Search Results (157)

Background: Guided Bone Regeneration (GBR) relies on barrier membranes, for which polylactic acid (PLA) and its copolymer poly(lactic-co-glycolic acid) (PLGA) are promising biodegradable polymers. However, their inherent hydrophobicity limits biological performance, and the evidence regarding how specific modifications affect key human cell types, particularly osteoblasts and fibroblasts, remains scattered. Methods: A systematic review was conducted to synthesize the in vitro evidence on the response of primary human osteoblasts and fibroblasts to polylactic acid-based materials. Following a pre-registered protocol (10.17605/OSF.IO/CE8KB), a comprehensive search was performed across four major databases, and the risk of bias in the included studies was assessed using an adapted OHAT tool. Results: Twenty-six studies were included, which showed that polylactic acid-based materials have limited bioactivity, and their modification significantly improves cellular responses. The incorporation of bioceramics and growth factors, or alterations in surface topography, notably enhanced osteogenic differentiation and mineralization in osteoblasts. For gingival fibroblasts, topographical modifications like micro-grooves guided cell alignment and modulated proliferation. Conclusions: Native polylactic acid-based materials display limited bioactivity. However, functionalization through bioceramics incorporation, growth factor delivery, and surface topographical modification is crucial for transforming them into bioactive scaffolds capable of achieving the dual biofunctionality required for successful GBR. Full article

In the context of guided bone regeneration (GBR), the selection of an appropriate resorbable membrane plays a crucial role in the clinical success of the procedure. Precise knowledge about the distinct differences in properties is fundamental for correct selection of the membrane. This article presents an integrated comparative analysis between membranes, conducted for this given purpose and one step beyond: to fabricate a novel membrane with dedicated enhanced properties according to the targeted function. Our previous analysis showed that polymer membranes that met most histopathological criteria also produced the most remarkable results when radiologically observed. The most effective scaffolds were those containing active macromolecules released conditionally and staged. The PLGA and polycaprolactone scaffolds were found in this category and they granted a marked increase in bone density and improvement in osteoinduction. Based on these results, we decided to create a new polycaprolactone membrane in order to compare it with a standard currently on the market, the Jason membrane. The Jason^® membrane is a natural collagen scaffold derived from porcine pericardium. Due to the unique production process, the membrane shows a natural honeycomb-like, multilayered collagen structure with an increased content of collagen type III, leading to remarkable tear resistance and a slow degradation rate. Also, the low thickness of 0.05–0.35 mm facilitates the soft tissue management. The Jason scaffold was compared to an innovative synthetic membrane based on polycaprolactone (PCL), focusing on their physicochemical characteristics, biological behavior, and clinical applicability. The Jason^® membrane was distinguished by its high biocompatibility and rapid integration, while PCL offered superior mechanical stability and long-term durability, making it a preferred option for complex or customized 3D regenerations. Based on this integrated analysis, we fabricated an innovative electrospun PCL membrane, enriched with a novel synthesized nanohydroxyapatite, in order to enhance its specific properties for the beneficial use in targeted reconstructions. Full article

Background: Platelet-rich fibrin (PRF) is an autologous biomaterial utilized as an adjunct in dental implant surgeries owing to its significant biocompatibility, supra-physiological concentration of growth factors, and ability to speed either soft or hard tissue regeneration. Methods: Today, PRF is available in both solid and liquid forms with an average resorption period of roughly 2 weeks. While various research endeavors have attempted to utilize Solid-PRF as a barrier membrane in guided bone regeneration (GBR) and various other applications, its two-week resorption period has limited its use as a solo “barrier” membrane owing to its faster-than-ideal resorption properties. Results: Recent studies have demonstrated that by heating and denaturing Liquid-PRF/albumin, the resorption properties of the heated albumin gel could be extended from 2 weeks to 4–6 months by utilizing the Bio-Heat technology. This emerging technology was given the working name ‘extended-PRF’ or e-PRF, with many clinical indications being proposed for further study. Numerous clinicians have now utilized extended-PRF (e-PRF) membranes as a substitute for collagen barrier membranes in various clinical applications, such as guided tissue/bone regeneration, recession coverage, and lateral window sinus lifts. Conclusions: This two-part case series paper aims to first illustrate the evolution of techniques developed taking advantage of this new technology in clinical practice for alveolar ridge preservation. This includes four different methods of fabrication of e-PRF along with its application in clinical practice. This article discusses the clinical outcomes, including the advantages/disadvantages of utilizing each of the four separate techniques to prepare and utilize e-PRF membranes for ridge preservation. Full article

