The Effectiveness and Complication Rate of Resorbable Biopolymers in Oral Surgery: A Systematic Review
Abstract
1. Introduction
- Osteoconductive: Serving as a scaffold for new bone growth, guiding the regenerative processes of native bone.
- Osteoinductive: Stimulating the formation of new osteoblasts to accelerate regeneration.
- Osteopromotive: Enhancing the osteoinductive effect of other grafts or membranes [15].
2. Materials and Methods
2.1. Search Strategy
- POPULATION: Patients requiring a bone augmentation procedure for implant dentistry.
- INTERVENTION: Bone augmentation using synthetic resorbable polymers.
- COMPARISON: Comparison among different types of resorbable polymers.
- OUTCOME: Effective bone augmentation (with evidence of effective volume measures in the interval time included) and reported complications related to the procedure.
- Human RCT studies focusing on regenerative surgery with at least a minimum number of 10 subjects included.
- No restriction for the anatomical site.
- Use of synthetic biopolymers.
2.2. Risk of Bias Assessment
3. Results
3.1. Are Resorbable Biopolymers Used for Regenerative Surgery?
3.2. Are Resorbable Biopolymers Performing Better than Conventional Materials?
3.3. Are There Any Complications Reported?
4. Discussion
Complications Associated with Resorbable Biopolymers
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
Abbreviation | Definition |
GBR | Guided Bone Regeneration |
GTR | Guided Tissue Regeneration |
RCT | Randomized Controlled Trial |
PLA | Polylactic Acid |
PCL | Polycaprolactone |
PEG | Polyethylene Glycol |
PRGF | Platelet-Rich Growth Factors |
PRF | Platelet-Rich Fibrin |
PRP | Platelet-Rich Plasma |
TCP | Tricalcium Phosphate |
MMP | Matrix Metalloproteinases |
ORC | Oxidized Regenerated Cellulose |
PDLA | Poly-D-Lactic Acid |
ABM/P-15 | Anorganic Bone Matrix/Peptide-15. |
PRISMA | Preferred Reporting Items for Systematic Reviews and Meta-Analyses |
PDL | Periodontal Ligament |
CA | Citric Acid |
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Author | Article Title | Description | Number of Patients | Time of Follow Up | Key Findings | Complications Reported | Conclusions |
---|---|---|---|---|---|---|---|
Shahdad et al. [28] | Randomized clinical trial comparing PEG-based synthetic to porcine-derived collagen membrane in the preservation of alveolar bone following tooth extraction in anterior maxilla | The aim of this randomized controlled clinical trial was to compare alveolar bone preservation covered by either a synthetic membrane or a porcine collagen membrane. | 30 | 6 months | PEG membrane resulted in significantly lower percentage loss in both labial and coronal dimensions compared to porcine collagen. Implant placement was comparable in both groups. | No major complications reported. | Use of PEG membrane led to a better preservation of ridge dimensions following extraction. |
Jung et al. [29] | A randomized, controlled clinical trial to evaluate a new membrane for guided bone regeneration around dental implants | The aim of this study was to evaluate a synthetic resorbable hydrogel membrane based on polyethylene glycol (PEG) that could provide vertical bone fill comparable to that of a standard collagen membrane. | 37 | 6 months | Vertical bone gain after 6 months was similar between PEG and collagen membranes (5.63 mm vs. 4.25 mm). PEG showed slightly more soft tissue issues but allowed for simplified application. | More soft tissue complications with PEG membrane (e.g., delayed/incomplete healing) but allowed for simplified application. All complications were resolved uneventfully. | PEG membrane achieved comparable regenerative outcomes to collagen with easier handling despite minor soft tissue complications. |
