Search Results (14)

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

Purpose: To evaluate the clinical and histological outcomes of patients that receive implant-supported crowns after vacuum plasma surface treatment (VPST) of biomaterials used in socket preservation (SP) and guided bone regeneration (GBR). Materials and methods: This study was designed as a case series. Patients in need of tooth extraction and socket preservation or guided bone regeneration were enrolled. The socket preservation technique was performed after tooth extraction using a heterologous collagen bone graft and a collagen xenomatrix, both activated with vacuum plasma. Meanwhile, a two-stage horizontal ridge augmentation was performed using a customized titanium mesh and a mix of autologous (untreated) and heterologous (treated) bone grafts, along with a treated collagen membrane. ACTILINK Reborn with Universal Vortex Holder (Plasmapp Co., Ltd., Daejeon, Republic of Korea) was used to treat all biomaterials. The outcome measures were implant and prosthesis failures, complications, and histological examination. Soft and hard tissue samples were collected at the time of implant placement only in patients treated with SP. Results: A total of six patients were treated—three with socket preservation and delayed implant placement, and three with staged GBR. No implant or prosthesis failed. One customized titanium mesh broke after plasma treatment, requiring replacement with a pericardium membrane. No other complications occurred. Histological analysis at three months post-surgery revealed well-vascularized newly formed bone at different stages of maturation with integrated bone graft particles, while the soft tissue appeared to be physiologically structured. Conclusion: VPST may enhance the hydrophilicity of biomaterials, supporting favorable healing outcomes in SP and GBR. Further randomized controlled trials with appropriate sample size calculations are needed to confirm these preliminary results. Full article

Background/Objectives: The primary aim of this retrospective clinical study was to assess the success and bone gain achieved by using the Fibrinogen-Induced Regeneration Sealing Technique (F.I.R.S.T.) in different indications. Methods: In this single-center retrospective clinical study, F.I.R.S.T. was performed in the following indications: alveolar ridge preservation (ARP), immediate implant placement, and horizontal and vertical guided bone regeneration (GBR) with simultaneous dental implant placement. F.I.R.S.T. is a modified approach to GBR characterized by the application of a porcine cortical lamina, as a long-term resorbable bone barrier to cover the bone defect, and a fibrin sealant for easy adaptation of the xenogenic bone graft material and the fixation of the collagenic bone barrier. Patients with uncontrolled systemic diseases, medications, or diseases that may alter bone metabolism; local inflammation; poor oral hygiene; and heavy smoking were excluded from this study. Horizontal and vertical bone gain (HBG and VBG) were measured by comparing postoperative and preoperative cone beam computed tomography (CBCT) reconstructions. Patients were recalled for controls and oral hygiene treatment every 6 months. Results: Altogether, 62 patients (27 male, 35 female, age 63.73 ± 12.95 years) were included in this study, and 105 implants were placed. Six implants failed during the 50.67 ± 22.18-month-long follow-up. Cumulative implant survival throughout the groups was 94.29 %. In the immediate implant group, HBG was 0.86 mm (range: −0.75–8.19 mm) at the 2 mm subcrestal level, while VBG was 0.87 ± 1.21 mm. In the ARP group, HBG was 0.51 mm (range: −0.29–3.90 mm) at the 2 mm subcrestal level, while VBG was −0.16 mm (range: −0.52–0.92 mm). In the horizontal GBR group, HBG was 2.91 mm (range: 1.24–8.10 mm) at the 2 mm subcrestal level. In the vertical GBR group, VBG was 4.15 mm (range: 3.00–10.41 mm). Conclusions: F.I.R.S.T. can be utilized successfully for bone augmentation. The vertical and horizontal bone gains achieved through F.I.R.S.T. allow for implant placement with adequate bone width on both the vestibular and oral aspects of the implant. Full article

An insufficient volume of the alveolar bone may prevent implants from being placed in the prosthetically optimal position. Complex restoration of bony structures is required to achieve long-term peri-implant bone stability and represents an adequate prosthetic solution. Background and Objectives: The shell technique has become a widespread and important method for guided bone regeneration in dentistry. Allogeneic bone materials appear to be the most similar substitution for autogenous bone transplants. However, there are few studies using cortical bone allografts in combination with a mix of autogenous and xenograft materials for the augmentation of horizontal ridge defects. This combination offers the advantage of reduced patient morbidity while adding adequate volume and contour to the alveolar ridge. Case report: The present case study aimed to clinically and radiographically evaluate the efficacy of allogenic cortical bone lamina combined with a composite bone graft in the augmentation of a horizontal bone defect in the edentulous maxilla during a 6-year follow-up period. Three CB CT scans taken before treatment, 6 months after the augmentation period/before implant placement, and after a 6-year follow-up period, were analyzed using stable referent points. After the 6 -year follow-up period, the average resorption rate was 21.65% on the augmented buccal side, with no implant exposure being observed. Conclusions: The bone shell technique used in conjunction with allogenic bone plates combined with autogenous bone, xenografts, and collagen membranes is an effective technique to manage horizontal ridge defects. Full article

