The concept of guided tissue regeneration (GTR) in endodontic surgery is derived from periodontal regenerative therapy for periodontal disease. Periapical tissue regeneration will occur predictably after endodontic surgery if intra- and extraradicular infections are controlled by adequate root-end resection and complete retrograde seal of the root canal. Indications for GTR technique in endodontic surgery are limited and should be clearly recognized to prevent misuse. They include: combined endodontic-periodontic lesions, through-and-through bone lesions, and large periapical lesions almost involving the alveolar crest bone. The materials, such as barrier membranes and bone grafts used in GTR technique should be biocompatible and approved by the FDA. Possible pre-surgical, intra-surgical, and post-surgical complications of GTR technique in endodontic surgery must be prevented to avoid failures. GTR technique in endodontic surgery could improve periapical wound healing in through-and through bone lesions and possibly in cases with large periapical lesions.
