Guided bone regeneration: A literature review

Document Type : Review Article(s)

Authors

1 Dentist, Private Practice, Kerman, Iran

2 Assistant Professor, Kerman Oral and Dental Diseases Research Center, Department of Periodontics, Dental School, Kerman University of Medical Sciences, Kerman, Iran

Abstract

Guided bone regeneration (GBR) is a reconstructive procedure of alveolar ridge using membranes. This procedure is indicated when there is no sufficient bone for implantation, or in the case of optimal implant installation for esthetic or functional needs. GBR can be performed before implant placement, when there is not enough bone for initial stability of implants and less predictable outcomes (staged approach), or performed simultaneously with implantation (combined approach). GBR techniques have been used for vertical and horizontal ridge augmentations with acceptable results. This literature review discusses the background, principles of GBR, the materials used in GBR (types of membranes and bone grafts), success criteria and long term results of GBR.

Keywords


  1. Schropp L, Wenzel A, Kostopoulos L, Karring T. Bone healing and soft tissue contour changes following singletooth
  2. extraction: a clinical and radiographic 12-month prospective study. Int J Periodontics Restorative Dent 2003;
  3. (4): 313-23.
  4. Urist MR. Bone: formation by autoinduction. Science 1965; 150(3698): 893-9.
  5. Buch F, Albrektsson T, Herbst E. The bone growth chamber for quantification of electrically induced osteogenesis.
  6. J Orthop Res 1986; 4(2): 194-203.
  7. Ilizarov GA. The tension-stress effect on the genesis and growth of tissues: Part II. The influence of the rate and
  8. frequency of distraction. Clin Orthop Relat Res 1989; (239): 263-85.
  9. Dahlin C, Linde A, Gottlow J, Nyman S. Healing of bone defects by guided tissue regeneration. Plast Reconstr Surg
  10. ; 81(5): 672-6.
  11. Nyman S, Karring T, Lindhe J, Planten S. Healing following implantation of periodontitis-affected roots into gingival
  12. connective tissue. J Clin Periodontol 1980; 7(5): 394-401.
  13. Melcher AH. On the repair potential of periodontal tissues. J Periodontol 1976; 47(5): 256-60.
  14. Karring T, Nyman S, Lindhe J. Healing following implantation of periodontitis affected roots into bone tissue. J
  15. Clin Periodontol 1980; 7(2): 96-105.
  16. Dahlin C, Gottlow J, Linde A, Nyman S. Healing of maxillary and mandibular bone defects using a membrane technique.
  17. An experimental study in monkeys. Scand J Plast Reconstr Surg Hand Surg 1990; 24(1): 13-9.
  18. Dahlin C, Sennerby L, Lekholm U, Linde A, Nyman S. Generation of new bone around titanium implants using a
  19. membrane technique: an experimental study in rabbits. Int J Oral Maxillofac Implants 1989; 4(1): 19-25.
  20. Schenk RK, Buser D, Hardwick WR, Dahlin C. Healing pattern of bone regeneration in membrane-protected defects:
  21. a histologic study in the canine mandible. Int J Oral Maxillofac Implants 1994; 9(1): 13-29.
  22. Wang HL, Carroll MJ. Guided bone regeneration using bone grafts and collagen membranes. Quintessence Int 2001;
  23. (7): 504-15.
  24. Wang HL, Boyapati L. "PASS" principles for predictable bone regeneration. Implant Dent 2006; 15(1): 8-17.
  25. Greenstein G, Caton JG. Biodegradable barriers and guided tissue regeneration. Periodontol 2000 1993; 1: 36-45.
  26. Hardwick R, Hayes BK, Flynn C. Devices for dentoalveolar regeneration: an up-to-date literature review. J Periodontol
  27. ; 66(6): 495-505.
  28. Scantlebury TV. 1982-1992: a decade of technology development for guided tissue regeneration. J Periodontol
  29. ; 64(11 Suppl): 1129-37.
