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Background/purpose Guided bone regeneration (GBR) is the most popular technique for alveolar ridge augmentation in implant dentistry, and resorbable cell barrier membrane, made of collagen, is widely used. We tried to develop a new resorbable cell barrier membrane from an animal-free product. This study aimed to investigate the safety and feasibility for clinical application of poly ( l -lactic acid/e-caprolactone) [P (LA/CL)] membrane, a novel biodegradable synthetic material used for GBR. Materials and methods Patients who required horizontal bone augmentation (≥3 mm implant exposure) for implant treatment were included in the study. P (LA/CL) membrane was used simultaneously with implant placement to achieve bone augmentation by GBR. The occurrence of adverse events was assessed until the follow-up period of a second surgical procedure. The amount of bone augmentation was assessed by means of cone-beam computed tomography, and implant stability was assessed by measuring the implant stability quotient (ISQ). Student's t-test was used and the level of significance was set at p Results This first-in-human study comprised five participants. Adverse events were observed in three of five patients, and a cause-and-effect relationship of the membrane could not be denied in one of them. Good bone formation was observed in the GBR region of all five patients. The ISQ during the second surgical procedure indicated good osseointegration in all the patients. Conclusion The application of P (LA/CL) membrane for bone augmentation with GBR made it possible to maintain the augmented bone volume without causing any irreversible adverse events. However, further investigations on humans are required to confirm the safety of this biomaterial.

Guided bone regeneration (GBR) is a therapeutic modality to achieve bone regeneration with the use of barrier membranes. The use of deproteinized bovine bone material (DBBM) for ridge preservation allows the preservation of the edentulous ridge dimensions. Here, we present a case of horizontal GBR using DBBM and a resorbable membrane, with simultaneous implant placement. Simultaneously, ridge preservation of the pontic area, using DBBM within a “socket seal” procedure was performed. Two implants were places at sites 23 and 26 to support a fixed partial denture (FPD). The mesial implant showed exposed buccal threads, which were then covered with autogenous bone particles and small size granules of DBBM. The collagen membrane was stabilized with periosteal mattress suture. Six months postoperatively, CBCT images revealed a stable buccal bone layer at the implant site, indicating a successful GBR procedure. At this point in time, tooth 24 was atraumatically extracted. A ridge preservation was done utilizing DBBM, and a soft tissue graft form the tuber. A ceramic-metal FPD with excellent “white aesthetics” and a harmonic transition zone to the soft tissue was fabricated. At 3 years follow up, the peri-implant bone levels were stable, and the clinical outcomes were excellent. It is concluded that a GBR procedure, utilizing DBBM and a collagen barrier membrane with simultaneous implant placement, as well as ridge preservation using DBBM, are predictable therapeutic methods. However, gentle manipulation of the soft tissues, and wound stability, with tension-free passive closure of the wound margins are prerequisites for a long-term clinical success.

Developmental anomalies are one of the challenging clinical conditions to achieve successful treatment outcomes. Among these, Palatogingival groove [PGG] is a rare developmental anomaly usually found on the palatal aspect of maxillary anterior teeth. As self-cleansing is difficult in such patients, it can lead to serious localized periodontal lesion or can occur in combination with endodontic lesion. It is our sole responsibility being a specialist in the field of dentistry, to early diagnose and provide treatment for such conditions. On the basis of PGG extension to the pulp, it can be classified as simple or complex; accordingly, plethora of treatment options are available. Clinically taking interdisciplinary treatment modalities into consideration, curettage of the involved gingival tissues, elimination of the groove by grinding (saucerization), or by sealing with a Biocompatible material which might enhance the healing potential. Incase if the groove extends beyond the middle-third of the root, surgical flap debridement along with combined use of barrier membrane and alloplastic bone graft are recommended. This article represents a rare clinical case reports in management of PGG defect with an innovative conservative approach for simple, minimal groove extensive case and groove extension beyond 1/3rd of the root region, treated with surgical multi-interdisciplinary approach. Keywords: Biodentine, Collagen Membranes, Endodontic­periodontal lesion, Maxillary lateral incisor, Palato­ gingival developmental groove, Platelet­rich fibrin, Saucerization.

