Guided Tissue RegenerationRebuilding support around natural teeth

When gum disease has eaten a pocket of bone down beside a tooth, guided tissue regeneration (GTR) aims to grow back the bone and the ligament that hold the tooth, rather than simply cleaning the defect and accepting the loss.

What GTR Does

After gum disease is treated, the gum normally heals faster than bone and fills a bone defect with soft tissue. GTR places a barrier, a membrane, over the defect to keep the fast-growing gum out, giving the slower cells that form bone, ligament and root attachment time to fill the space instead. A bone graft is usually placed in the defect first, and growth factors may be applied to the root.

GTR is used for teeth that have lost support to gum disease. For rebuilding bone where a tooth is missing, before an implant, the related procedure is Guided bone regeneration.

Which Defects Respond

GTR works best on vertical defects: narrow, deep pockets of bone loss beside a tooth with bone walls still standing around them, and on some furcation defects, where bone is lost between the roots of a back tooth. The more walls the defect has, the better it holds the graft and the more predictable the result.

It does not rebuild bone that has been lost evenly across several teeth (horizontal bone loss). Where that is the pattern, treatment focuses on controlling the disease and protecting what remains.

The Procedure

Under local anesthetic, the gum is opened to reach the defect. Infected tissue and deposits are removed and the root surface is cleaned and conditioned. The defect is filled with bone graft material, a growth factor may be applied, and a membrane is placed over it before the gum is closed with sutures.

Membranes: resorbable collagen, which dissolves on its own, or non-resorbable, which is removed later
Graft materials: donor bone, processed animal-derived bone, or synthetic material, sometimes bound with PRF as sticky bone
Growth factors: Emdogain® (enamel matrix derivative) or recombinant PDGF (GEM 21S®), applied to the root to encourage new attachment (see growth factors)

GTR and LANAP

Some patients are candidates for LANAP laser gum treatment, a laser protocol that treats gum disease and has FDA clearance for periodontal regeneration without opening the gum. Others have defects better suited to a membrane and graft. Some benefit from both in different parts of the mouth. Dr. Samadian performs both and decides tooth by tooth from your measurements and X-rays.

Healing and Results

The gum heals within a few weeks; the bone fills in over several months and is checked with X-rays. Results depend heavily on keeping the area clean, on regular gum maintenance visits, and on not smoking. A successful result can turn a tooth that was heading for extraction into one that is stable for many years, but no regenerative procedure is guaranteed to work.

Risks

Swelling, discomfort and bruising for several days; infection; exposure of the membrane through the gum, which can reduce the result or require early removal; some gum shrinkage as the area heals, making teeth look slightly longer; temporary sensitivity; and partial or no regeneration, in which case the tooth may still be lost. These are covered in writing before treatment.

Related Treatments

Guided Tissue Regeneration FAQ

What is guided tissue regeneration in dentistry?

It is a gum surgery that rebuilds bone and attachment lost to gum disease around a natural tooth. A bone graft is placed in the defect and a membrane keeps the gum out of it, so bone and ligament can grow back into the space.

What is the difference between GTR and GBR?

GTR regenerates the support around a natural tooth: bone, ligament and root attachment. GBR (guided bone regeneration) builds bone where a tooth is missing, usually to make room for an implant. Both use membranes and bone grafts.

Can lost bone around teeth really grow back?

In the right kind of defect, yes. Narrow, deep defects with bone walls around them respond best. Bone lost evenly across many teeth does not grow back predictably, and treatment there focuses on stopping further loss.

Is GTR painful?

It is done under local anesthetic. Afterwards, expect several days of soreness and swelling, managed with the medication prescribed for you.

How long does healing take?

The gum heals in a few weeks. The bone takes several months to mature and is checked on X-rays at follow-up visits.

Will insurance cover guided tissue regeneration?

Many dental plans cover part of periodontal surgery, including graft and membrane procedures, when gum disease is documented. The team verifies your benefits and gives you a written estimate first.

Treating patients throughout San Francisco. Dr. Samadian specializes in treatments such as smile makeovers, porcelain veneers, digital reconstructions, aesthetic dentistry, and dental implants. Focusing on regeneration and restoring tooth structure, bone loss, and gum recession utilizing the latest LANAP laser technology.