  30. Buser D. Twenty years of guided bone regeneration in implant dentistry. 2nd ed. Chicago, IL: Quintessence; 2009.
  31. Buser D, Bragger U, Lang NP, Nyman S. Regeneration and enlargement of jaw bone using guided tissue regeneration.
  32. Clin Oral Implants Res 1990; 1(1): 22-32.
  33. Lundgren D, Lundgren AK, Sennerby L, Nyman S. Augmentation of intramembraneous bone beyond the skeletal
  34. envelope using an occlusive titanium barrier. An experimental study in the rabbit. Clin Oral Implants Res 1995;
  35. (2): 67-72.
  36. Jovanovic SA, Schenk RK, Orsini M, Kenney EB. Supracrestal bone formation around dental implants: an experimental
  37. dog study. Int J Oral Maxillofac Implants 1995; 10(1): 23-31.
  38. Lundgren AK, Sennerby L, Lundgren D. Guided jaw-bone regeneration using an experimental rabbit model. Int J
  39. Oral Maxillofac Surg 1998; 27(2): 135-40.
  40. Watzinger F, Luksch J, Millesi W, Schopper C, Neugebauer J, Moser D, et al. Guided bone regeneration with titanium
  41. membranes: a clinical study. Br J Oral Maxillofac Surg 2000; 38(4): 312-5.
  42. Hoffmann O, Bartee BK, Beaumont C, Kasaj A, Deli G, Zafiropoulos GG. Alveolar bone preservation in extraction
  43. sockets using non-resorbable dPTFE membranes: a retrospective non-randomized study. J Periodontol 2008; 79(8):
  44. -69.
  45. Bartee BK, Carr JA. Evaluation of a high-density polytetrafluoroethylene (n-PTFE) membrane as a barrier material
  46. to facilitate guided bone regeneration in the rat mandible. J Oral Implantol 1995; 21(2): 88-95.
  47. Walters SP, Greenwell H, Hill M, Drisko C, Pickman K, Scheetz JP. Comparison of porous and non-porous teflon
  48. membranes plus a xenograft in the treatment of vertical osseous defects: a clinical reentry study. J Periodontol 2003;
  49. (8): 1161-8.
  50. Pitaru S, Tal H, Soldinger M, Noff M. Collagen membranes prevent apical migration of epithelium and support new
  51. connective tissue attachment during periodontal wound healing in dogs. J Periodontal Res 1989; 24(4): 247-53.
  52. Blumenthal NM. The use of collagen membranes to guide regeneration of new connective tissue attachment in dogs.
  53. J Periodontol 1988; 59(12): 830-6.
  54. Minabe M, Kodama T, Kogou T, Tamura T, Hori T, Watanabe Y, et al. Different cross-linked types of collagen
  55. implanted in rat palatal gingiva. J Periodontol 1989; 60(1): 35-43.
  56. Charulatha V, Rajaram A. Influence of different crosslinking treatments on the physical properties of collagen
  57. membranes. Biomaterials 2003; 24(5): 759-67.
  58. Rothamel D, Schwarz F, Sager M, Herten M, Sculean A, Becker J. Biodegradation of differently cross-linked collagen
  59. membranes: an experimental study in the rat. Clin Oral Implants Res 2005; 16(3): 369-78.
  60. von AT, Buser D. Horizontal ridge augmentation using autogenous block grafts and the guided bone regeneration
  61. technique with collagen membranes: a clinical study with 42 patients. Clin Oral Implants Res 2006; 17(4): 359-66.
  62. Silverstein LH, Ccllon DP. Similarities Between an Acellular Dermal Allograft and a Palatal Graft, for Tissue Augmentation:
  63. Ctinical Report. Periodontal Insights 1999; 6: 3-6.
  64. Fowler EB, Breault LG, Rebitski G. Ridge preservation utilizing an acellular dermal allograft and demineralized
  65. freeze-dried bone allograft: Part I. A report of 2 cases. J Periodontol 2000; 71(8): 1353-9.
  66. Borges GJ, Novaes AB, Jr., Grisi MF, Palioto DB, Taba M, Jr., de Souza SL. Acellular dermal matrix as a barrier in
  67. guided bone regeneration: a clinical, radiographic and histomorphometric study in dogs. Clin Oral Implants Res
  68. ; 20(10): 1105-15.