Objective The effectiveness of GBR procedures for the reconstruction of periodontal defects has been well documented. The objective of this investigation was to evaluate the degradation kinetics and biocompatibility of two resorbable collagen membranes in conjunction with a bovine xenograft material. Materials and Methods Lower premolars and first molars were extracted from 18 male Yucatan minipigs. After 4 months of healing, standardized semi‐saddle defects were created (12 mm × 8 mm × 8 mm [l˙̇ × W˙ × d]), with 10 mm between adjacent defects. The defects were filled with a bovine xenograft and covered with a either the bilayer collagen membrane (control) or the porcine pericardium‐derived collagen membrane (test). Histological analysis was performed after 4, 8, and 12 weeks of healing and the amount of residual membrane evaluated. Non‐inferiority was calculated using the Brunner‐Langer mixed regression model. Results Histological analysis indicated the presence of residual membrane in both groups at all time points, with significant degradation noted in both groups at 12 weeks compared to 4 weeks (p = .017). No significant difference in ranked residual membrane scores between the control and test membranes was detected at any time point. Conclusions The pericardium‐derived membrane was shown to be statistically non‐inferior to the control membrane with respect to resorption kinetics and barrier function when utilized for guided bone regeneration in semi‐saddle defects in minipigs. Further evaluation is necessary in the clinical setting.

Introduction Periodontal regeneration of maxillary molar proximal furcation defects are challenging due to limited access. While combination therapy of open flap debridement with barrier membrane, bone graft, and biologics are reported to be more successful than monotherapeutic approaches, combination therapy can be complicated and costly. Case presentation A total of four teeth in three patients are presented to demonstrate radiographic bone regeneration of deep Class 2 maxillary molar proximal furcation defects (MMPFD) treated with microscope-assisted papilla preservation technique (PPT) and demineralized freeze-dried bone allograft (DFDBA). Conclusion(s) Radiographic bone regeneration of deep Class 2 MMPFD is possible with microscope-assisted PPT and DFDBA. Furthermore, treatment outcomes appear to be superior to those from previous clinical trials of Class 2 MMPFD treatment.

Tooth loss due to trauma often triggers residual alveolar resorption to a greater degree in the sagittal direction leading to atrophy. However, in a pediatric patient, if this defect is left untreated, it can cause further atrophy leading to collapse of the arch. In the maxillary anterior area, this is also of esthetic concern. Hence, it is viable to reconstruct the alveolar defects and restore the alveolar anatomy with superior quality of bone while the patient is still in growing phase to avoid any structural and dental malformation, as well as to provide a more novel treatment like dental implant at a later stage when growth ceases. Modes for successfully augmenting the bone are diverse. Among these, barrier membrane with guided bone regeneration, distraction osteogenesis, and bone block graft is ubiquitous. The current case report deals with the management of horizontal atrophic anterior maxillary region using autologous block bone graft harvested from mandibular symphysis, to augment the alveolar ridge and aid in esthetic and functional restoration of alveolar anatomy by restoring the defect with the bone of superior quality as well as preparing the site for receiving implant prosthesis in future when growth ceases. How to cite this article: Bhandary M, Hegde AM, Shetty R, et al. Augmentation of Narrow Anterior Alveolar Ridge Using Autogenous Block Onlay Graft in a Pediatric Patient: A Case Report. Int J Clin Pediatr Dent 2021;14(2):311–314.

Background/purpose Alveolar bone deficiency is sometimes found in the patients who need dental implantation. This study used autogenous bone grafts and titanium mesh-guided alveolar ridge augmentation for the patients with alveolar bone deficiency but requiring dental implantation. Materials and methods In this study, autogenous bone grafts and titanium mesh-guided alveolar ridge augmentation was performed in four patients with different situations of alveolar bone deficiency. The titanium mesh was used as the barrier membrane and provided support to the compartment which was filled with calcium sulfate materials. Autogenous bone fragments harvested from adjacent implant osteotomy or from cortical bone of the recipient site were spread on the external surface of titanium mesh as the resources of osteoblasts for new bone formation. Results Four months after above-mentioned procedures, cone-beam computed tomography showed adequate alveolar bone formation. The titanium mesh was removed and dental implant was placed in the augmented alveolar ridge at the same time. We found that secondary bone graft combined with autogenous bone and inorganic bovine bone were covered by the pseudo-periosteum and suitable for dental implantation in our four patients. The implants were submerged for 3–4 months till uncovering, and then the prostheses were delivered one month afterwards with successful clinical outcomes. Conclusion The clinical outcomes of our four patients indicate that the vital autogenous bone grafts and the titanium mesh possess the ability to induce and guide new bone formation in four months and can be successful used for alveolar ridge augmentation and subsequent dental implantation.

