Guided tissue regeneration in severe periodontal defects in anterior teeth. Case reports
Investigators reported on four consecutive, chronic, severe periodontal bone defects in anterior teeth that were treated by GTR using a polytetrafluoroethylene periodontal membrane. The membrane was coated by butyl-cyanoacrylate (BCA), which caused rigidity to the membrane and preserved space between the root surface and the membrane. No controls were used in the cases.
Case 1: A 12-year-old girl presented with extreme mobility and progressive extrusion of the upper central incisors. Initial orthodontic treatment and subsequent orthodontic treatment had facilitated a horizontal defect presenting at the level of the facial aspect of both incisors. A non-resorbable membrane painted with BCA, preserving the membrane convexity and space underneath, was secured. The flap was replaced, and four weeks later the membrane was removed, revealing hard tissue that nearly covered the previously exposed root surfaces.Case 2: A 46-year-old woman presented with advanced periodontitis. After comprehensive periodontal treatment, which included scaling and root planing and oral hygiene instructions, an active lesion at the level of tooth #23 persisted. The tooth had been treated for endo-pulpal involvement earlier. A membrane was placed and coated with BCA. At uncovering four weeks later, new tissue was observed filling most of the area previously without bone.
Case 3: A 48-year-old woman was treated for advanced periodontal disease. Tooth #11 continued to harbor a 10 mm pocket. Flap surgery using GTR was necessary. Two membranes were required because of the large size of the defect. The membranes were treated with the BCA agent to provide membrane rigidity. At four weeks the membranes were removed and hard tissue was noted covering most of the previously denuded area.
Case 4: A 35-year-old man was treated for rapidly progressive periodontitis. Treatment included episodes of scaling and root planing, periodontal surgery at two localized areas, and three-month SPT recalls. Nevertheless, deep pockets persisted in tooth #6, which served as an abutment for a bridge. GTR was utilized using a non-resorbable membrane coated with BCA. The membrane was retrieved four weeks later showing new, hard tissue covering part of the previously exposed root surface as well as interproximal spaces. Six months later a new bridge was placed. [D.S.S.]
Echeverria, J., and C. Manzanares, J Periodont, 66:295, 1995