Membranes

for Guided
Tissue and
Bone
Regeneration
Emine Elif Alaaddinoğlu
eminea@baskent.edu.tr
Periodontium
Periodontitis is
the inflammation of the
supporting structures
(periodontium) of the Cementum
teeth
Gingiva

Alvelar bone

Periodontal ligament
 standard

Outcomes of periodontal wound healing

Repair Healing of a wound by tissue that does not fully restore the architecture or the function of the
part. Within the periodontal wound, it refers to restoration of a normal gingival sulcus at the
same level as the base of the previous pathologic periodontal pocket. Often repair is typified
by the presence of a long junctional epithelium

Reattachment Refers to the reattachment of the gingiva to areas from which it was mechanically removed

New attachment Occurs when newly generated fibers are embedded in new cementum on a portion of the root
that was uncovered by disease
Regeneration Reproduction or reconstruction of a lost or injured part in such a way that the architecture and
ideal function of the lost or injured tissues are completely restored. This takes place by growing
precursor cells replacing lost tissue

Resorption Loss or blunting of some portion of a root, sometimes idiopathic, but also associated with
orthodontic tooth movement, inflammation, trauma, endocrine disorders, and neoplasia

Ankylosis Fusion of the tooth and the alveolar bone

Repair vs • To prevent down-growth of gingival epithelium a
membrane must be placed between the mucosa and
bone-root surface
Regenerasyon
Periodontitis
Mechanical treatment
Periodontitis
Before After
 Membrane

PDL

Bone

1. Exclusion of epithelium and

gingival connective tissue.
2. Barrier membrane maintain
space between the defect and
tooth.
3. Stabilize the clot

Root surface is repopulated with cells from the PDL,

cementum cells, and alveolar bone.
Guided bone
regeneration (GBR)
• Only bone regeneration
• biological rationale advocated the
mechanical exclusion of undesirable soft
tissues for growing into the osseous
defect, thereby allowing only osteogenic
cell populations derived from the parent
bone to repopulate the osseous wound
space (Dahlin et al. 1988; Hammerle et
al. 1995)
Classification of GTR
membranes
Types of Membranes
for GTR and GBR
Membranes

Non-
Resorbable
resorbable

Synthetic

Natural
Millipore laboratory filter
Ideal membrane
properties
• Biocompatibility: The interaction between membranes and
host tissue should not induce an adverse effect.
• Space maintenance: It should be able to maintain a space for
cells from surrounding bone tissue to migrate for a stable time
duration.
• Cell occlusiveness: It should prevent brous tissue that delays
bone formation from invading the defect site.
• Mechanical strength: It should possess proper physical
properties to allow and protect the healing process, including
protection of the underlying blood clot.
• Degradability: An adequate degradation time must match the
regeneration rate of bone tissue to avoid a secondary surgical
procedure to remove the membrane.
Non-resorbable membranes
e-PTFE membran designs
Titanium re-
inforced e-PTFE
• Titanium is shaped to create a space
between the membrane and the defect
• Even if it is exposed, the barrier
integrity will not compromise
d-PTFE membrane
(dense
polytetrafluoroethylene)
• <0.2μm
• Prevents bacterial adhesion
• not porous
• poor tissue integration
• Primary flap closure not required!
Titanyum mesh (ağ)
• can be exposed
• Microorganisms cannot adhere
• No barrier function, only support
• Fixation required
Resorbable
membranes
Synthetic resorbable membranes
 8-10 weeks to 6-7 months non-resorbable PGA
membrane for guided bone regeneration

Cross-sectional view: 3- Superficial appearance:

layer structure; 2 random
reticulate layers on the outer
surfaces and a cell
impermeable layer in the
middle.
the outer surface structure
gives flexibility to the
membrane.
Natural resorbable membranes
Cross-linking
Increasing naturally
occurring connections
between collagen
molecules (Gluteraldehyde,
Gamma, UV radiation)
Thrombocyte concentrates (PRP,
PRF)
Emdogain
The major constituents are amelogenins, which are
highly hydrophobic proteins that aggregate and serve
as a nidus for crystallization. Other proteins identified
include ameloblastin and enamelin. This protein
preparation uses propylene glycol alginate (PGA) as a
carrier.

EMD is absorbed
into the hydroxyapatite and collagen fibers of the root
surface, where it induces cementum formation followed
by periodontal regeneration.
Clinical Cases Utilizing
Barrier Membranes
Standard GBR procedures using
collagen barrier membranes
Extensive GBR procedures using titanium
and titanium-reinforced membranes
GBR using collagen barrier membranes
with simultaneous implant placement
Periodontal regeneration
utilizing GTR
Current Trends in the
Development of Membranes
• Improved antibacterial properties
• Growth factors
• Improved mechanical properties
• Surface modifications
Conclusion
Which of the following is a
Resorbable membrane
A. dPTFE
B. Nucleopore
C. Vicryl membrane
D. ePTFE
Grafts taken from a donor of
another species are:
A. Xenogenic grafts
B. Alloplastic grafts
C. Autogenous grafts
D. Allogenic grafts
Which is true about collagen
membrane except:
A. Hemostatic
B. Chemotaxis for fibroblasts
C. Rate of degradation can be controlled by varying its cross-linkage
D. Anticoagulant