Periodontal repair in dogs: Gingival tissue occlusion, a critical requirement for GTR?

Ulf M E Wikesjö, Won Hee Lim, Robert C. Thomson, W. Ross Hardwick

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Background: Design criteria for guided tissue regeneration (GTR) devices include biocompatibility, cell occlusion, space maintenance, tissue integration, and ease of use. Previous studies have established the importance of wound stabilization and space provision during the early healing sequel for successful GTR outcomes as well as evaluated biocompatibility, tissue integration, and clinical manageability of various biomaterials. The importance of cell or tissue occlusion has yet to be established. The objective of this study was to evaluate the role of tissue occlusion as a critical determinant for GTR outcomes. Methods: Routine, critical size, 5-6 mm, supra-alveolar, periodontal defects were created around the mandibular premolar teeth in six young adult Beagle dogs. Space-providing expanded polytetrafluoroethylene (ePTFE) membranes, with (macroporous) or without (occlusive) 300-μm laser-drilled pores, 0.8 mm apart, were implanted to provide for GTR. Treatments were randomly assigned to left and right jaw quadrants in subsequent animals. The gingival flaps were advanced to cover the membranes and sutured. The animals were euthanized at 8 weeks postsurgery for histologic and histometric analysis. Results: Three animals experienced wound failure within 2-3 weeks postsurgery resulting in exposure and removal of the occlusive ePTFE membranes. All defect sites, irrespective of membrane configuration or history of membrane exposure and removal, exhibited substantial evidence of periodontal regeneration including a functionally oriented periodontal ligament. To evaluate the biologic potential of GTR devices, only animals without wound failure and membrane removal were included. Alveolar bone regeneration for animals receiving occlusive and macroporous ePTFE membranes averaged (±SD) 3.2±1.1 versus 2.0±0.4mm (p = 0.3113). Cementum regeneration was enhanced in defect sites receiving the occlusive ePTFE membrane compared to the macroporous membrane (4.7±0.4 versus 2.3±0.2 mm; p = 0.0167). Ankylosis was observed in one animal. Limited root resorption was observed in a second animal. Conclusion: Tissue occlusion does not appear to be a critical determinant for GTR. However, tissue occlusion may be a requirement for optimal GTR. Moreover, macroporous space-providing devices may increase the predictability of clinical GTR therapy.

Original languageEnglish (US)
Pages (from-to)655-664
Number of pages10
JournalJournal of Clinical Periodontology
Volume30
Issue number7
DOIs
StatePublished - Jul 1 2003

Fingerprint

Guided Tissue Regeneration
Dogs
Membranes
Polytetrafluoroethylene
Equipment and Supplies
Regeneration
Orthodontic Space Maintenance
Wounds and Injuries
Root Resorption
Dental Cementum
Ankylosis
Periodontal Ligament
Bone Regeneration
Bicuspid
Biocompatible Materials
Cell- and Tissue-Based Therapy
Jaw
Young Adult
Tooth
Lasers

Keywords

  • Periodontal regeneration
  • Tissue engineering
  • Wound dehiscance
  • Wound healing

ASJC Scopus subject areas

  • Periodontics

Cite this

Periodontal repair in dogs : Gingival tissue occlusion, a critical requirement for GTR? / Wikesjö, Ulf M E; Lim, Won Hee; Thomson, Robert C.; Hardwick, W. Ross.

In: Journal of Clinical Periodontology, Vol. 30, No. 7, 01.07.2003, p. 655-664.

