eriodontal disease is usually initiated by opportunistic infections. Treatment of the periodontal disease is a great challenge because the infection occurs due to bacterial biofilm which is highly resistant to the antimicrobials and host response.(1) Removal of the bacteria from the periodontal cavity is a tedious task and the bacteria continue to remain in the oral cavity. The severity of disease mainly depends on the bacterial components present as well as on the host response. (2) Various approaches applied for the treatment of disease include mechanical therapy, the use of pharmacological agents and periodontal regeneration. (3,4)
One of the most frequently documented reconstructive procedures is guided tissue regeneration (GTR). In this procedure, a biocompatible barrier membrane (either resorbable or nonresorbable) is surgically implanted to isolate and protect the bone defect. (5)
The goal of membrane barrier procedures is to guide proliferation of the different tissues during healing after therapy (selective cell repopulation) (6). Cells that have the capability to form bone, cementum and periodontal ligament must occupy the defect to stimulate regeneration of the tissues. The progenitor cells reside in the periodontal ligament or alveolar bone or both, which remain around the tooth or bony defect. Placement of a physical barrier between the gingival flap and the defect before flap repositioning and suturing prevents gingival epithelium and connective tissue (undesirable cells) from contacting the space created by the barrier. It also facilitates repopulation of the defect by regenerative cells (7).
Amniotic membrane:
Though the amniotic membrane has been used in general surgery for a long period of time, its use in dentistry especially in oral and periodontal surgeries is increasing with promising results. Its biological properties of rapid re epithelialization, vascularization and formation of granulation tissue makes AM a good biological dressing. These fetal membranes are being used as a graft or dressing in the management of burns; in the reconstruction of the oral cavity, bladder, and vagina; tympanoplasty; arthroplasty and so forth. Its adhesive and tight contact with the injured surface promotes hemostasis and good pain relief due to exposition of nerve fibres. The ECM of the AM is an effective conduit for peripheral nerve regeneration and is used as a biodegradable scaffold with unique biochemical because of this it is used for neuronal regeneration and differentiation.(8)
These membranes are extremely thin around 300 nm in cross sectional thickness unlike the other collagen membranes used for guided tissue regeneration which are around 700 - 800 nm. Because of its thin diameter it intimately molds according to the defect anatomy and root surfaces easily. However further long term clinical trial and research on the stability of the hyperdry AM in the oral environment remains to be elucidates. Though it is known to keeps its strength and morphology at least one month in vitro when soaked in sterilized physiologic saline solution at room temperature, further investigation is needed to evaluate its ability to resist the masticatory forces, biodegradable rate for subsequent repair and maturation of the mucosal tissues when used as a barrier membrane. (9)