Goal of Bone Replacement Grafts and Guided Tissue Regeneration

Goal of Bone Replacement Grafts and Guided Tissue Regeneration
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Abstract
Periodontal disease is a worldwide medical problem. The disease leads to loss of periodontal supporting structures such as the alveolar bone, periodontal ligament, and cementum. Ultimately, this leads to loss of teeth. Periodontal therapy aims at stopping continuous loss of connective tissue attachments. The goal of periodontal therapy is the regeneration of periodontal supporting structures to previous form and function. According to the Glossary of Periodontal terms, guided tissue regeneration refers to procedures that try to regenerate damaged periodontal structures through the response of differential tissues. On the other hand, bone replacement grafts procedures aid in periodontal regeneration and bone formation.
This paper focuses on the goals of the two periodontal therapy procedures; bone replacement grafts and guided tissue regeneration. It also gives brief explanations how these goals are achieved; that is the various mechanisms. Finally, the paper looks at how and when the two procedures are used together.
Goal of Bone Replacement Grafts and Guided Tissue Regeneration
Goal of Bone Replacement Grafts
Bone replacement grafts procedures aim to achieve various goals. In periodontal therapy, the procedure is used to fill defects or cavities resulting from periodontitis. Bone replacement grafts aid in periodontal regeneration and bone formation. Other techniques such open flap debridement only offer part restoration of periodontal tissues through repair and halting progress of periodontitis (Jangid et al.

, 2016). Bone replacement grafts procedures take care of this; the bone grafting material act as matrices and structural scaffolds for anchorage and attachment of osteoblasts. In achieving its biological goals, bone replacement grafts enables structural framework remodeling, maturation and clot development for the formation of bone (Jangid et al., 2016). According to research, the procedure also has the ability to promote the coordinated formation of the periodontal ligament, cementation, and bone, when carried out in periodontal defects (Jangid et al., 2016). Through osteoconduction, bone replacement graft procedures guide the reparative growth of the natural bone. Osteoinduction, on the other hand, is another bone replacement graft mechanism that leads to the formation of active osteoblast from undifferentiated cells. Another bone replacement graft mechanism is osteogenesis. Osteogenesis leads to remodeling through the living bone cells in the graft material.
Goal of Guided Tissue Regeneration
Guided tissue regeneration procedures aim to regenerate periodontal structures which are lost; this is done through the response of differential tissues. This procedure is not a treatment procedure for periodontitis; rather it aims at regenerating defects brought about by periodontitis. The procedure includes; use of barrier membrane, bone replacement grafts and cellular modulating factors. The procedure uses a barrier membrane to allow selective tissue regeneration. Guided tissue regeneration gives an advantage to specific cells to repopulate the defect area hence give rise to new attachment apparatus. The procedure achieves its goal by delaying apical migration of gingival epithelium. It excludes gingival connective tissue hence allowing repopulation of tissue obtained from alveolar bone and periodontal ligaments. The repopulation occurs in the space next to the denuded root surface (Naylor et al., 2011).
Using Bone Replacement Grafts and Guided Tissue Regeneration together
As discussed above, both of these procedures offer periodontal therapy. The aim of these techniques is to stop the spread of the disease by regenerating the tooth’s lost attachment apparatus and controlling the infection.
The two procedures can be used together. Bone replacement grafts procedures are used to compensate for the lack of space maintaining the effect of the available membranes after guided tissue regeneration procedures. Bone replacement grafts procedures can also be used together with guided tissue regeneration to promote bone formation. During healing after a guided tissue regeneration procedure, the space below the barrier is maintained for some time. This is to allow for complete periodontal regeneration. However, in some instances, the membrane collapses towards the roots or into the defects. This leads to inadequate space for the repopulation of periodontal ligament cells. Ultimately, this leads a lower amount of bones formed (Yadav, Narula, Tewari & Yadav, 2011). To compensate for these effects of guided tissue regeneration procedure, bone replacement graft procedure is carried out. According to research to carry out clinical evaluation of a combination of the two procedures, there was a more clinical success when the two procedures were combined compared to only guided tissue regeneration (Yadav et al., 2011). They attributed this to the presence of physical support beneath the membrane. When the flaps are stitched up over the defect, they exert pressure on the membrane. Therefore the support under the membrane aids the membrane to maintain its position. The group also noted that bone grafts might aid in wound stability; this is important for periodontal regeneration to occur (Yadav et al., 2011).
References
Jangid, M., Rakhewar, P., Nayyar, A. & Cholepalil A. (2016). Bone grafts in periodontal regeneration factors impacting treatment outcome. Basic Research Journal of Medicine and Clinical Sciences, 5(6), 106-109.
Naylor, J., Mines, P., Anderson, A. &Kwon, D. (2011). The Use of Guided Tissue Regeneration Techniques among Endodontists. Clinical Research, 37(11), 1495-1498.
Yadav, V., Narula, S. Sharma, R., Tewari, S. & Yadav, R. (2011). Clinical evaluation of guided tissue regeneration combined with autogenous bone mixed with bioactive glass in intrabony defects. Journal of Oral Science, 53(4), 481-488.