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Objective and Background: Guided bone regeneration (GBR) has proved to be a suitable and somehow predictable technique for promoting bone regeneration. A variety of synthetic and naturally derived GBR barriers have been used in clinics to facilitate bone regeneration. These barriers may differ in composition and structure and these may affect the outcomes of GBR. Therefore, the present study was undertaken to evaluate the in vitro ability of osteoblasts (MC3T3-E1) to attach to various GBR membranes., Materials and Methods: Six GBR/GTR (guided tissue regeneration) membranes [BioMend (BM), Resolut (RL), Guidor (GD), EpiGuide (EG), Gore-Tex (GT) and Millipore filter (MP)] were tested. For controls, cells were directly plated on culture dishes (CD). Each test membrane was secured to the bottom of a culture dish with a double-sided adhesive tape. All samples were triplicate. At 1.5 and 24 h after plating of 2 ml (5 x 10(4) cells/ml) of MC3T3-E1 (passage 7) cells, the specimens were rinsed with phosphate-buffered saline to wash out any unattached cells and then fixed with a 10% buffered formalin solution for 1 d. After washing with distilled water, the cells were stained with hematoxylin. The number of attached cells was counted under a light microscope equipped with an ocular-micrometer in a unit area of 0.25 mm(2) (five areas on each membrane). In addition, cell morphology attached to the membranes was evaluated under scanning electron microscope., Results: Data were presented as mean +/- standard error and analyzed for statistical difference using a generalized Wilcoxon's test. Cell attachment at 1.5 h was as follows: MP (27.5 +/- 2.1) > RL (17.0 +/- 1.4) approximately equals BM (14.5 +/- 1.4) approximately equals EG (11.4 +/- 1.0) > GD (5.2 +/- 0.8) approximately equals GT (3.1 +/- 0.6); and at 24 h was: MP (67.6 +/- 3.6) > RL (35.8 +/- 1.8) > BM (15.4 +/- 0.9) approximately equals EG (13.3 +/- 1.3) > GD (5.9 +/- 0.7) approximately equals GT (5.6 +/- 1.3). At 24 h, the scanning electron microscope finding revealed that cells attached on MP, RL, BM and EG were flatter in shape, like cells on CD, than cells on GD and GT, where cells were rather round., Conclusions: Results from this study suggested that MP, BM, RL and EG enhanced the early osteoblast attachment. However, the true benefit of this observation in clinic remains to be determined.

The purpose of this study was to evaluate the biological effects of guided tissue regeneration (GTR) membrane materials, per se, on the periodontal tissue regeneration. Rat periodontal ligament (PDL)-derived cells were used to study the attachment, proliferation and differentiation, in vitro, on various GTR membranes. Five commercially available membranes bovine type I collagen (BioMend; BM), bovine type I atelocollagen (Tissue Guide; TG), polylactic acid (Epi-Guide; EG), co-polymer of polylactic acid and polyglycolic acid (Resolute; RL) and expanded polytetrafluoroethylene: e-PTFE (Gore Tex; GT)-were examined. A 3 x 3 mm section of the membrane was fixed to the bottom of a 35 x 10 mm style culture dish and plated with 2 ml of cell suspension at an initial density of 5 x 10(4) cells/ml in culture medium with 10% fetal bovine serum. For cell growth analysis, the specimens were fixed with 10% buffered formalin and stained with hematoxylin at 1.5 hours and 1, 3 and 5 days after cell seeding. The number of cells included in a unit area of 0.25 mm2 were counted under light microscopy. As a comparative scaffold of cell proliferation, a plastic cover for cell culture slip (Celldesk; CD) was used. For analysis of cell differentiation, activity of alkaline phosphatase (ALP) and calcification were histochemically revealed after 2-week cultivation. The initial number of PDL cells attached to the membrane at 1.5 hours after cell seeding was different among membranes. RL, TG and EG had the same level of attached cell numbers as that on CD, while the cell numbers on GT and BM were significantly lower than that on CD (p < 0.01). The rate of cell proliferation with time also differed among the membranes examined. RL and BM demonstrated a significantly higher number of cells at 5 days than at 1.5 hours (p < 0.01). TG had increased numbers of cells at 3 and 5 days after cell seeding. However, there was no statistical difference between the cell numbers at 1.5 hours and 5 days after cell seeding (p > 0.1). EG had a similar number of cell attachments to that at 1.5 hours throughout the experimental period. There was almost no cell proliferation on GT. Cell clusters of ALP positive cells and foci of calcification were seen on all membranes except for GT, where a scant number of cells were seen. Results from this study implied that GTR membrane materials, per se, may influence cell proliferation and differentiation in the process of periodontal tissue regeneration.

