Guided Tissue Regeneration


The goal of regenerative surgery is to create an environment where the body rebuilds structures lost due to the disease process that attach a tooth to the jaw, including the bone. This therapy is recommended when the pattern of bone loss is more vertical in nature, creating deep crevices within the bone surrounding teeth. After administering anesthetic, the periodontist pushes back the gums from the affected tooth and thoroughly cleans the pocket out. Next, instead of smoothing out the defects in the diseased bone, the defects (or holes) are filled with a graft material and then covered with a membrane (like a fancy band-aid). The gums are then re-positioned over the affected site and sutured. Over the next six months to one year, your body will fill in the periodontal defect with new bone and gum tissue, effectively increasing the support for that tooth and improving its lifespan. Typically antibiotics are prescribed for this treatment and over-the-counter pain medication is sufficient for any post-operative discomfort.

GTR pic 1

Case Study 1

This case is of 14 year-old female patient with localized aggressive periodontitis, a rapidly destructive form of periodontitis that causes severe bone loss around the front teeth (incisors) and first molars. See initial photographs, radiographs (“x-rays”), and measurements taken at this patient’s first appointment with Dr. Weiner. Also notice how just looking at the patients gums, you may not guess that disease is present.

Areas of severe bone loss


Dr Weiner determined that the patient needed regenerative therapy on all four of her first molars to treat the severe bony defects. After all surgeries were completed, this patient was seen every 3 months for periodontal maintenance therapy and after 1.5 years, it was determined her gums and bone were healthy enough to allow her to get braces!

Radiographs (“x-rays”) taken before and 1.5 years after bone grafting

(A)  Upper right first molar – pocket depth reduced 10 mm from to 5 mm


(B)  Upper left first molar – pocket depth reduced from 10 mm to 5 mm


(C)  Lower left first molar – pocket depth reduced from 10 mm to 5 mm


(D)  Lower right first molar – pocket depth reduced from 9 mm to 5 mm



Case Study 2

41 year-old male referred to Dr. Weiner for evaluation and treatment of residual deep pockets; scaling and root planing was previously completed. Below is the patient’s first visit to Dr. Weiner – although guided tissue regeneration was completed in multiple areas throughout the patient’s mouth we will focus on the lower right molar region. Note the severe bone loss and deep pockets on the first and second molar.



Guided tissue regeneration was performed on the front side of the lower right first molar and back of the second molar.
Radiographs (”x-ray”) were taken 6 months post grafting. (Note the red lines and circles indicating bone levels and pocket depths prior to grafting versus the purple lines and circles showing areas where bone and tissue was regrown back to a level consistent with health). At this point, the patient was placed on 3 month periodontal maintenance.


            Prior to grafting                                         6 months post grafting

Radiographs, photos, and measurements taken 1.5 years post grafting illustrates stability of the graft and achievement of healthy bone and gums in this region. All pockets were less than 5 mm deep with no bleeding spots.