  69. Oh TJ, Meraw SJ, Lee EJ, Giannobile WV, Wang HL. Comparative analysis of collagen membranes for the treatment
  70. of implant dehiscence defects. Clin Oral Implants Res 2003; 14(1): 80-90.
  71. Piattelli A, Scarano A, Coraggio F, Matarasso S. Early tissue reactions to polylactic acid resorbable membranes: a
  72. histological and histochemical study in rabbit. Biomaterials 1998; 19(10): 889-96.
  73. Von AT, Broggini N, Jensen SS, Bornstein MM, Schenk RK, Buser D. Membrane durability and tissue response of
  74. different bioresorbable barrier membranes: a histologic study in the rabbit calvarium. Int J Oral Maxillofac Implants
  75. ; 20(6): 843-53.
  76. Simion M, Maglione M, Iamoni F, Scarano A, Piattelli A, Salvato A. Bacterial penetration through Resolut resorbable
  77. membrane in vitro. An histological and scanning electron microscopic study. Clin Oral Implants Res 1997; 8(1):
  78. -31.
  79. Lundgren D, Laurell L, Gottlow J, Rylander H, Mathisen T, Nyman S, et al. The influence of the design of two different
  80. bioresorbable barriers on the results of guided tissue regeneration therapy. An intra-individual comparative
  81. study in the monkey. J Periodontol 1995; 66(7): 605-12.
  82. Garg AK, Gargenese D, Peace I. Using platelet-rich plasma to develop an autologous membrane for growth factor
  83. delivery in dental implant therapy. Dent Implantol Update 2000; 11(6): 41-4.
  84. Robinson E. Osseous coagulum for bone induction. J Periodontol 1969; 40(9): 503-10.
  85. Schallhorn RG, Hiatt WH, Boyce W. Iliac transplants in periodontal therapy. J Periodontol 1970; 41(10): 566-80.
  86. Froum SJ, Thaler R, Scopp IW, Stahl SS. Osseous autografts. I. Clinical responses to bone blend or hip marrow
  87. grafts. J Periodontol 1975; 46(9): 515-21.
  88. Bowen JA, Mellonig JT, Gray JL, Towle HT. Comparison of decalcified freeze-dried bone allograft and porous particulate
  89. hydroxyapatite in human periodontal osseous defects. J Periodontol 1989; 60(12): 647-54.
  90. Schallhorn RG, Hiatt WH. Human allografts of iliac cancellous bone and marrow in periodontal osseous defects. II.
  91. Clinical observations. J Periodontol 1972; 43(2): 67-81.
  92. Quintero G, Mellonig JT, Gambill VM, Pelleu GB, Jr. A six-month clinical evaluation of decalcified freeze-dried
  93. bone allografts in periodontal osseous defects. J Periodontol 1982; 53(12): 726-30.
  94. Yukna RA, Harrison BG, Caudill RF, Evans GH, Mayer ET, Miller S. Evaluation of durapatite ceramic as an alloplastic
  95. implant in periodontal osseous defects. II. Twelve month reentry results. J Periodontol 1985; 56(9): 540-7.
  96. Callan DP, Rohrer MD. Use of bovine-derived hydroxyapatite in the treatment of edentulous ridge defects: a human
  97. clinical and histologic case report. J Periodontol 1993; 64(6): 575-82.
  98. Misch CE, Dietsh F. Bone-grafting materials in implant dentistry. Implant Dent 1993; 2(3): 158-67.
  99. Shah P, Keppler L, Rutkowski J. A Review of Bone Morphogenic Protein : An Elixir for bone grafting. J Oral Implantol
  100. Yukna RA, Callan DP, Krauser JT, Evans GH, Aichelmann-Reidy ME, Moore K, et al. Multi-center clinical evaluation
  101. of combination anorganic bovine-derived hydroxyapatite matrix (ABM)/cell binding peptide (P-15) as a bone replacement
  102. graft material in human periodontal osseous defects. 6-month results. J Periodontol 1998; 69(6): 655-63.