Background/Objectives: Vertical ridge augmentation (VRA) is often necessary in severe bone atrophy, yet the most predictable approach remains unclear. This systematic review compared Guided Bone Regeneration (GBR) and the Shell Technique (ST) for vertical bone gain (VBG), bone quality, complications, patient-reported outcomes (PROMs), and implant survival. Methods: Following PRISMA 2020 and PROSPERO registration (CRD420251128502), PubMed and Scopus databases were searched. Adults requiring VRA before implants were included. Interventions were GBR using titanium-reinforced dense PTFE (Polytetrafluoroethylene) or collagen membranes and ST using autogenous or allogeneic cortical plates. Results: Both techniques achieved clinically meaningful vertical augmentation. Median VBG was 4.24 mm for GBR (range 2.20–8.78 mm) and 5.16 mm for ST (range 3.10–7.60 mm) at re-entry (typically 4–9 months). Long-term series showed maintained gains for ST up to 10 years and multi-year stability after GBR in selected cohorts. Major early-healing complications were uncommon with both methods. Minor soft-tissue events varied; several GBR cohorts reported more exposures/dehiscence and occasional infections. Implant survival was uniformly high; validated PROMs were seldom reported. Conclusions: GBR and ST both enable vertical reconstruction sufficient for implant placement. ST tended toward higher median VBG but requires greater technical expertise and, when autogenous, adds donor-site morbidity; allogeneic shells reduce harvesting needs. GBR remains a versatile, donor-site-sparing alternative. Standardized outcome (including validated PROMs) reporting and head-to-head randomized trials are needed to refine case selection and confirm comparative effectiveness. Full article

The barrier membrane is a key component in guided bone regeneration (GBR); however, there is no current commercially available membrane universally suitable for all clinical situations. The semi-resorbable bioactive barrier membrane derived from a silk fiber sheet (SF), polyvinyl alcohol (PVA), and biphasic calcium phosphate (BCP) was fabricated to provide improved physical, mechanical, and bioactive properties. There were four experimental groups: PVA/SF, 1BCP/PVA/SF, 3BCP/PVA/SF, and 5BCP/PVA/SF. All fabricated membranes appeared white in color with a smooth texture; however, SEM images revealed a rougher top surface compared to the bottom surface. FTIR and DSC validated the presence of the SF and PVA with or without BCP. All membranes displayed high hydrophilicity, except the PVA/SF group, which remained hydrophobic on the bottom surface. The water uptake of all groups reached the plateau phase within 10 min. The degradation rate fell within the range of 5–20% over a three-month period. Both fibroblastic and osteoblastic cells attached and survived on the BCP-incorporated membranes, comparable to those observed in the commercially available ossifying collagen membrane. Among the fabricated membranes, the 3BCP/PVA/SF formulation demonstrated the most favorable physical, mechanical, and biological properties for GBR applications. Full article

Biodegradable magnesium (Mg) alloys hold promising application prospects in the field of guided bone regeneration (GBR) membranes, particularly for oral and maxillofacial applications. However, their corrosion resistance requires further improvement. Additionally, Mg alloys are susceptible to bacterial infection upon implantation, while copper (Cu) is known for its excellent antibacterial properties. Introducing Cu into the micro-arc oxidation (MAO) coating can enhance both the corrosion resistance and antibacterial performance of Mg alloys. However, the sealing effect of such coatings remains suboptimal. Hydroxyapatite (HA), which possesses outstanding bioactivity, is a promising bone substitute material. This study investigates the influence of HA content on the microstructure, corrosion resistance, cytotoxicity, and antibacterial properties of Cu-containing MAO coatings. The results demonstrate that as the HA concentration increases, the corrosion resistance of the composite coating is significantly enhanced. The corrosion rate decreased from 0.32 mm/y for the untreated MAO coating to 0.27 mm/y and 0.23 mm/y for the HA-treated samples with EDTA–Ca concentrations of 125 mmol/L and 175 mmol/L, respectively. Cytotoxicity assessment indicates that the incorporation of an HA layer significantly improves cell compatibility compared to the bare MAO coating. However, the enhanced corrosion resistance provided by the denser HA layer (at 175 mmol/L EDTA–Ca) unfortunately acts as a barrier, limiting the release of antibacterial Cu²⁺. Among the coatings tested, the one with 125 mmol/L EDTA–Ca exhibited the best overall performance, demonstrating good corrosion resistance, cytocompatibility, and effective antibacterial properties. Full article