(1) Background: Ridge augmentations either horizontal (HRA) or vertical (VRA) in the posterior mandible are very challenging regenerative procedures. To attain and retain tension-free primary closure, buccal periosteal and mylohyoid muscle releases should be performed. The purpose of the present study was to review, analyze and discuss the three different techniques for the mylohyoid muscle release (MMR) in VRA and HRA surgeries on a clinical and human cadaver level. (2) Presentation of the techniques: Three different techniques are described in the literature regarding the lingual flap management: (i) the finger sweep technique (FST), (ii) the release of the mylohyoid muscle attachment on the lingual flap (MMALF), and (iii) the mylohyoid preservation technique (MPT) in three key anatomical zones. All three techniques, even though they use a different approach, can achieve similar amount of horizontal and vertical mylohyoid muscle release although MPT showed statistically significant higher flap advancement. The human cadaver analyses revealed that all three techniques are considered safe since they do not approximate vital anatomical structures. (3) Conclusions: All three techniques are considered safe, but they are not free of limitations or complications; therefore, they should be performed only by highly experienced and trained clinicians. MPT achieved statistically significant higher flap advancement. Full article

The use of xenogenic cortical bone laminas in Guided Bone Regeneration (GBR) has been well described in the literature over the past decade. These biomaterials present a very low degree of complications due to their nature (porcine or equine collagenated bone) and the fact that when they become exposed, they simply hydrolyze without major complications. One of the problems related to the first generation of these laminas was their extreme rigidity and return elasticity, often forcing clinicians to anchor them with pins and/or screws. A new generation of bone laminas called Flex Cortical Sheet (FCS) have recently been introduced with machine-made thicknesses of 0.2, 0.5, and 0.9 mm and increased flexibility and adaptability to ridge defects. This paper has the goal of presenting a case of vertical and horizontal reconstruction performed by means of a 0.5 mm FCS and showing the workflow necessary to successfully restore a complex situation. After 8 months of healing, the GBR resulted in a horizontal and vertical augmentation of 8 mm and 8 mm, respectively. The radiographic examination at 18 months demonstrated great stability of new bone around implants. Full article

Guided bone regeneration (GBR) is a reliable technique used to treat ridge deficiencies prior or during implant placement. Injectable-platelet rich fibrin (i-PRF) laced with a bone substitute (sticky bone) has heralded the way for advancing the outcomes of bone regeneration. This study evaluated the efficacy of sticky bone in horizontal ridge augmentation with and without collagen membrane. A total of 20 partially edentulous patients (Group-I n = 10; Group-II n = 10) that indicated GBR were included, and the surgical procedure was carried out. In Group-I, the sticky bone and collagen membrane were placed in ridge-deficient sites and Group-II received only sticky bone. At the end of 6 months, 20 patients (Group-I (n = 10); Group-II (n = 10)) completed the follow-up period. A CBCT examination was performed to assess changes in the horizontal ridge width (HRW) and vertical bone height (VBH). A statistically significant increase in HRW (p < 0.05) was observed in both groups with mean gains of 1.35 mm, 1.55 mm, and 1.93 mm at three levels (crest, 3 mm, and 6 mm) in Group-I and 2.7 mm, 2.8 mm, and 2.6 mm at three levels in Group-II. The intergroup comparison revealed statistical significance (p < 0.05) with respect to HRW and KTW (Keratinised tissue width) gains of 0.775 at the 6-month follow-up. Sticky-bone (Xenogenic-bone graft + i-PRF) served as a promising biomaterial in achieving better horizontal bone width gain. Full article