  103. Bhatnagar RS, Qian JJ, Wedrychowska A, Sadeghi M, Wu YM, Smith N. Design of biomimetic habitats for tissue
  104. engineering with P-15, a synthetic peptide analogue of collagen. Tissue Eng 1999; 5(1): 53-65.
  105. Carvalho AL, Faria PE, Grisi MF, Souza SL, Taba MJ, Palioto DB, et al. Effects of granule size on the osteoconductivity
  106. of bovine and synthetic hydroxyapatite: a histologic and histometric study in dogs. J Oral Implantol 2007;
  107. (5): 267-76.
  108. Misiek DJ, Kent JN, Carr RF. Soft tissue responses to hydroxylapatite particles of different shapes. J Oral Maxillofac
  109. Surg 1984; 42(3): 150-60.
  110. Yang Y, Dennison D, Ong JL. Protein adsorption and osteoblast precursor cell attachment to hydroxyapatite of different
  111. crystallinities. Int J Oral Maxillofac Implants 2005; 20(2): 187-92.
  112. LeGeros RZ, LeGeros JP, Daculsi G, Kijkowska R. Calcium phosphate biomaterials: preparation, properties, and
  113. biodegradation. In: Wise DL, Trantolo DJ, Altobelli DE, Yaszemski MJ, Gresser JD, Schwartz ED, editors. Encyclopedic
  114. Handbook of Biomaterials and Bioengineering.New York, NY: Marcel Dekker; 1995.
  115. Takeshita F, Ayukawa Y, Iyama S, Suetsugu T, Oishi M. Histological comparison of early wound healing following
  116. dense hydroxyapatite granule grafting and barrier placement in surgically-created bone defects neighboring implants.
  117. J Periodontol 1997; 68(10): 924-32.
  118. Deligianni DD, Katsala ND, Koutsoukos PG, Missirlis YF. Effect of surface roughness of hydroxyapatite on human
  119. bone marrow cell adhesion, proliferation, differentiation and detachment strength. Biomaterials 2001; 22(1): 87-96.
  120. Oonishi H, Hench LL, Wilson J, Sugihara F, Tsuji E, Kushitani S, et al. Comparative bone growth behavior in granules
  121. of bioceramic materials of various sizes. J Biomed Mater Res 1999; 44(1): 31-43.
  122. Sun JS, Liu HC, Chang WH, Li J, Lin FH, Tai HC. Influence of hydroxyapatite particle size on bone cell activities:
  123. an in vitro study. J Biomed Mater Res 1998; 39(3): 390-7.
  124. Kuroda T. Bone formation and mechanical properties of the cancellous bone defect site filled with hydroxyapatite
  125. granules. Nihon Seikeigeka Gakkai Zasshi 1995; 69(10): 1037-49. [In Japanese].
  126. Aghaloo TL, Moy PK. Which hard tissue augmentation techniques are the most successful in furnishing bony support
  127. for implant placement? Int J Oral Maxillofac Implants 2007; 22(Suppl): 49-70.
  128. Simion M, Trisi P, Piattelli A. Vertical ridge augmentation using a membrane technique associated with osseointegrated
  129. implants. Int J Periodontics Restorative Dent 1994; 14(6): 496-511.
  130. Tinti C, Parma-Benfenati S, Polizzi G. Vertical ridge augmentation: what is the limit? Int J Periodontics Restorative
  131. Dent 1996; 16(3): 220-9.
  132. Esposito M, Grusovin MG, Coulthard P, Worthington HV. The efficacy of various bone augmentation procedures
  133. for dental implants: a Cochrane systematic review of randomized controlled clinical trials. Int J Oral Maxillofac Implants
  134. ; 21(5): 696-710.
  135. Esposito M, Grusovin MG, Felice P, Karatzopoulos G, Worthington HV, Coulthard P. The efficacy of horizontal
  136. and vertical bone augmentation procedures for dental implants - a Cochrane systematic review. Eur J Oral Implantol
  137. ; 2(3): 167-84.
  138. Park SH, Wang HL. Clinical significance of incision location on guided bone regeneration: human study. J Periodontol
  139. ; 78(1): 47-51.
