the use of an ePTFE membrane to treat
gingival recessions. Cortellini et al. (1993) conducted a
histological study on a patient, demonstrating that the root
coverage obtained with the use of an ePTFE membrane,
while treating a gingival recession, led to new connective
tissue attachment and new bone formation. In 2001, Harris,
while examining the histology of four teeth with gingival
recessions treated with GTR, reported healing with a long
junctional epithelium attachment without regeneration.
INDICATIONS
Moderate to severe gingival recessions
Thin palate
ARMAMENTARIUM
This includes the basic surgical kit plus the following:
Barrier membrane: resorbable (e.g., Resolut (W.L. Gore,
Flagstaff, AZ, USA) XT, XTN2, or XTW1 and/or nonresorbable (e.g., Gore-Tex titanium reinforced TRN2,
TRW2 or GTN1, GTN2, GTW1, or GTW2)
Citric acid, pH 1 (40%), or 1 capsule of tetracycline
hydrochloride (HCl), 250 mg
Figure 9.2. The exposed root surface is thoroughly scaled with a backaction chisel.
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Figure 9.3. Two vertical incisions are placed, avoiding the interproximal
papillae.
Figure 9.4. The flap is reflected exposing some of the alveolar bone.
At this stage, the buccal flap, full at the top and partial at
the bottom, when moved coronally should be able to cover
and lie passively on the recession. This is critical because
any tension while suturing will affect the positive outcome
of the procedure. The papillae are de-epithelialized, and
the membrane is trimmed and adjusted to cover the recession (Fig. 9.5).
The membrane should extend approximately 2 mm beyond
the borders of the recession mesially, distally, and apically.
The membrane should be coronally placed at the level of
the cemento-enamel junction and sutured in place with a
circumferential suture and a palatally tied knot (Fig. 9.6).
The knot is then palatally tucked into the gingival sulcus.
When the sulcus is shallow, a small intrasulcular incision
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Figure 9.7. The buccal flap is sutured with the aim of covering as much
of the membrane as possible.
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Wound healing
Teflon/ePTFE membranes
These are nonresorbable, biocompatible membranes that
require a second surgery for removal. There are two parts
to this membrane. The first is an open microstructure collar
inhibiting epithelial migration, and the second is an occlusive apron isolating the root surface from the surrounding
tissues (Gottlow et al. 1986).
Possible complications
The most common complication is membrane exposure
(Fig. 9.9). If the membrane is resorbable, and there are no
signs of infection, the patient should be advised to rinse
with chlorhexidine gluconate. With time, the membrane will
disintegrate.
If the membrane is nonresorbable and the exposure limited, the patient is given a course of antibiotics (i.e., amoxicillin, 1.5 g/day for 7 days) and asked to rinse with
chlorhexidine gluconate until removal of the membrane
(after 6 weeks). An infected nonresorbable membrane
should be removed (Nowzari et al. 1995).
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REFERENCES
American Academy of Periodontology (1996) Annals of Periodontology
World Workshop in Periodontics. Chicago: American Academy of
Periodontology, 1: 621.
Cortellini, P., Clauser, C., & Pini-Prato, G. (1993) Histologic assessment of new attachment following the treatment of a human buccal
recession by means of a guided tissue regeneration procedure.
Journal of Periodontology 64, 387391.
Gottlow, J., Nyman, S., Lindhe, J., Karring, T., & Wennstrom, J. (1986)
New attachment formation in the human periodontium by guided
tissue regeneration: Case reports. Journal of Clinical Periodontology
13, 604616.
Gottlow, J., Laurell, L., Lundgren, D., Mathisen, T., Nyman, S., Rylander,
H., & Bogentoft, C. (1994) Periodontal tissue response to a new
bioresorbable guided tissue regeneration device: A longitudinal
study in monkeys. International Journal of Periodontics and
Restorative Dentistry 14, 437450.
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