Guided tissue regeneration in endodontic surgery by using a bioactive resorbable membrane

Guided tissue regeneration is a valuable technique available to the endodontist because the quality, quantity, or extent of bone loss cannot be visualized by the surgeon until the tissue is reflected and the surgical site is exposed.

After repeated attempts at nonsurgical treatment, a patient with a recurring sinus tract over the distobuccal root of an upper molar ultimately had the distobuccal root resected, leaving a 10 × 10 mm bony defect. This dehiscence was filled with freeze-dried bone and covered with a flexible and absorbable bioactive membrane that was new to endodontics.

Healing was uneventful, and bone regeneration was rapid and extensive as observed at the time of a second surgery just 5 months later. This can be attributed at least in part to the use of the bioactive membrane that contains an array of growth factors that enhance cell proliferation, inflammation, recruitment of progenitor cells, and metalloproteinase activity.

The use of the bioactive membrane in endodontic surgery should be considered to best restore the attachment apparatus to the tooth and prevent the downgrowth of a long junctional epithelium. The endodontist's attention must not be limited to the apical region alone.