  140. Wang HL, Al-Shammari K. HVC ridge deficiency classification: a therapeutically oriented classification. Int J Periodontics
  141. Restorative Dent 2002; 22(4): 335-43.
  142. Misch CE. Contemporary Implant Dentistry. 2nd ed. Louis, Missouri: Mosby; 1999.
  143. Kleinheinz J, Buchter A, Kruse-Losler B, Weingart D, Joos U. Incision design in implant dentistry based on vascularization
  144. of the mucosa. Clin Oral Implants Res 2005; 16(5): 518-23.
  145. Greenstein G, Greenstein B, Cavallaro J, Elian N, Tarnow D. Flap advancement: practical techniques to attain tension-
  146. free primary closure. J Periodontol 2009; 80(1): 4-15.
  147. Romanos GE. Periosteal releasing incision for successful coverage of augmented sites. A technical note. J Oral Implantol
  148. ; 36(1): 25-30.
  149. Kfir E, Kfir V, Eliav E, Kaluski E. Minimally invasive guided bone regeneration. J Oral Implantol 2007; 33(4): 205-10.
  150. de Conti OJ, Pastorello MT, Defino HLA. Bone decortication in spinal graft integration an experimental study. Acta
  151. Ortop Bras 2006; 14(2): 67-71.
  152. Gordh M, Alberius P, Lindberg L, Johnell O. Bone graft incorporation after cortical perforations of the host bed.
  153. Otolaryngol Head Neck Surg 1997; 117(6): 664-70.
  154. Nishimura I, Shimizu Y, Ooya K. Effects of cortical bone perforation on experimental guided bone regeneration.
  155. Clin Oral Implants Res 2004; 15(3): 293-300.
  156. Mellonig JT, Triplett RG. Guided tissue regeneration and endosseous dental implants. Int J Periodontics Restorative
  157. Dent 1993; 13(2): 108-19.
  158. Fugazzotto PA. Implant and Regenerative Therapy in Dentistry: A Guide to Decision Making. 1st ed. New Delhi:
  159. Wiley-Blackwell; 2009.
  160. Brunel G, Brocard D, Duffort JF, Jacquet E, Justumus P, Simonet T, et al. Bioabsorbable materials for guided bone
  161. regeneration prior to implant placement and 7-year follow-up: report of 14 cases. J Periodontol 2001; 72(2): 257-64.
  162. Lorenzoni M, Pertl C, Polansky R, Wegscheider W. Guided bone regeneration with barrier membranes--a clinical
  163. and radiographic follow-up study after 24 months. Clin Oral Implants Res 1999; 10(1): 16-23.
  164. Mayfield L, Skoglund A, Nobreus N, Attstrom R. Clinical and radiographic evaluation, following delivery of fixed
  165. reconstructions, at GBR treated titanium fixtures. Clin Oral Implants Res 1998; 9(5): 292-302.
  166. Nevins M, Mellonig JT, Clem DS, III, Reiser GM, Buser DA. Implants in regenerated bone: long-term survival. Int
  167. J Periodontics Restorative Dent 1998; 18(1): 34-45.
  168. Fugazzotto PA. Success and failure rates of osseointegrated implants in function in regenerated bone for 6 to 51
  169. months: a preliminary report. Int J Oral Maxillofac Implants 1997; 12(1): 17-24.
  170. Fugazzotto PA. Success and failure rates of osseointegrated implants in function in regenerated bone for 72 to 133
  171. months. Int J Oral Maxillofac Implants 2005; 20(1): 77-83.
  172. Simion M, Jovanovic SA, Tinti C, Benfenati SP. Long-term evaluation of osseointegrated implants inserted at the
  173. time or after vertical ridge augmentation. A retrospective study on 123 implants with 1-5 year follow-up. Clin Oral
  174. Implants Res 2001; 12(1): 35-45.
  175. Zarb GA, Alberktsson T. Criteria for determining clinical success with osseointegrated dental implants. Cah Prothese
  176. ; 71: 19-26. [In French].
  177. Zitzmann NU, Scharer P, Marinello CP. Long-term results of implants treated with guided bone regeneration: a 5-year prospective study. Int J Oral Maxillofac Implants 2001; 16(3): 355-66.