Background/Aim. Alveolar ridge dimensional alterations following tooth extraction in the anterior maxilla often result in an inadequate bone volume for a correct implant placement. In order to obtain optimal bone volume various bone graft substitutes have become commercially available and widely used for socket grafting. The aim of this study was to examine and compare long-term clinical outcomes of dental implant therapy in the maxillary esthetic zone, after socket grafting with beta-tricalcium phosphate (TCP) combined with collagen type I, either with or without barrier membrane and flap surgery, after a 12-month follow-up. Methods. Twenty healthy patients were allocated to either C group (beta-TCP and type I collagen without mucoperiosteal flap coverage) or C+M group (beta-TCP and type I collagen barrier membrane with mucoperiosteal flap coverage). Following clinical parameters were assessed: implant stability (evaluated by a resonance frequency analysis - RFA), periimplant soft tissue stability (sulcus bleeding index - SBI, Mombelli sulcus bleeding index - MBI, periimplant sulcus depth, keratinized gingiva width, gingival level) and marginal bone level at the retroalveolar radiograms. Results. Within C+M group, RFA values significantly increased 12 weeks after implant installation compared to primary RFA values. Comparison between investigated groups showed a significantly reduced keratinized gingiva width in the C+M group compared to the C group after 3, 6, 9 and 12 months. Comparison between groups revealed significantly lower gingival level values in the C+M group at 9th and 12th month when compared to the C group. Conclusion. Implant treatment in the anterior maxilla could be effective when using a 9 months alveolar ridge preservation healing with combined treatment with beta-tricalcium phosphate and type I collagen, with regard to the peri-implant soft and hard tissue stability., Uvod/Cilj. Posle ekstrakcije zuba, dimenzionalne promene alveolarnog grebena u estetskoj regiji gornje vilice za posledicu često imaju nedovoljnu količinu kosti za ugradnju zubnih implanata. U vezi sa tim, primenjuju se različiti koštani zamenici sa ciljem očuvanja dimenzija alveolarnog grebena posle ekstrakcije zuba. Cilj rada bio je da se, posle prezervacije alveolarnog grebena beta-trikalcijum fosfatom (TCP) sa kolagenom tip 1, sa barijernom membranom i mukoperiostalnim režnjem i bez nje, ispitaju i uporede klinički ishodi zarastanja posle ugradnje zubnih implanata u estetskoj regiji gornje vilice, tokom jednogodišnjeg perioda praćenja. Metode. Dvadeset zdravih bolesnika podeljeno je u dve grupe: C (beta TCP/kolagen tip 1 bez barijerne membrane i mukoperiostalnog režnja) i C+M (beta TCP/kolagen tip 1 sa barijernom membranom i mukoperiostalnim režnjem). Praćeni su uobičajeni klinički parametri ishoda terapije: implantna stabilnost (analiza rezonantne frekvence), stanje mekih tkiva (indeks krvarenja, plak indeks, širina pripojne mukoze, recesija gingive) i nivo periimplantnog koštanog tkiva na retroalveolarnom radiogramu. Rezultati. U C+M grupi, implantna stabilnost posle 12 nedelja bila je značajno veća u odnosu na primarnu stabilnost. U C+M grupi, širina keratinizovane gingive bila je značajno manja posle 3, 6, 9 i 12 meseci u odnosu na C grupu. Recesija gingive bila je značajno veća u C+M grupi u odnosu na C grupu posle 9 i 12 meseci. Zaključak. Razmatrajući stabilnost mekog i tvrdog periimplantnog tkiva, terapija zubnim implantima može biti uspešna prilikom ugradnje u estetskoj regiji gornje vilice.

Objectives: To test the hypothesis of no difference in implant treatment outcome following lateral alveolar ridge augmentation with autogenous bone block graft with or without barrier membrane coverage.Material and Methods: PubMed (MEDLINE), Embase and Cochrane library search in combination with a hand-search of relevant journals was conducted. Human studies published in English until the 8th of February 2021 were included. Randomised controlled trials with an observation period longer than three months were included. Survival of implants and suprastructures were considered as primary outcomes measures, whereas peri-implant marginal bone loss, dimensional changes of the alveolar ridge, bone regeneration, patient-reported outcome measures, biological and mechanical complications were secondary outcome measures, as evaluated by descriptive statistics and meta-analysis including 95% confidence interval (CI).Results: Electronic search and hand-searching resulted in 411 entries. Five randomised controlled trials characterised by low or high risk of bias fulfilled inclusion criteria. No statistically significant difference between the two treatment modalities was observed in any of the outcome measures. However, barrier membrane coverage was associated with a non-significant gain in alveolar ridge width of 0.5 mm (95% CI = -0.1 to 1.1) and diminished resorption of -0.9 mm (95% CI = -2.4 to 0.7) compared with no barrier membrane coverage.Conclusions: Comparable implant treatment outcomes were revealed following lateral alveolar ridge augmentation with autogenous bone block graft alone with or without barrier membrane coverage. However, postoperative dimensional changes of the augmented seems to be diminished with the use of barrier membrane coverage as evaluated by two-dimensional linear measurements.