Cortical laminar bone membranes (CLBMs) combine mechanical strength with controlled resorption to overcome the limitations of conventional guided bone regeneration membranes. This narrative review synthesizes the clinical efficacy and comparative outcomes of CLBMs from human studies. A systematic literature search identified 13 human clinical studies evaluating CLBMs from xenogeneic (porcine, equine, bovine) and autogenous sources. Compared to conventional alternatives, CLBMs demonstrated superior outcomes: horizontal ridge augmentation achieved 3.1–5.8 mm gains with CLBMs versus 2.0–3.0 mm with collagen membranes (50–100% improvement); membrane exposure rates were 3–8% (CLBMs) versus 15–30% (titanium mesh); and socket preservation achieved a 72% resorption reduction versus natural healing controls. Vertical augmentation achieved 7–11 mm gains. Maxillary sinus augmentation achieved a 100% implant success (1–5 year follow-up). The overall implant survival rates ranged 90.9–100% with CLBMs, exceeding the reported success rates (85–95%) of conventional GBR approaches, with complication rates of 0–12.5%. A histomorphometric analysis demonstrated new bone formation of 29.7–40% at 6 months, with a residual biomaterial of 26.2–35%. CLBMs demonstrate favorable exposure rates and excellent biocompatibility. These membranes support lateral, vertical, and combined defect reconstruction, with reduced donor-site morbidity compared to autogenous approaches. High-quality comparative trials and extended follow-up studies are needed to establish definitive clinical guidelines. Full article

In guided bone regeneration (GBR) procedures, d-PTFE membranes are often used as a barrier to promote alveolar ridge regeneration. The aim of this randomized clinical trial was to examine the microbial diversity and structure of biofilms on two types of d-PTFE membranes, Permamem^® and Cytoplast™, over four-week oral cavity exposure periods. Bacterial biofilm analysis was performed using 16S rRNA next-generation sequencing (NGS) on 36 samples (20 Permamem^® and 16 Cytoplast™). The results showed significant differences in the microbial profiles: Cytoplast™ membranes showed reduced microbial diversity and an enhanced proportion of pathobionts like Selenomonas, Segatella, Fusobacterium and Parvimonas, which are associated with periodontal and peri-implant diseases and alveolar bone loss. Permamem^® membranes promoted colonization by bacteria associated with healthy oral conditions, such as the genera Streptococcus, Kingella and Corynebacterium. Overall, our results showed that Cytoplast™ membranes generate a specific type of biofilm, leading to reduction in health-related bacterial species and facilitating growth conditions for dysbiosis shift. Further research and patient follow-ups are essential to thoroughly evaluate the clinical implications of different d-PTFE membranes used in guided bone regeneration. Full article

Background and Objectives: Adequate buccal bone thickness is critical for long-term peri-implant health and stability. When residual alveolar bone volume is insufficient, guided bone regeneration (GBR) is a widely adopted technique. While non-resorbable membranes provide structural support, they carry a higher risk of complications and require secondary surgery. Resorbable collagen membranes, offer promising biological properties and easier clinical handling, yet clinical data remain limited. This prospective cohort study aimed to evaluate the clinical and radiographic outcomes of horizontal GBR using a native, non–cross-linked resorbable porcine pericardium membrane fixed with titanium pins, in conjunction with simultaneous implant placement. Materials and Methods: Eighteen patients (26 implants) with horizontal alveolar defects (<6 mm) underwent implant placement and GBR with deproteinized bovine bone mineral and a porcine pericardium collagen membrane. Horizontal bone gain and buccal bone thickness were measured at baseline and 6 months post-operatively. Post-operative complications, patient-reported outcomes (PROMs), and peri-implant tissue health were assessed up to 1 year post-loading. Results: Mean bone gain was 2.95 ± 0.95 mm, and all sites achieved a buccal bone thickness ≥ 1.5 mm. No membrane-related complications occurred. PROMs revealed low morbidity. At 1-year follow-up, marginal bone loss averaged 0.54 ± 0.7 mm, mean probing depth was 2.79 ± 0.78 mm, 92% of sites exhibited keratinized mucosa ≥ 2 mm. Conclusions: Native resorbable porcine pericardium membranes, when combined with DBBM and mechanical stabilization, seem to be effective for horizontal bone regeneration. Full article

