1 Marginal incisions at both the buccal and

1 –Marginal incisions at both the buccal and lingual aspect of the jaw, followed by releasing incisions. The releasing incisions must be placed a minimum of one tooth anterior and/or posterior to the tooth that is being treated. Care should be taken during this procedure to preserve the interdental papillae. 1

2 – All pocket epithelium is excised so that a fresh connective tissue is left on the full thickness flaps following reflection. All granulation tissue is removed and thorough debridement of the detached root surfaces is carried out using curettes, burs, etc. 2

4 – The interproximal space near the barrier should be closed first. In order to achieve good closure, a vertical mattress suturing technique is advocated. 3

5 – Removal of the barrier material by a minor surgical procedure. 4

Types of GTR barrier materials 1 – Non absorbable. A - Cellulose acetate (Millipore®). B - Poly. Tetra. Fluoro. Ethylene (PTFE). 5

2 - Natural or synthetic bioabsorbable materials A - collagen and polylactic acid B - copolymers of polylactic acid and polyglycolic acid 6

An ideal material for GTR technique should have the following characteristics: 1. It is important that the material is biocompatible. The material should not elicit an immune response, sensitization or chronic inflammation which may interfere with healing and present a hazard to the patient. 7

2. The material should act as a barrier to exclude undesirable cell types from entering the secluded space adjacent to the root surface. It is also considered an advantage that the material would allow the passage of nutrients and gases. 8

3. should have a Tissue integration property to prevent rapid epithelial down growth on the outer surface of the material or encapsulation of the material, and to provide stability to the overlying flap. 9

4. It is also essential that the barrier material is capable of creating and maintaining a space adjacent to the root surface. 10

5. It can be provided in configurations which are easy to trim and to place. 11

12