To evaluate the biological effects of guided bone regeneration (GBR) barrier materials on osteoblastic cell migration, migration of mouse osteoprogenitor cells (MC3T3-E1) was examined, in vitro, on various membranes. Eight commercially available GBR membranes - bovine type I collagen (BioMend; BM), porcine type I collagen (BioGide; BG), bovine type I atelocollagen (Tissue Guide; TG), polylactic acid (Epi-Guide; EG), co-polymer of polylactic acid and polyglycolic acid (Resolute; RL, Resolut XT; RL-XT), expanded polytetrafluoroethylene (e-PTFE; Gore Tex; GT) and co-polymer of cellulose acetate and nitrocellulose (Millipore filter; MP) - were tested. A 3x5 mm section of the membrane was fixed to the bottom of a culture dish with double-sided adhesive tape, and half of the membrane was closely covered by PARAFILM (American National Can) to leave an unexposed area for cell migration. The border between exposed and unexposed areas was marked as a baseline of cell migration. Membranes were then plated with 3 ml of cell suspension at an initial density of 1x105 cells/ml in alpha-MEM culture medium with 10% fetal bovine serum and ascorbic acid. After a 5-hour incubation, non-attached cells were completely washed out with phosphate buffered saline and the PARAFILM cover was removed. After 3 days cultivation, specimens were fixed with 10% buffered formalin and stained briefly with hematoxylin. The area of cell migration on a membrane was analyzed using a LA 500 Image Analysis System and migration area per unit length of the baseline (mm2/mm) was compared among membranes. Results demonstrated that cell migration was greater in the order: RL>RL-XT, BM, TG, MP>EG, BG. Membranes except for BG, EG and GT showed the migration rate equal to or higher than a plastic culture cover slip (Celldesk) (P<0.01) on which cells generally grow favorably. Only a small number of the cells attached to GT, and the net cell migration for the membrane could not be determined. These results indicate that GBR barrier materials per se may influence the process of bone regeneration in vivo through the effects of their presence on cell migration.

When nonabsorbable membranes are used for guided bone regeneration (GBR), second surgeries are required for membrane retrieval. In addition, these types of membranes show a high incidence of flap sloughing and membrane exposure that often lead to infection and unfavorable results. Absorbable barriers such as collagen membranes were developed to overcome these drawbacks. This article presents the principles and the clinical procedure of using barrier membranes composed of absorbable collagen in GBR aimed at the repair and regeneration of ridge dehiscence defects around implants. The unique properties of collagen membranes that make them ideally suited to GBR procedures are reviewed. In addition, the indications and contraindications for using collagen membranes for GBR procedures are examined. Finally, cases are presented to demonstrate details of surgical principles and techniques.

Collagen materials have been utilized in medicine and dentistry because of their proven biocompatability and capability of promoting wound healing. For guided tissue regeneration (GTR) procedures, collagen membranes have been shown to be comparable to non-absorbable membranes with regard to probing depth reduction, clinical attachment gain, and percent of bone fill. Although these membranes are absorbable, collagen membranes have been demonstrated to prevent epithelial down-growth along the root surfaces during the early phase of wound healing. The use of grafting material in combination with collagen membranes seems to improve clinical outcomes for furcation, but not intrabony, defects when compared to the use of membranes alone. Recently, collagen materials have also been applied in guided bone regeneration (GBR) and root coverage procedures with comparable success rates to non-absorbable expanded polytetrafluoroethylene (ePTFE) membranes and conventional subepithelial connective tissue grafts, respectively. Long-term clinical trials are still needed to further evaluate the benefits of collagen membranes in periodontal and peri-implant defects. This article will review the rationale for each indication and its related literature, both in vitro and in vivo studies. The properties that make collagen membranes attractive for use in regenerative therapy will be addressed. In addition, varieties of cross-linking techniques utilized to retard the degradation rate of collagen membranes will be discussed.