Background and Objectives: In vitro evaluation of macro and microscopic features of five resorbable barrier membranes used for Guided Bone Regeneration (GBR) in oral hard tissue surgery. Materials and Methods: Five different resorbable barrier membranes were analyzed by optical microscopy and scanning electron microscopy (SEM). For each sample, surface appearance, the presence and size of ridges and depressions, number of layers, and the inner structure were recorded. Each membrane was cut into 1 × 1 cm squares to determine mass, density and thickness. In addition, an EDX microanalysis was performed. Results: Under optical microscopy, all membranes appeared rough, with ridges and depressions. In cross-section, only Sample 2 presented true stratification. On SEM, most membranes showed a three-dimensional collagen fiber architecture. Sample 3, a sheet of collagenated equine bone, differed accordingly. EDX spectra showed broadly overlapping elemental composition, characterized by N, O and C. The mass depends on the composition: bone-containing membranes weighed more; those composed predominantly of collagen weighed less. Conclusions: Pore size, surface density and roughness, and the type of cross-linking can influence cell interaction and may lead to different regenerative scenarios, potentially improving the quality and timing of tissue regeneration. Membrane selection should be dictated by the clinical scenario, prioritizing properties most advantageous for the defect. Full article

Background: This prospective clinical study aimed to evaluate the effectiveness of platelet-rich fibrin (PRF) in guided bone regeneration (GBR) prior to dental implant placement. Material and methods: Sixty-five patients with alveolar bone defects were randomly assigned to three groups. All groups received a composite graft consisting of 70% allograft and 30% xenograft. Group A received the graft combined with PRF. Group B received the graft with PRF and a resorbable collagen membrane. Group C (control) received the same graft and membrane without PRF. Cone-beam computed tomography (CBCT) was used to assess bone regeneration at baseline and 6 months postoperatively. Implant stability was evaluated using ISQ values at the time of implant placement (6 months after grafting) and again at 3 to 4 months during the second-stage uncovering procedure. Soft tissue healing, postoperative complications, and pain scores were also recorded. Results: Group B showed the best outcomes, with the highest mean vertical bone gain (3.0 ± 0.4 mm), greatest implant stability (ISQ: 74.2 ± 1.8), and no complications. Group A achieved moderate bone gain (2.3 ± 0.4 mm) and good ISQ values (71.5 ± 2.3), with favorable soft tissue healing. In contrast, Group C had the lowest bone gain (2.1 ± 0.5 mm), reduced ISQ values (68.9 ± 2.9), and the highest incidence of complications, including dehiscence and minor infections. Conclusions: These results suggest that PRF enhances both hard and soft tissue regeneration, particularly when used with grafts and membranes. PRF may reduce healing time and postoperative discomfort, improving the overall success of regenerative implant procedures. Full article

Introduction: Guided bone regeneration (GBR) is a key approach for managing alveolar ridge defects. Although titanium meshes are widely used for non-resorbable space maintenance, their limitations have prompted interest in alternative materials. Polyetheretherketone (PEEK), a high-performance thermoplastic, has emerged as a potential barrier due to its mechanical strength, radiolucency, and compatibility with digital workflows. Objective: To map the current evidence on the use of PEEK barriers in GBR, focusing on biological performance, mechanical properties, and clinical outcomes in animal and human studies. Methods: A scoping review was conducted following PRISMA-ScR guidelines. Eligible studies included in vivo animal models or clinical trials involving PEEK barriers for alveolar bone regeneration. Data on study design, defect type, barrier characteristics, surgical protocol, outcomes, and complications were extracted. Results: Five studies met the inclusion criteria: two animal models and three clinical trials. All reported successful space maintenance and bone gain with PEEK barriers, with outcomes comparable to titanium meshes. Customization through CAD/CAM or 3D printing was common. Complications such as soft tissue dehiscence and exposure occurred but generally did not affect regeneration. Evidence was limited by small sample sizes, short follow-up, and single-center designs. Conclusions: PEEK barriers show promise as customizable alternatives to traditional GBR membranes. However, current evidence is limited and geographically concentrated. Future multicenter studies with long-term follow-up and standardized outcome measures are needed to validate the clinical potential of PEEK in bone regeneration. Full article

