Marwa Mahmoud Bedier

Indications:

1- Extensive bone loss in relation to one root.

2-Fracture of one root.

3- Resorption, caries or perforation in one root.

Contraindications :

1- fused roots.

2- uncooperative patient.

3- lack of bone support for remaining root.

4-Endodonticaly inoperable remaining root/roots

2. Hemisection:
 It is surgical division of multi-rooted teeth  into 2 halves and
removal of devective half.
E.g  lower molars

3. Bicuspidization
 It is surgical division of multi-rooted teeth  into 2 halves, retaining both halves and  each  then restored with  a separate crown

Bicuspidization

    The concept of GTR was introduced by Melcher in 1976

It is a technique that prevent apical migration of gingival epithelium and allowing tissue derived from the periodontal ligament to repopulate the space adjacent to the denuded root surface.

Indications of GTR in endodontic surgery

1. Large periapical lesions.

2. Through and through lesions

 3. Furcation involvment as a result of

     perforation

 4. Periapical lesion communicating with the

     alveolar crest

 5. Root perforation with bone loss 

       to alveolar crest 

What we need for GTR???

Membrane barriers

Criteria of an ideal barrier material:

Types of GTR membranes

Non-Resorbable

    ePTFE (expanded polytetrafluoroethylene)

    The first commercially available barrier membrane was an called Gore- Tex.

Bio-absorbable

Pecora et al. 1995, reported in large apical lesions (>10mm)  the use of Gore Tex was resulted in quicker healing

Some points to remember while using barrier membranes are:

1. The membranes should extend at least 2 to 3 mm beyond the margins of the bone cavity.

2. A space must be created underneath the membrane to allow the growth of new tissue

3. The membrane should be totally submerged because exposed membrane increases the risk of infection.

Some points to remember while
using barrier membranes are:

4.The membrane must be stable and immovable.

5. The membrane must act as a selective barrier for at least 6 to 8 weeks.

6. Mobile teeth must be splinted.

7. A strict oral hygiene regimen must be followed with gentle brushing.

Bone Augmentation

Using Bone Graft

Is a procedure used to build or enhance bone growth.

Bone Grafts

The principles of successful bone grafts include:

Grafting materials according to source

Autograft:

   Transplant of viable cortical or cancellous bone from one location to another within the same patient.eg. Ramus, tuberosity

Allograft

   A bone allograft refers to a graft between genetically dissimilar members of same species

Ex: Decalcified Freezed Dried Human Bone,

      Freeze-  dried bone allograft (FDBA)

Xenograft :

   cross-species transplantation of tissue such as anorganic bovine bone or porcine collagen

 Alloplasts:

   Implantation of sythetic material , such as HA or

   TCP , bioactive glass , non-ceramic polymer

Growth Factors/Cytokines/Host Modulating Agents Used to Promote
Periodontal Regeneration

Platelet Rich Plasma (PRP)

    Is a highly concentrated suspension of autologous platelets, secrete bioactive growth factors.

They help to enhance key stages of wound healing and regenerative processes including chemotaxis, proliferation, differentiation, and angiogenesis

Platelet-rich Plasma and Guided
Tissue Regeneration Membrane in the Healing
of Apicomarginal Defects

     Treatment of Periapical Inflammatory Lesion with the Combination of Platelet-Rich   
         Plasma and Tricalcium Phosphate

PDGF is a growth factor

    Involved in wound healing ,stimulates the regenerative potential of periodontal tissues including bone, cementum, and periodontal ligament.

PepGen P-15

     Stimulates osteoblasts , which may accelerate repair of bone defects created during periradicular or dental implant surgeries

ADVANTAGES OF GTR

DISADVANTAGES OF GTR