46. Guided tissue regeneration - methods and techniques.

Question 1

Essential conditions for the successful regeneration of alveolar bone

Answer 1

• Exclusion of gingival tissue from site of regeneration during bone development
• Maintenance of bacteria-free closed area under membrane=>
• w/ primary wound healing main aim

Question 2

Primary surgical approaches used in guided tissue regeneration

Answer 2

• Modified Papilla Preservation Flap (MPPF)
• Simplified Papilla Preservation Flap (SPPF)
• Minimally Invasive Surgical Technique

Question 3

Main objective of the Modified Papilla Preservation Flap (MPPF)

Answer 3

• Primary closure of flap in interdental space over membrane

Question 4

Procedure for Modified Papilla Preservation Flap (MPPF)

Answer 4

• Horizontal incision in buccal keratinized gingiva at base of papilla=>
• Connected w/ mesio-distal buccal intrasulcular incisions
• Elevation off full-thickness buccal flap and dissection of residual interdental tissues
• Elevation of a full-thickness palatal flap including interdental papilla=>
• Expose the interdental defect.
• Debridement of defect and mobilization of buccal flap w/ vertical and periosteal incisions

Question 5

How suturing performed in the Modified Papilla Preservation Flap (MPPF)

Answer 5

• Horizontal internal crossed mattress suture placed beneath mucoperiosteal flaps=>
• Between base of palatal papilla and buccal flap
• Vertical internal mattress suture placed between buccal aspect of interdental papilla and most coronal portion of buccal flap
• Modified internal mattress suture=>
• Stability and primary closure of interdental tissues=>
• Suture through buccal and lingual flaps and tied it on buccal side

Question 6

Purpose of the Simplified Papilla Preservation Flap (SPPF)

Answer 6

• Overcome technical problems encountered w/ MPPF=>
• Narrow interdental spaces and posterior areas
• Suturing technique suitable for non-supportive barriers

Question 7

Describe the procedure for the Simplified Papilla Preservation Flap (SPPF

Answer 7

• Oblique incision across defect-associated papilla=>
• From gingival margin at buccal-line angle to mid-interdental portion of papilla
• Continuation of incision intrasulcularly on buccal aspect of teeth neighboring defect
• Elevation of full-thickness buccal flap and dissection of remaining tissues of papilla
• Debridement of defect and root planing
• Vertical releasing or periosteal incisions to improve buccal flap mobility

Question 8

How suturing performed in the Simplified Papilla Preservation Flap (SPPF)

Answer 8

• Horizontal internal mattress suture (offset mattress suture) positioned in defect-associated interdental space
• Suturing interdental tissues above membrane=>
• Primary closure using one of three approaches depending on interdental space width and tissue thickness=>
• One interrupted suture, two interrupted sutures, or internal vertical/oblique mattress suture

Question 9

Goal of the minimally invasive surgical technique in guided tissue regeneration

Answer 9

• Provide greater wound stability and limit patient morbidity=>
• Papilla preservation flap w/ high-power magnification-assisted surgical techniques=>
• Combined w/ biologically active agents=> enamel matrix derivatives (EMD) or growth factors

Question 10

When SPPF and MPPF used in the minimally invasive surgical technique

Answer 10

• SPPF =>width of interdental space is 2 mm or narrower
• MPPT=>interdental sites wider than 2 mm

Question 11

Procedure for the minimally invasive surgical technique

Answer 11

• Extending interdental incision (SPPF or MPPT) to buccal and lingual aspects of adjacent teeth=>
• Strictly intrasulcular to preserve gingiva
• Elevating small full-thickness flap to expose 1–2 mm of defect-associated residual bone crest
• Minimizing mesio-distal extension of incision and flap reflection
• Accessing only the defect-associated papilla, avoiding vertical releasing incisions when possible.
  Elevating the full-thickness flap to expose the bone crest, adjusting the extent based on the depth and location of the bony wall components.

Question 12

Post-operative care regimen following guided tissue regeneration surgery

Answer 12

• Prescribing systemic antibiotics (doxycycline or amoxicillin) for one week post-surgery.
  Chlorhexidine mouthrinsing (0.2% or 0.12%) two to three times per day.
  Weekly professional tooth cleaning until membrane placement.
  Avoiding mechanical oral hygiene and chewing in the treated area.
  Removing non-resorbable membranes 4–6 weeks post-surgery with continued chlorhexidine rinsing and professional cleaning.
  Extending infection control for 6–8 weeks when using bioresorbable membranes or regenerative materials.
  Gradually resuming mechanical oral hygiene after this period and enrolling patients in a periodontal care program for one year.
  Avoiding probing or deep scaling in the treated area before the 1-year follow-up.