Zwahlen et al. [4] | A comparison of two resorbable membrane systems in bone regeneration after the removal of wisdom teeth: a randomized controlled clinical pilot study | Randomized, prospective, and partially blinded pilot study, 15 patients received biodegradable membrane system Inion GTR™ on one side and the double-layer resorbable membrane Bio-Gide® by Geistlich on the other. | 15 | 3–6 months | Bone biopsies showed similar new bone formation between Inion (synthetic) and Bio-Gide (xenogenic) membranes. CT and histological analysis revealed no statistically significant differences in bone regeneration or membrane performance. | Mild adverse events (wound infection, hematoma, late swelling) in three patients; healing generally uneventful. | Both membranes performed similarly in terms of safety and regenerative capacity. The main difference lies in the origin: synthetic vs. animal. |
De Angelis et al. [30] | 3D-Printable Biopolymers for Socket Preservation Technique: Soft Tissues Response: A Pilot Randomised Clinical Study | Randomized study on the healing of post-extraction sites with 3D-printed biomaterials vs. control group. | 39 | 6 weeks | Both 3D-printed biopolymers (PLA+HA and PCL+β-TCP) significantly outperformed the open healing control group in soft tissue closure for posterior sockets (p < 0.05). Anterior sockets healed fully in all groups by 4 weeks, with no significant differences. | No complications reported. Healing was uneventful in all 39 patients. | 3D-printed biopolymer membranes effectively promote soft tissue closure after extraction, particularly in posterior sites. |
Saini et al. [31] | Assessment of combination techniques in enhancing the regenerative potential of tricalcium phosphate graft in treatment of infrabony periodontal defects | The aim of the present study was to evaluate and compare the clinical outcomes after reconstructive surgery using tricalcium phosphate (TCP) alone; TCP and root conditioning with citric acid (CA); and TCP, CA, and an oxidized regenerated cellulose (ORC) membrane. | 39 | 6 months | All groups (TCP alone, TCP + CA, TCP + CA + ORC) showed significant improvements in PPD reduction, CAL gain, and defect fill. No significant intergroup differences. | No significant complications reported. | TCP combination therapies are at least as effective as TCP alone for infrabony defect regeneration. |
Pradeep et al. [32] | Clinical effectiveness of autologous platelet-rich plasma and Peptide-enhanced bone graft in the treatment of intrabony defects | This study was conducted to compare the effectiveness of two regenerative techniques (autologous PRP plus ABM/P-15 versus autologous PRP alone) in the treatment of intraosseous defects in humans, analyzing clinical and radiological parameters. | 28 | 9 months | PRP + ABM/P-15 showed statistically significant improvement in clinical and radiologic outcomes versus PRP alone. Greater bone fill observed on CT in the test group. | No significant complications reported. | PRP + ABM/P-15 is more effective than PRP alone for treating intrabony defects. Larger studies needed. |
Machado et al. [33] | Randomized clinical study of injectable dextrin-based hydrogel as a carrier of a synthetic bone substitute | The aim of this randomized controlled clinical trial was to compare alveolar ridge preservation outcomes using a synthetic bone substitute alone or combined with a dextrin-based injectable hydrogel. | 12 | 6 months | DEXGEL Bone showed greater granule resorption, better handling, and improved implant primary stability. Similar bone volume and density compared to control. | No local or systemic complications observed. | DEXGEL Bone is a safe and effective injectable carrier that enhances bone substitute handling and implant stability. |
Kusirisin et al. [34] | Polycaprolactone versus collagen membrane and 1-year clinical outcomes: a randomized controlled trial | The aim of this randomized controlled clinical trial was to evaluate and compare the outcomes of guided bone regeneration using a bilayered polycaprolactone membrane versus a collagen membrane over a 1-year period following implant placement. | 24 | 1 year | PCL membrane showed similar buccal bone thickness (BBT) and soft tissue dimensional change (STC) outcomes compared to collagen membrane; no statistically significant differences at 1-year follow-up. | Four early membranes exposed were found in the test group and three in the control group at 2 weeks after surgery. No other biological complications were seen during the study periods. | PCL membrane provides comparable outcomes to collagen membrane for GBR with simultaneous implant placement; further studies with larger sample size are needed. |