(1) Background: Bone Lamina Technique and Guided Bone Regeneration (GBR) are commonly used for horizontally-deficient maxillary ridge reconstruction, although more detailed evaluation to assess the differences between such techniques is necessitated. (2) Methods: In this retrospective study, patients having a horizontal bone width of ≤4 mm in the maxilla, who were treated with Cortical Strut (CS), were collected to represent the “test group”, and those treated with GBR with no CS involvement represented the “control group”. A 1:1 mixture of autogenous bone (AB) and anorganic bovine bone (ABB) with resorbable collagen membrane was applied to both groups. Volumetric changes between groups were measured with cone-beam computed tomography (CBCT). The primary outcome represented volumetric graft resorption rate whilst the secondary outcomes represented any probable complications and implant insertion torque. (3) Results: A total of 36 patients were included in this study (36 grafted sites; 18 for CS group and 18 for GBR group). Mean bone graft volume reduction in the CS and GBR groups was 8.26 ± 1.60% and 14.36 ± 3.55%, respectively. The GBR group showed significantly more bone resorption than the CS group (p < 0.001). Complications and insertion torque were similar between the groups (p > 0.05). (4) Conclusions: Both CS and GBR techniques for hard-tissue augmentation provided sufficient bone graft mass volume for implant insertion, whereas CS demonstrated lower resorption rate at maxillary augmented sites, compared to GBR. Full article

The augmentation of the alveolar crest after the loss of one or several teeth can be carried out using different bone augmentation techniques. These techniques include bone distraction, ridge expansion, bone block grafts, etc. Guided bone regeneration is an alternative to increase the volume of the hard tissues for the subsequent placement of the implants in the optimal three-dimensional position. The objective of this paper is to show a case report of the use of customized titanium mesh for posterior vertical bone regeneration. Case report and Results: A 59-year-old woman comes to rehabilitate edentulous spaces with implants. After taking the anamnesis and the intra and extraoral exploration, a vertical and horizontal bone defect is observed in the third quadrant. After the radiological study with CBCT, a bone height of 6.04 mm to the inferior alveolar nerve and a width of the bone crest of 3.95 mm was observed. It was decided to carry out a regeneration with a preformed titanium mesh (Avinent^®, Santpedor, Spain) and four microscrews (Avinent^®, Santpedor, Spain). The flap was closed without tension. Regular check-ups were performed without complications. At 7 months, the mesh was removed and two osteoingrated implants (Avinent^®, Santpedor, Spain) were placed with a torque greater than 45 N/cm and an ISQ of 82 and 57 N/cm, respectively. The bone gain obtained was 1.84 and 1.92 mm in width and 4.2 and 3.78 mm in height for positions 3.5 and 3.6. The newly formed bone, obtained by trephine, was well-structured and histologically indistinguishable from the previous bone. Conclusion: The use of a customized pre-formed titanium mesh together with the mixture of autologous bone and xenograft is a feasible and predictable technique for vertical bone regeneration. Full article

We performed this clinical study in order to evaluate the reliability of the Guided Bone Regeneration (GBR) surgical technique through the use of customized CAD CAM titanium meshes (Yxoss CBR^® Reoss) in order to show an alternative method of bone augmentation. Materials and methods: Nine patients presenting 10 bone defects were referred to solve oral dysfunction due to edentulous atrophic ridges. Guided bone regeneration was performed with titanium meshes combined with autogenous bone grafting and heterologous bovine bone mineral grafting, and exclusively a “poncho technique” soft tissue approach for all the cases. After a mean 9 months of graft healing (range 6–12 months), titanium meshes were removed, and implant surgery was subsequently performed. The results we obtained were positive in terms of volumetric increases in height, length and thickness of the atrophic ridges without biological complications detectable before implant surgery. Results: Out of nine, one site met titanium mesh exposure: however, in all 10 sites a three-dimensional volumetric bone implementation was obtained. The statistical results were estimated by uploading and superimposing cbct scans before and after CBR surgery for each patient, so it was possible evaluate the maximum linear vertical and horizontal bone gain through dedicated Cad Cam software (Exocad GmbH^®). The average horizontal gain was 6.37 ± 2.17 mm (range 2.78–9.12 mm) and vertical gain was 5.95 ± 2.06 mm (range 2.68–9.02 mm). A total of 18 implants were placed into the grafted sites with a 100% survival rate (clearly they are relative percentages to be compared to the short time elapsed). Conclusions: The results we obtained in this study suggest that this CBR procedure (Yxoss^® by Reoss) is reliable and safe for bone regeneration to allow implant-prosthetic restoration in horizontal, vertical and combined bone defects. The soft tissue management is diriment: all the cases were managed with a “poncho” flap approach to decrease exposure complication. Full article

