Guided Tissue Regeneration to Save Teeth?

My 59-year-old friend is deciding whether to undergo guided tissue regeneration which her dentist has recommended. The dentist said that if she did not do it now, she might lose teeth in her 80’s. What is your take on this procedure?

– April 6, 2009

Guided tissue regeneration, also known as guided bone regeneration, is a dental procedure used to prevent loss of teeth by strengthening the bone that supports them. Weakening of that bone is the outcome of a long process that begins with formation of dental plaque, the colorless, sticky substance that is a mixture of bacteria, mucus, and minerals from food and saliva. If you don’t brush and floss regularly, plaque hardens into tartar that can’t be removed by brushing your teeth and favors the growth of bacteria that cause gum disease or gingivitis.

Gum disease begins as inflammation and swelling of the gums. You can reverse this with good dental hygiene and professional care, but untreated gingivitis can progress to periodontitis, inflammation of tissues around the teeth, with recession of gums leaving pockets that harbor bacteria. The immune system tries to fight the infection, but this inflammatory process can damage both soft tissue and bone that support the teeth.

Guided tissue regeneration is a surgical technique to replace damaged or destroyed tissue and bone. A small piece of mesh made of fabric is inserted between the damaged bone and gum to prevent the gum from growing into the area where bone should be. This encourages regrowth of bone and healthy connective tissue. (It is an alternative to an older procedure in which dentists lift back gums to remove tartar deposits from deep pockets and then suture them back in place.)

I checked with my own (holistic) dentist Steven A. Swidler, DDS about these procedures. He is very familiar with them, although he doesn’t perform either one himself. He recommended getting a second opinion from a periodontist, a dental specialist who diagnoses and treats gum diseases before consenting to such an invasive treatment.

If you’re considering guided bone or tissue regeneration, be sure to ask the dentist about his or her experience with the procedure and rates of success among patients.

Andrew Weil, M.D.

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