Research output: Contribution to journalArticle

Wikesjö, Ulf M E ; Lim, Won Hee ; Thomson, Robert C. ; Hardwick, W. Ross. / Periodontal repair in dogs : Gingival tissue occlusion, a critical requirement for GTR?. In: Journal of Clinical Periodontology. 2003 ; Vol. 30, No. 7. pp. 655-664.
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abstract = "Background: Design criteria for guided tissue regeneration (GTR) devices include biocompatibility, cell occlusion, space maintenance, tissue integration, and ease of use. Previous studies have established the importance of wound stabilization and space provision during the early healing sequel for successful GTR outcomes as well as evaluated biocompatibility, tissue integration, and clinical manageability of various biomaterials. The importance of cell or tissue occlusion has yet to be established. The objective of this study was to evaluate the role of tissue occlusion as a critical determinant for GTR outcomes. Methods: Routine, critical size, 5-6 mm, supra-alveolar, periodontal defects were created around the mandibular premolar teeth in six young adult Beagle dogs. Space-providing expanded polytetrafluoroethylene (ePTFE) membranes, with (macroporous) or without (occlusive) 300-μm laser-drilled pores, 0.8 mm apart, were implanted to provide for GTR. Treatments were randomly assigned to left and right jaw quadrants in subsequent animals. The gingival flaps were advanced to cover the membranes and sutured. The animals were euthanized at 8 weeks postsurgery for histologic and histometric analysis. Results: Three animals experienced wound failure within 2-3 weeks postsurgery resulting in exposure and removal of the occlusive ePTFE membranes. All defect sites, irrespective of membrane configuration or history of membrane exposure and removal, exhibited substantial evidence of periodontal regeneration including a functionally oriented periodontal ligament. To evaluate the biologic potential of GTR devices, only animals without wound failure and membrane removal were included. Alveolar bone regeneration for animals receiving occlusive and macroporous ePTFE membranes averaged (±SD) 3.2±1.1 versus 2.0±0.4mm (p = 0.3113). Cementum regeneration was enhanced in defect sites receiving the occlusive ePTFE membrane compared to the macroporous membrane (4.7±0.4 versus 2.3±0.2 mm; p = 0.0167). Ankylosis was observed in one animal. Limited root resorption was observed in a second animal. Conclusion: Tissue occlusion does not appear to be a critical determinant for GTR. However, tissue occlusion may be a requirement for optimal GTR. Moreover, macroporous space-providing devices may increase the predictability of clinical GTR therapy.",
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AU - Wikesjö, Ulf M E

AU - Lim, Won Hee

AU - Thomson, Robert C.

AU - Hardwick, W. Ross

PY - 2003/7/1

Y1 - 2003/7/1

N2 - Background: Design criteria for guided tissue regeneration (GTR) devices include biocompatibility, cell occlusion, space maintenance, tissue integration, and ease of use. Previous studies have established the importance of wound stabilization and space provision during the early healing sequel for successful GTR outcomes as well as evaluated biocompatibility, tissue integration, and clinical manageability of various biomaterials. The importance of cell or tissue occlusion has yet to be established. The objective of this study was to evaluate the role of tissue occlusion as a critical determinant for GTR outcomes. Methods: Routine, critical size, 5-6 mm, supra-alveolar, periodontal defects were created around the mandibular premolar teeth in six young adult Beagle dogs. Space-providing expanded polytetrafluoroethylene (ePTFE) membranes, with (macroporous) or without (occlusive) 300-μm laser-drilled pores, 0.8 mm apart, were implanted to provide for GTR. Treatments were randomly assigned to left and right jaw quadrants in subsequent animals. The gingival flaps were advanced to cover the membranes and sutured. The animals were euthanized at 8 weeks postsurgery for histologic and histometric analysis. Results: Three animals experienced wound failure within 2-3 weeks postsurgery resulting in exposure and removal of the occlusive ePTFE membranes. All defect sites, irrespective of membrane configuration or history of membrane exposure and removal, exhibited substantial evidence of periodontal regeneration including a functionally oriented periodontal ligament. To evaluate the biologic potential of GTR devices, only animals without wound failure and membrane removal were included. Alveolar bone regeneration for animals receiving occlusive and macroporous ePTFE membranes averaged (±SD) 3.2±1.1 versus 2.0±0.4mm (p = 0.3113). Cementum regeneration was enhanced in defect sites receiving the occlusive ePTFE membrane compared to the macroporous membrane (4.7±0.4 versus 2.3±0.2 mm; p = 0.0167). Ankylosis was observed in one animal. Limited root resorption was observed in a second animal. Conclusion: Tissue occlusion does not appear to be a critical determinant for GTR. However, tissue occlusion may be a requirement for optimal GTR. Moreover, macroporous space-providing devices may increase the predictability of clinical GTR therapy.

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KW - Tissue engineering

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