This article reviews the role of barrier membranes in guided tissue regeneration (GTR) and guided bone regeneration (GBR), including the advantages of using absorbable barrier membranes in GTR and GBR and the unique properties of collagen membranes. The indications and contraindications for using collagen membranes for these procedures are examined, and successful cases are presented. Finally, the role of collagen membranes in the future of regenerative therapy is considered.

This study evaluated whether differences in design of 3-dimensional polylactic acid barriers (EPi-Guide and Guidor) would influence hard tissue results in the treatment of Grade II furcations in humans. A multicenter study was conducted, using 40 patients with moderate to advanced bilateral chronic adult periodontitis of the mandibular first or second molars. After flap access, debridement, and root preparation, surgical bone level measurements were taken and membranes were placed on a random basis. Surgical reentry occurred at 1 year. Data collected from all 3 investigative centers were pooled and analyzed using an analysis of variance appropriate for a counterbalancing design. Both barrier materials resulted in significant gains of attachment level and defect reduction. The composite reduction in the vertical component of the osseous defects was greater in the sites treated with Epi-Guide as compared to those treated with Guidor; the difference between barriers reached statistical significance (P = 0.02).

This study evaluated two bioresorbable polylactic acid barriers (Epi-Guide and Guidor) to determine if design differences were of therapeutic significance in the treatment of Grade II furcation defects in humans. Forty patients with bilaterally matched, Grade II furcation defects in maxillary or mandibular first or second molars were treated in a multicenter study. Comprehensive initial periodontal therapy, followed by defect debridement and root preparation, preceded randomized membrane placement. Data collected from all three investigative centers were pooled and analyzed using an analysis of variance appropriate for a counterbalancing design. Both barrier types produced measurable improvements of clinical probing values. Barrier exposure scores taken through the eighth week postoperative revealed that Epi-Guide was less likely to become exposed than Guidor. The findings of this study, which was conducted over a 12-month period, demonstrated that Epi-Guide and Guidor were comparable as measured by clinical probing determinations.

Over the past 15 years, techniques aimed at regeneration of lost periodontal tissue have become widely used and accepted in clinical practice. Among these techniques are those which use the principles of guided tissue regeneration (GTR), wherein barriers (i.e., membranes) are used to control cell and tissue repopulation of the periodontal wound. A variety of non-absorbable and absorbable barriers have been developed and used for this purpose, with a trend in recent years toward increased use of absorbable GTR materials. This article describes the evolution of absorbable barrier materials and overview materials available for clinical use today. In addition, advantages and disadvantages of these materials are discussed, as well as possible new developments in barrier-based GTR therapy.

The use of guided tissue regeneration (GTR) procedures in the treatment of gingival recession has shown promising results and is gaining clinical acceptance. The purpose of this study was to assess the use of a bioabsorbable collagen membrane as a barrier device in root coverage treatment of gingival recession defects. The study consisted of 10 patients with 10 defects of either Miller Class I or II description and gingival recession > or =2.5 mm. Clinical measurements taken at baseline included plaque index (PI) and gingival index (GI), clinical attachment level (CAL) measured with an automated probe and reference stent, recession depth (RD; mean = 3.19 +/- 0.26 mm), recession width (RW; 3.95 +/- 0.41 mm), probing depth (PD; 2.3 +/- 0.2 mm), and width of keratinized tissue (KT; 2.4 +/- 0.3 mm); measurements were repeated at 1, 2, and 4 weeks and 3 and 6 months post-treatment. During the surgical procedure, a mucoperiosteal flap was elevated and the respective root thoroughly planed. The collagen membrane was cut to cover the defect and surrounding bone, positioned over the root, and secured with 5-0 gut interdental sutures. The flap was coronally positioned to cover the membrane and sutured with 5-0 silk. Data were analyzed using the Student paired t-test to compare pre- and postsurgery measurements. The nonparametric Wilcoxon matched pairs test was used to analyze the significance of PI and GI at different time intervals. A statistically significant (P < 0.01) reduction in RD (-1.66 +/- 0.25 mm) was observed at 6 months, representing 51.6% total attainable root coverage. Clinically, a statistically significant mean gain of 1.34 +/- 0.47 mm CAL and 0.90 +/- 0.32 mm KT was observed at 6 months. No statistical differences were found in PD and RW between baseline and 6 months postoperatively. PI and GI remained low and showed no statistically significant change (P < 0.05) throughout the study period. Results from this study suggest that a collagen membrane can be used successfully as a barrier device in GTR-based root coverage procedures.

