Guided tissue regeneration
Guided tissue regeneration describes procedures attempting to regenerate periodontal attachment. Barrier membranes are placed
over the cleaned pockets in the hope of excluding an ingrowth of epithelium corium from the root in the belief that it interferes
with regeneration of meaningful attachment.
General technique for placing bone grafts
1. If chlorhexidine is used as an irrigant during surgery, rinse it off thoroughly with lactated Ringer's solution since chlorhexidine
can devitalize periodontal ligament cells and interfere with attachment.
2. Create an access flap with interdental and sulcular incisions. Plane the root smooth with a curette, and remove excess
3. Add four to six drops of the patient's blood, sterile water or saline solution to 0.5 ml of the graft material in a dappen
4. Mix the liquid and particulate in the dappen dish with a spatula for 10 seconds to achieve the consistency of firm wet
sand, and apply it into the defect area. Alternatively, carry the granules to the defect and mix them with the patient's blood.
5. Suture the access flap without tension.
Postoperative care includes pain control and antimicrobial medication. The patient is fed a soft diet for several days. Gentle
brushing can begin one week after surgery. Reexamine the surgical site every two weeks until clinical healing is confirmed,
and obtain radiographs of the area in four months.
Technique for palatal periodontal pockets
Palatal pocket therapy is indicated in cases in which > 25 percent attachment loss is present on the palatal aspect of one
or both maxillary canine teeth and the periodontal probe does not yet enter the nasal cavity. When deep pockets are diagnosed
(Photo 2), pocket therapy should be performed or the tooth should be extracted and the defect closed. If left untreated, the
pocket might progress until it penetrates the nasal cavity, creating an oronasal fistula.
Photo 2: A 10-mm intrabony palatal defect measured with a periodontal probe.
1. Make 2- to 4-mm mesial and distal incisions to the bone at 20 degree angles palatally from the affected tooth (Photo 3).
2. Use a Molt or Freer periosteal elevator to gently raise a full-thickness flap.
3. Use a thin curette to clean accessible granulation tissue, calculus and plaque between the root and alveolus.
4. Carry bone-grafting particles into the cleaned defect (Photo 4).
Photo 5: Surgical closure of the palatal periodontal pocket defect site.
Photo 4: Placement of alloplast synthetic graft material (Consil—Nutramax).
Photo 3: Flap exposure of the cleaned palatal periodontal pocket defect.
5. Oppose the flap snugly against the tooth with 4-0 absorbable suture on an atraumatic needle (Photo 5).