This single-blinded, randomized, controlled study aimed to clinically and radiographically evaluate hard tissue volume stability beyond the bony envelope using three-dimensional preformed titanium mesh (3D-PFTM) for peri-implant dehiscence defects in the anterior maxilla. A total of 28 patients who wished to undergo implant surgery combined with guided bone regeneration (GBR) after extraction of a single maxillary anterior tooth were randomly assigned to two groups depending on the type of collagen membrane used, additionally with the 3D-PFTM—test (n = 14, cross-linked collagen membrane; CCM) and control (n = 14, non-cross-linked collagen membrane; NCCM) groups. Each implant was evaluated radiographically using CBCT at baseline, immediately after surgery, and at 6 months postoperatively. The relative position and distances from the bony envelope to the outlines of the augmented ridge were further determined immediately after GBR and 6 months after healing. At the platform level, the mean horizontal hard tissue gain (HG) at all the sites was 2.35 ± 0.68 mm at 6 months postoperatively. The mean HG rate was 84.25% ± 14.19% in the CCM group and 82.56% ± 13.04% in the NCCM group, but the difference was not significant between the groups. In all cases, HG was maintained beyond the bony envelope even after 6 months of GBR. This study suggests that 3D-PFTM should be considered a valuable option for GBR for peri-implant dehiscence defects in the anterior maxilla. In addition, 3D-PFTM may confer predictable hard tissue volume stability even after the healing period of hard tissue augmented outside the bony envelope by GBR. Full article

Background: The purpose of this study was to compare clinical results of two different horizontal ridge augmentation techniques: guided bone regeneration with sticky bone (SB) and the bone-shell technique (BS). Methods: Records of patients who underwent horizontal ridge augmentation with SB (test) and BS (control) were screened for inclusion. Pre-operative and 6-month post-operative ridge widths were measured on cone beam computer tomography (CBCT) and compared. Post-operative complications and implant survival rate were recorded. Results: Eighty consecutive patients were included in the present study. Post-operative complications (flap dehiscence, and graft infection) occurred in ten patients, who dropped out from the study (12.5% complication rate). Stepwise multivariate logistic regression analysis showed a significant inverse correlation between the occurrence of post-operative complications and ridge width (p = 0.025). Seventy patients (35 test; 35 control) with a total of 127 implants were included in the final analysis. Mean ridge width gain was 3.7 ± 1.2 mm in the test and 3.7 ± 1.1 mm in the control group, with no significant difference between the two groups. No implant failure was recorded, with a mean follow-up of 42.7 ± 16.0 months after functional loading. Conclusions: SB and BS showed comparable clinical outcomes in horizontal ridge augmentation, resulting in sufficient crestal width increase to allow implant placement in an adequate bone envelope. Full article

Alveolar bone ridge resorption occurred after natural teeth loss and it can restrict the possibility of dental implants placement. The use of bone regenerative procedures is frequently required. The existing evidence regarding the efficacy of horizontal bone ridge augmentation trough guided bone regeneration (GBR) using polymeric membranes was stated. A systematic review and meta-analysis were performed. Electronic and manual literature searches were conducted. Screening process was done using the National Library of Medicine (MEDLINE by PubMed), Embase, and the Cochrane Oral Health. Included articles were randomized controlled trials and observational studies. Weighted means were calculated. Heterogeneity was determined using Higgins (I2). If I2 > 50% a random-effects model was applied. It was found that the mean of horizontal bone gain was 3.95 mm, ranging from 3.19 to 4.70 mm (confidence interval 95%). Heterogeneity is I2 = 99% (confidence interval 95%) and significance of the random-effects model was p < 0.001. The complications rate was 8.4% and membrane exposure was the most frequent. Through this study, we were able to conclude that the existing scientific evidence suggests that GBR using polymeric membranes is a predictable technique for achieving horizontal bone augmentation, thus, permitting a proper further implant placement. Full article

The aim of this work was to test the effectiveness of using enzymatically deantigenated equine bone block as a scaffold for guided bone regeneration (GBR) during a horizontal augmentation of the lower jaw. A partially edentulous atrophic mandible was augmented using an equine-derived block with an expanded polytetrafluoroethylene membrane. After 8.5 months, two bone core samples were collected at the augmentation site, and implants were placed. A definitive prosthesis delivered 6 months after implant placement provided excellent functional and aesthetic rehabilitation throughout the follow-up period. Histological and histomorphometrical analysis of the biopsies showed newly formed bone to be present and the residual biomaterial was still undergoing remodeling. Comparison of cone beam computed tomography scans taken before augmentation and 26 months later showed maintenance of ridge width and possible corticalization of the vestibular augmented ridge side. The equine-derived bone block placed in accordance with GBR principles provided a successful clinical, radiographic, and histological outcome. Full article