This study aimed to evaluate the efficacy of cross-linked collagen membranes. Two types of collagen membranes were compared: a non-cross-linked collagen membrane (group A) and a cross-linked (group B) collagen membrane. In the in vitro study, the degradation rate in the presence of collagenase, the tear strength of the membranes, and the cytotoxicity of the cross-linked collagen membrane were evaluated. A total of 57 participants with cystic defects were randomized to undergo guided bone regeneration (GBR) using either membrane. Graft volume and new bone formation were measured by cone-beam computed tomography after 6 months of follow-up. In vitro findings revealed that the cross-linked collagen membrane retained more than 20% of its relative weight after 12 h. Meanwhile, the non-cross-linked collagen membrane exhibited complete degradation after 6 h. Clinically, no significant differences were observed between the groups in terms of graft resorption, new bone formation, and overall bone regeneration. These results indicate that cross-linking has comparable biocompatibility and enhances physical properties, including tear strength and resistance to degradation. However, clinical outcomes related to bone regeneration were not significantly different between cross-linked and non-cross-linked collagen membranes. Further research is warranted to determine the benefits of cross-linked collagen membranes in GBR procedures. Full article

Background/Objectives: Guided bone regeneration (GBR) requires barrier membrane materials that balance biodegradation with mechanical stability. Magnesium (Mg)-based metals have good prospects for use as biodegradable barrier materials due to their elastic modulus, good biocompatibility, and osteogenic properties. In this study, gallium (Ga) was introduced into Mg to enhance the mechanical strength and optimize the degradation behavior of the alloy, addressing the limitations of conventional magnesium alloys in corrosion control and strength retention. Methods: Mg-xGa alloys (x = 1.0–3.0%, wt.%) were evaluated for biocompatibility, degradation, and osteogenic potential. Corrosion rates were calculated via weight loss, Mg²⁺ release, and pH changes. Osteogenic effects were assessed using rat bone marrow mesenchymal stem cells (rBMSCs) for alkaline phosphatase (ALP) activity, extracellular matrix (ECM) mineralization, and osteogenic-related gene expression. Optimal alloy was fabricated into barrier membranes with different pore sizes (0.85–1.70 mm) for the rabbit mandibular defect to evaluate the porosity effect on new bone formation. Results: Cytocompatibility tests established a biosafety threshold for Ga content below 3 wt.%. Mg-1Ga demonstrated uniform corrosion with a rate of 1.02 mm/year over 28 days. In vitro, Mg-1Ga enhanced ALP activity, ECM mineralization, and osteogenic gene expression. The 1.70 mm pore size group exhibited superior new bone formation and bone mineral density at 4 and 8 weeks. Conclusions: These results highlight Mg-1Ga’s biocompatibility, controlled degradation, and osteogenic properties. Its optimized pore design bridges the gap between collagen membranes’ poor strength and titanium meshes’ non-degradability, offering a promising solution for GBR applications. Full article

Electrospun nanofibrous membranes have gained considerable attention in bone tissue engineering due to their ability to mimic the extracellular matrix and provide a suitable environment for cell attachment and proliferation. This study investigates the fabrication, characterization, and biocompatibility of poly(L-lactic acid) (PLA)-based membranes enhanced with periclase (MgO) and gold nanoparticles (AuNPs). The membranes were fabricated using an optimized electrospinning process and subsequently characterized using scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), Fourier-transform infrared spectroscopy (FT-IR), and contact angle measurements. Additionally, in vitro biodegradation studies in simulated body fluid (SBF) and cytocompatibility tests with osteoblast-like cells were conducted. The results demonstrated that the incorporation of MgO and AuNPs significantly influenced the structural and chemical properties of the membranes, improving their wettability and bioactivity. SEM imaging confirmed uniform fiber morphology with well-distributed nanoparticles. FT-IR spectroscopy indicated successful integration of bioactive components into the PLA matrix. Cytocompatibility assays showed that modified membranes promoted higher osteoblast adhesion and proliferation compared to pristine PLA membranes. Furthermore, biodegradation studies revealed a controlled degradation rate suitable for guided bone regeneration applications. These findings suggest that electrospun PLA membranes enriched with MgO and AuNPs present a promising biomaterial for GBR applications, offering improved bioactivity, mechanical stability, and biocompatibility. Full article