Gingival recession defects and guided tissue regeneration: a review

The last decade has seen an increasing number of clinical reports on guided tissue regeneration (GTR) for reconstruction of gingival recession defects . This article reviews the value of GTR in the management of gingival reces sion defects based on records from such reports. Studies and case-series us ing nonresorbable and bioresorbable membranes, studies comparing GTR to the subepithelial connective tissue graft (CTG) procedure, and histologic repo rts of healing following GTR, published in the English language from 1985 t o 2000, were identified using a Medline search and were included in the dat a-base for this review. The following pre- and post-treatment data were col lated and evaluated for each of the reports: gingival recession depth, prob ing depth, clinical attachment and width of the keratinized gingiva. In per spective of the limitations of the level, studies reviewed, it has been sho wn that GTR may be used for reconstruction of gingival recession defects. I mportantly, it has not been shown that GTR provides an added clinical benef it for the patient treatment planned for reconstruction of gingival recessi on defects, i.e. GTR does not appear to offer a significant advantage over mucogingival procedures such as the connective tissue graft or the advanced flip procedure. It is imperative to recognize inherent technical difficult ies associated with GTR including primary wound closure and secondary membr ane exposure; membrane exposures being negatively correlated to desired cli nical outcomes. Also, membrane exposures appear consistently more common in smoker's than in non-smokers. It is also imperative to recognize shortcomi ngs and adverse effects including space maintenance and unacceptable foreig n body reactions associated with some bioresorbable GTR technologies.