Jung et al. [35] | Comparison of a polyethylene glycol membrane and a collagen membrane for the treatment of bone dehiscence defects at bone level implants—a prospective, randomized, controlled, multicenter clinical trial | The aim of this randomized controlled multicenter clinical trial was to evaluate and compare the clinical outcomes of guided bone regeneration using a polyethylene glycol membrane versus a collagen membrane in the treatment of bony dehiscence defects at bone level implants. | 117 | 18 months | PEG and collagen membranes both resulted in vertical bone fill (59.7% PEG vs. 64.4% BG). The non-inferiority of PEG could not be demonstrated; MBL slightly increased in both groups. | Soft tissue complications occurred in both PEG and collagen groups, without significant differences. | Both membranes supported bone regeneration, but PEG could not be shown to be non-inferior to collagen. |
Santana et al. [36] | Synthetic polymeric barrier membrane associated with blood coagulum, human allograft, or bovine bone substitute for ridge preservation: a randomized, controlled, clinical and histological trial | The aim of this randomized controlled clinical and histological trial was to assess the extent of alveolar ridge preservation following socket grafting with blood coagulum, human allograft, or bovine bone substitute, each covered by a synthetic polyethylene glycol membrane. | 32 | 6 months | Use of AL + PEG membrane preserved ridge width (1.5 mm) better than BB (2.5 mm) or BC (2.3 mm). New bone formation was highest in BC (47.8%), followed by AL (33.3%) and BB (28.2%). | Post- surgical complications were minimal for all treatment modalities tested. | Alveolar bone preservation was best achieved using AL with PEG barrier. Different graft materials yielded different bone formation percentages. |
Arunjaroensuk et al. [37] | The Stability of Augmented Bone Between Two Different Membranes Used for Guided Bone Regeneration Simultaneous with Dental Implant Placement in the Esthetic Zone | The aim of this randomized controlled clinical trial was to compare the effectiveness of a synthetic polylactic acid membrane versus a collagen membrane in maintaining buccal bone thickness following simultaneous guided bone regeneration and implant placement. | 48 | 6 months | Both PLA (synthetic) and collagen membranes showed comparable reductions in facial bone thickness at all levels (0–6 mm apical to implant shoulder). No statistically significant differences. | Minor complications of gingival inflammation and membrane exposure were observed in three cases in the test group and two cases in the control group, but all sites recovered uneventfully. | PLA membrane is as effective as collagen membrane in maintaining stable augmented bone in the esthetic zone. |
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Fabozzi, R.; Bianchetti, F.; Baldi, D.; Sanchez, C.Y.; Bagnasco, F.; De Angelis, N. The Effectiveness and Complication Rate of Resorbable Biopolymers in Oral Surgery: A Systematic Review. Dent. J. 2025, 13, 264. https://doi.org/10.3390/dj13060264
Fabozzi R, Bianchetti F, Baldi D, Sanchez CY, Bagnasco F, De Angelis N. The Effectiveness and Complication Rate of Resorbable Biopolymers in Oral Surgery: A Systematic Review. Dentistry Journal. 2025; 13(6):264. https://doi.org/10.3390/dj13060264
Chicago/Turabian StyleFabozzi, Riccardo, Francesco Bianchetti, Domenico Baldi, Catherine Yumang Sanchez, Francesco Bagnasco, and Nicola De Angelis. 2025. "The Effectiveness and Complication Rate of Resorbable Biopolymers in Oral Surgery: A Systematic Review" Dentistry Journal 13, no. 6: 264. https://doi.org/10.3390/dj13060264
APA StyleFabozzi, R., Bianchetti, F., Baldi, D., Sanchez, C. Y., Bagnasco, F., & De Angelis, N. (2025). The Effectiveness and Complication Rate of Resorbable Biopolymers in Oral Surgery: A Systematic Review. Dentistry Journal, 13(6), 264. https://doi.org/10.3390/dj13060264