The purpose of this study was to determine the effect of use of an absorbable collagen membrane in guided tissue regeneration (GTR) therapy upon the subgingival microflora. The study group consisted of 12 systemically healthy patients with bilateral mandibular furcation defects with attachment loss > or = 6 mm; one site was randomly assigned for GTR treatment while the contralateral site received surgical flap debridement only. Subgingival plaque samples were collected by paper point on the day of surgery and at 2, 4 and 6 months post-surgery. Three sites were sampled in each patient: a collagen membrane site, a control surgical site, and an unoperated control site. Plaque samples were transported in a non-phosphated buffer solution and examined by phase-contrast microscopy. Cocci, rods, spirochetes, fusiforms, curved rods, and total bacteria were recorded per 10 high-power fields. Following statistical analysis utilizing the Bonferroni (Dunn) t test, no differences in total bacterial counts were found among the sites at any of the time intervals examined. Total bacterial counts were found lower at both the collagen membrane and control surgical sites post-surgery as compared to unoperated control sites, but these differences were not statistically significant (P > .05). In addition, no significant differences were detected in bacterial profiles between sites or individual time points. Results from this 6-month limited clinical trial suggest that the placement of an absorbable collagen membrane as part of a standard surgical regimen for GTR therapy does not alter the local microflora.

Microbial colonization of barrier materials used in guided tissue regeneration (GTR) is known to adversely affect treatment outcomes. The purpose of this study was to compare the rate at which 11 commonly-occurring oral bacteria species colonize three different barrier materials (collagen, expanded polytetrafluoroethylene, and polylactic acid). The study group consisted of 10 systemically healthy individuals with no history of periodontal disease and absence of antimicrobial therapy within the previous 3 months. In each patient, 4 teeth per quadrant (P1, P2, M1, M2) were selected and 3 teeth were randomly assigned as test teeth while the remaining tooth acted as a control site (i.e., natural colonization of the tooth surface). These teeth were then randomly assigned to receive one of the three barrier types (i.e., each patient received 4 barriers of each type, 1 per quadrant). A 2 x 5 mm piece of barrier material was positioned over the oral surface of the buccal marginal gingiva and secured with an external sling suture. With oral hygiene procedures suspended, one barrier of each type was collected at 1, 3, 7, and 14 days. Slot immunoblot assay demonstrated that all species types (A. actinomycetemcomitans, A. viscosus, B. melaninogenicus, F. nucleatum, P. gingivalis, P. intermedia, S. mutans, S. sanguis, Selenomonas sputigena, T. denticola, and T. vincentii) were present. Semi-quantitative scoring (scale 0 to 3) of slot blot results and analysis by chi-square ratio and Pearson correlation test indicated that while total bacteria adherence increased over time (P < 0.05), the 3 barrier types and the control sites did not differ in numbers or species of colonizing bacteria detected per time point. These results suggest that under these experimental conditions the barrier materials tested do not differ in bacteria adherence or antimicrobial properties.

Predictable coverage of exposed root surfaces and the corresponding treatment of gingival recession defects remain important objectives of periodontal therapy. A variety of techniques have been developed during the past several decades to address this common clinical challenge. Traditional surgical approaches have been relatively successful in achieving root coverage. Attempts have been made recently to achieve root coverage with surgical techniques based on the principles of guided tissue regeneration, using resorbable and nonresorbable materials. The learning objective of this article is to present case documentations of root coverage, using a resorbable collagen barrier. The results achieved illustrate the potential of this material in the treatment of gingival recession. The biologic properties of collagen as a barrier material, the surgical approach, and the principles of case selection are reviewed.

