|
Surgical Procedure
Patient Selection
In a successful GTR procedure, not only do you need the proper defect, but selection of the appropriate patient is also important. As is the case with any dental or general surgical procedure, patients presenting with certain medical conditions or taking particular prescription medications may be at increased risk. Patients with certain cardiac conditions, uncontrolled diabetes, and anticoagulant therapies are examples. Clinicians should consult with the patient's primary care physician to identify potential risks associated with the procedure.
The BioMend membrane has not been evaluated in pregnant women or in children. Although no immune or sensitivity reactions were noted during clinical investigation, BioMend membrane should not be used in patients with a known sensitivity to products of bovine origin. The BioMend membrane should not be used in patients with acute infections or contaminated wounds in the oral cavity. Patients should be instructed about appropriate periodontal hygiene before surgery. Proper care at home following surgery will be key in preventing the recurrence or even progression of the periodontal condition. |
Defect Selection
The following criteria should be observed when choosing defects for GTR therapy:
• At least 4 - 5mm of attachment loss at the defect site.
• Sufficient flap dimensions, including an adequate zone of gingival tissue, to allow for closure over the membrane. The presence of attached keratinized gingiva is helpful.
• Some remaining periodontium to facilitate regenerative capacity.
• A defect morphology that allows for space creation and maintenance. |
 |
The specific types of defects that can be treated include: Class II furcation defects, two or three wall vertical defects, interproximal type defects, distal defects. The success of treating other types of natural tooth defects such as Class III furcations is less predictable. Treatment of multiple adjacent teeth during a quadrant of surgery is also more technically demanding because of the time requirements and more difficult flap maintenance. Given the basic requirements of space maintenance, defects with significant horizontal components are not recommended because the regenerative space is usually limited.
Presurgical Therapy
These procedures are recommended prior to surgery:
- The patient is instructed on proper oral hygiene procedures. This is critical to long-term success.
- Presurgical scaling and root planing are performed, especially if root accretions are present.
- Measurements of attachment level and pocket depth are recorded; radiographs are recommended to record bone loss and verify the presence of osseous defects.
- Indices such as plaque, bleeding, and tooth mobility are also recorded.
- Prior to GTR therapy, the patient's response to presurgical procedures and compliance in plaque control are evaluated. Patients demonstrating continued poor oral hygiene should not be considered for GTR therapy.
Surgical Procedure:
Root Coverage
Mucoperiosteal flaps are developed in the treatment sites using sulcular incisions. Care must be taken to preserve the attached keratinized gingiva and interdental papillae, as this will facilitate subsequent membrane coverage.
Vertical incisions may be utilized to gain greater access to the defect area and assist in membrane coverage. The vertical incisions should be placed at least one tooth mesially and/or distally to the tooth being treated. The BioMend membrane should not be placed beneath these vertical incisions, as delayed healing of the flaps may result. Pocket epithelium is excised, leaving a connective tissue layer for the membrane to interface.
At this time, an appropriately sized BioMend sheet is chosen and hydrated for approximately 5 to 10 minutes prior to final placement. The membrane may be hydrated in its tyvek packaging by introducing sterile water or saline.
Hydration will increase the pliability and adaptability of the membrane. Alternatively, the membrane will become pliable upon contact with blood and fluid in the defect site.
Meticulous debridement of the defect site is now performed. Because residual contaminants could affect the regenerative result, debridement must be extremely thorough. Instrumentation is chosen according to preference: hand, rotary, sonic, and ultrasonic devices are effective for root scaling and planing. Enamel projections associated with furcation defects should be removed with high-speed finishing burs. A clean root surface, free of granulation tissue or calculus, should be the end result.
Salivary contamination of the wound site should be minimized.
Root conditioning using chemotherapeutic agents (e.g., citric acid) was not evaluated during clinical trials; therefore, Zimmer Dental cannot recommend their use.
Once the defect has been prepared, the BioMend membrane must be trimmed to properly fit the defect site. A sterile template made from medical grade, high-density polyethylene is separately packaged and included with each BioMend membrane to assist in trimming the membrane to final configuration. Three popular preformed patterns are provided as a guide and may be conveniently punched out of the template. Alternatively, the open area on the template may be used to trim a custom shape if desired. Sharp, sterile scissors should be used for any trimming or modification procedures.
The template material is also embossed with a raised pattern to further distinguish it from the membrane.
Note that the membrane will be required to extend beyond the defect margins by a minimum of 3mm mesially, distally, and apically. The coronal portion of the membrane must lie above the alveolar crest, apical to the gingival margin.
The template material is trimmed until the proper configuration is achieved. It is then placed against the collagen membrane, and a duplicate shape is trimmed from the membrane. Smooth, rounded corners should be trimmed from the collagen membrane to avoid possible perforation of the overlying tissue. The template material is not implantable and should be discarded immediately following modification of the membrane.
» back to top
|
|
