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Year : 2013  |  Volume : 24  |  Issue : 2  |  Page : 278
Guided bone regeneration in the treatment of fenestration osseous defect

1 Department of Periodontics, Kanti Devi Dental College and Hospital, Mathura, Uttar Pradesh, India
2 Department of Orthodontics, Kanti Devi Dental College and Hospital, Mathura, Uttar Pradesh, India

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Date of Submission16-Jan-2011
Date of Decision21-Sep-2011
Date of Acceptance28-Dec-2011
Date of Web Publication20-Aug-2013


This article presents a case with a fenestration defect which was treated by placing a resorbable barrier alone. In the case presented, the osseous defect was a natural space maker with the wall of the defect providing sufficient support to prevent collapse of the membrane into the space. So the use of membrane alone is the preferred treatment. Resorbable collagen membrane was placed in order to avoid a second surgical procedure to remove the nonresorbable membrane. The membrane was positioned by placing a resorbable sling suture such that it covered the defective site adequately. Postsurgical healing of the defect was evaluated 1 month after the surgery and it was satisfactory. Thus guided bone regeneration of the fenestration defect is a reliable treatment procedure.

Keywords: Collagen, fenestration, guided bone regeneration, osseous defect

How to cite this article:
Mahesh H V, Ramya K S. Guided bone regeneration in the treatment of fenestration osseous defect. Indian J Dent Res 2013;24:278

How to cite this URL:
Mahesh H V, Ramya K S. Guided bone regeneration in the treatment of fenestration osseous defect. Indian J Dent Res [serial online] 2013 [cited 2023 May 29];24:278. Available from:
Guided bone regeneration (GBR) is a technique that based on the principle of guided tissue regeneration which is a surgical periodontal regenerative procedure. The procedure involves the placement of cell occlusive physical barrier membrane between the connective tissue and the alveolar bone defect to facilitate bone regeneration.

   Case Report Top

A 35-year-old female patient was referred to OPD, Department of Periodontics, Kanti Devi Dental College and Hospital Mathura with the chief complaint of swelling of gum and pus-like discharge from right upper back tooth region.

On intraoral examination, dental status was found normal. On further examination of periodontal status, a draining sinus was observed in relation to attached gingiva of 15 [Figure 1] and shallow periodontal pocket in relation to distal aspect of 15 and 16 was explored. During exploration of pocket it was observed that there was no direct physical connection between the pocket and sinus.
Figure 1: Sinus in relation to 15

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Hence to get a clear picture of underlying lesion, radiograph was taken after inserting gutta percha cone into the sinus until resistance met following which the radiograph revealed the presence of radioleucency in relation to mid-root segment or alveolar housing of 15 region and intrabony/vertical periodontal pocket distal to 15 to 16 [Figure 2].
Figure 2: Radiograph with gutta percha cone

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Later the case was discussed, investigated for medical fitness and planned to treat only the defect for study purpose. Under adequate local anesthesia, the sulcular incision with no 12 B.P. blade was placed in relation to 16, 15 and 14 region and a full-thickness mucoperiosteal flap raised until complete accessibility of the defect site gained. Following elevation of flap, initially the defect was covered with granulation tissue which was debrided to expose the overall defect site.

Following the complete debridement of granulation tissue the extent of defect was confined to mid-root of 15 labillay [Figure 3], extending up to mid-half of root volume toward palatally but not through and through and not involving marginal alveolar bone, indicating the osseous defect is fenestration. Knowing the defect type it was planned to place only the barrier to facilitate bone regeneration. The defect site was covered adequately with the collagen membrane, making sure the barrier was minimum 2 mm or more covering from the borders of defect [Figure 4]. The membrane was positioned with resorbable sling suture.
Figure 3: Following complete debridement - fenestration

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Figure 4: Placement and positioning of collagen membrane

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Surgical site was sutured [Figure 5] packed with periodontal dressing and following which patient was discharged with proper postoperative care, instructions and follow-up. In the follow-up at 4 th postoperative week it was observed clinically the healing was acceptable, healthy tissue was formed in relation to the sinus depicting the achievement of objective [Figure 6].
Figure 5: Sutures placement

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Figure 6: Clinical picture at 4th week postoperative

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   Discussion Top

In the present case the defect surgically exposed, debrided and treated under regenerative concept by placing only the cell occlusive physical barrier membrane between the alveolar bone defect and connective tissue to promote bone regeneration.

The placement of cell occlusive barrier membrane between connective tissue and bone creates a space into which native cells are allowed to form native tissue leading to true periodontal regeneration. Nyman et al. [1] experimented using mechanical barrier like Millipore filters in the treatment of fenestration showed significant regeneration of bone. The histological predictability of the GTR technique was demonstrated by Gotlow [2] by using Millipore filters and goretex membrane and by Magnusson et al. [3] using Millipore filters.

The use of barrier and augmentative (bone grafts) is depends on type of osseous defects. In large, noncontained, nonspace-making osseous defect there is insufficient support to prevent collapse of the barrier membrane into the defect thus occluding the space. In these instances bone augmentative/graft has been used to support the barrier membrane and to provide either a lattice network for osseoconduction or bone inductive proteins for osteoinduction.

In the present case the osseous defect was natural space making, which the wall of the defect provides sufficient support to prevent the collapse of the membrane into the space, so these of membrane alone is the treatment of choice. Resorbable collagen membrane was placed (to avoid second surgical entry to remove the barrier in case of nonresorbable) covering adequately the defect site and positioned by placing resorbable sling suture.

Following the barrier positioned and the flap placed back and sutured. On observation of the healing of defect site clinically at 4 th postoperative week the healing was acceptable depicting the achievement of objective.

In the present case, further surgical re-entry and radiological investigation is required to evaluate and to know the type of and quality of underlying bone regeneration that occurred.

   Conclusions Top

The result of GBR is based on multifactors such as patient, defect anatomy, presurgical, surgical and postsurgical factors. Attention must be paid on all above factors to achieve maximum results.

   References Top

1.Nyman S, Lindhe J, karring T, Rylander H. New attachment following surgical treatment of human periodontal diseas. J Clin Periodont 1982;9:290-6.  Back to cited text no. 1
2.Gottlow J, Nyman S, Karring T, Lindhe J. New attachment formation as the result of controlled tissue regeneration. J Clin Periodont 1984;11;494.  Back to cited text no. 2
3.Magnusson I, Nyman S, karring T, Egelberg J. Connective tissue attachment formation following exclusion of gingival connective tissue and epithelium during healing. J Periodont Res 1985;20:201-8.  Back to cited text no. 3

Correspondence Address:
H V Mahesh
Department of Periodontics, Kanti Devi Dental College and Hospital, Mathura, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-9290.116681

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  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]


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