The aim of this study was to compare the clinical regenerative capacity of collagen membrane with and without demineralized freeze-dried bone allografts (DFDBA) in treating periodontal intrabony defects. Ten systemically healthy patients with similar bilateral periodontal defects were scheduled for surgery. Each patient had at least > or = 6 mm clinical probing depth and loss of attachment at selected sites. Baseline measurements included gingival index (GI), plaque index (PI), gingival recession (GR), clinical attachment level (CAL), probing depth (PD), and mobility. At the time of surgery, the defects were randomly assigned to either test (collagen membrane plus DFDBA) or control group (collagen membrane only). Stent to base of the defects, stent to crest bone, crest of bone to base of the defect, and width of the defects were recorded at the time of surgery and reentry. Eight patients returned after 6 months for reentry surgery. Statistical analysis with a paired t test was used to evaluate the treatment effect and comparison between test and control groups. In addition, a McNemar test was used to analyze the significance of GI, PI, and mobility at different times. The result of this study indicated that both the collagen plus DFDBA and the collagen alone treatment groups had a significant decrease of PD (3.4 +/- 0.4 and 3.2 +/- 0.4 mm), gain of CAL (2.3 +/- 0.5 and 2.0 +/- 0.4 mm), and defect fill (1.7 +/- 0.3 and 1.9 +/- 0.9 mm) (P < 0.05) when compared to the presurgery status. However, there was no significant difference in PD, AL, GR, defect fill, crestal bone resorption, GI, PI, or mobility between the test group and control group. No adverse tissue reaction, infection, or delayed wound healing was noted throughout the treatment in either group. This study suggests that the collagen membrane is well tolerated by the human tissues. Both treatments, either collagen membrane plus DFDBA or collagen membrane alone, promoted significant resolution of periodontal intrabony defects. The addition of a bone graft (DFDBA) with a collagen membrane appears to add no extra benefit to the collagen membrane treatment.

Barrier membranes composed of resorbable collagen have demonstrated potential for use in guided tissue regeneration (GTR) procedures for repair and regeneration of periodontal defects. This article reviews the rationale for use of a collagen membrane in GTR therapy and related clinical procedures. Characteristics of the material are outlined, and indications and contraindications for utilization are discussed. Two cases are presented to demonstrate details of these principles and techniques. The learning objective of this article is to familiarize the reader with a new absorbable collagen membrane and its application in the periodontal area.

Microorganisms can adhere and colonize on an exposed guided tissue regeneration (GTR) membrane thus developing a nidus of infection. The purpose of this study was to compare early bacterial adhesion to three different GTR membranes. Expanded polytetrafluoroethylene, polyglactin 910, and collagen were used as the test membranes. In part I of this study 15 different oral microbes were used to compare their relative ability to adhere to the membranes. Six of the most strongly adherent bacteria (Actinomyces viscosus, Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Streptococcus mutans, Fusobacterium nucleatum, and Selenomonas sputigena) were selected for part II of this study. The membranes were placed in tubes containing broth cultures containing identical concentrations (1 x 10(8) cells/ml) of these bacteria at 37 degrees C. Membranes were placed in tubes of media without bacteria as controls. At 4, 6, 12, and 24 hours, the bacterial cultures were decanted and the membranes in the tubes were agitated gently in reduced transfer fluid (RTF) 4 times to remove non-adherent bacteria. Each tube was then sonicated for 30 seconds in 10 ml RTF to detach adherent bacteria. The detached adherent bacteria were counted using a Petroff-Hausser chamber. Data were analyzed by using the SAS program. Analysis of variance was used to test for differences between multiple means. Results showed S. mutans had the strongest attachment to the collagen membrane at 4 and 6 hours. Selenomonas sputigena had the lowest adherence capability to all test membranes. Polyglactin 910 had significantly (P < 0.05) lower S. mutants adherence than either the ePTFE or the collagen membrane at 4 and 6 hours.(ABSTRACT TRUNCATED AT 250 WORDS)