Background: In dentistry, barrier membranes are used for guided tissue regeneration (GTR) and guided bone regeneration (GBR). Various membranes are commercially available and extensive research and development of novel membranes have been conducted. In general, membranes are required to provide barrier function, biosafety, biocompatibility and appropriate mechanical properties. In addition, membranes are expected to be bioactive to promote tissue regeneration. Objectives: This review aims to organize the fundamental characteristics of the barrier membranes that are available and studied for dentistry, based on their components. Results: The principal components of barrier membranes are divided into nonbiodegradable and biodegradable materials. Nonbiodegradable membranes are manufactured from synthetic polymers, metals or composites of these materials. The first reported barrier membrane was made from expanded polytetrafluoroethylene (e-PTFE). Titanium has also been applied for dental regenerative therapy and shows favorable barrier function. Biodegradable membranes are mainly made from natural and synthetic polymers. Collagens are popular materials that are processed for clinical use by cross-linking. Aliphatic polyesters and their copolymers have been relatively recently introduced into GTR and GBR treatments. In addition, to improve the tissue regenerative function and mechanical strength of biodegradable membranes, inorganic materials such as calcium phosphate and bioactive glass have been incorporated at the research stage. Conclusions: Currently, there are still insufficient guidelines for barrier membrane choice in GTR and GBR, therefore dentists are required to understand the characteristics of barrier membranes.

Crestal bone thickness is a critical determinant of peri-implant tissue stability. This retrospective observational study sought to quantify the buccal bone thickness achieved adjacent to virtual dental implants following guided bone regeneration (GBR) surgery and evaluate the influence of patient- and procedure-related variables on buccal bone thickness.Cone-beam computed tomography (CBCT) images acquired from patients who had undergone GBR surgery between July 1, 2012, and November 7, 2016, were used for this analysis. In all cases, the GBR procedure involved a dense polytetrafluoroethylene (dPTFE) barrier membrane and a mineralized cortical particulate freeze-dried bone allograft (FDBA). Eighty-four virtual dental implants were placed at planned locations using CBCT images from 84 patients, and the adjacent buccal bone thickness was measured at each site. The effects of sex, age, estimated baseline ridge width, number of missing teeth in site, site type (tooth-bounded versus terminal position in arch), dental arch (mandibular or maxillary), arch location (anterior or posterior), smoking status, titanium reinforcement in the membrane, membrane fixation, and tenting screw use were assessed.The mean post-GBR buccal bone thickness adjacent to virtual dental implants was 2.24 ± 1.01 mm. Fifty-nine of 84 virtual implants (70%) exhibited buccal bone thickness 1.9 mm. GBR sites using membrane fixation produced significantly greater virtual implant buccal bone thickness than those without membrane fixation (2.31 ± 0.96 versus 1.15 ± 1.25 mm, P = 0.012). Virtual implant buccal bone thickness also exhibited moderate correlation with estimated initial ridge width (r = 0.43, P 0.0001). The alveolar ridge at 81 virtual implant sites (96%) was classified as good or satisfactory, meaning dental implants were actually placed at these sites, with or without additional grafting at implant placement.Observations in this study suggest GBR procedures using dPTFE membranes and FDBA result in favorable ridge dimensions for dental implant placement in most cases. However, additional augmentation at implant surgery may be necessary at ≈ 30% of sites, if buccal bone thickness 1.9 mm is intended.

This case series is an attempt to evaluate the potentials of calcium sulfate as a regenerative modality in the treatment of furcation involvement. Conventionally, different types of alloplastic bone grafts such as demineralized freeze-dried bone allograft, freeze-dried bone allograft, beta-tricalcium phosphate (β-TCP), hydroxyapatite, bioactive glass, or a combination of these with barrier membrane have been employed. Very few studies have been carried out on human furcation involvement using calcium sulfate bone graft. The results obtained were encouraging in terms of regeneration. This case series sheds light on calcium sulfate in the management of furcal involvement.

Mucograft is collagen matrix was designed for use in open healing situations due to its compact outer layer. The technique presented in this article is an attempt to avail this attribute for covering open oral wound in guided bone regeneration (GBR) procedure. The essential idea of this technique is to avoid scoring of periosteum, submucosa and muscle layer for buccal flap advancement. Therefore, we used mucograft to cover bone substitute and barrier membrane in GBR surgical procedure. Thus, we avoided periostal-releasing incisions (PRI) and gained reposition of the flap to original level without impairing the attached keratinized gingiva. Buccal flap advancement in situations of shallow vestibulum, shortly attached gingiva and strong muscle pull may reduce or eliminate attached gingiva with an adverse effect on extended survival of placed implants. This technique promises to be beneficial for the preservation of the soft tissue around dental implants after GBR procedure.

Successful implant treatment requires prosthetically driven placement of an implant, primary stability at placement, and careful living bone management. The resorptive changes of alveolar bone are an inevitable process following tooth loss, periodontal disease or trauma which causes bone defects. This results in various aesthetic and functional complications such as soft tissue recession, infection and inflammation. Various methods have been tried and advocated for augmenting these bone deficiencies. Guided Bone Regeneration (GBR) is a successful modality for bone augmentation with a wide range of indications and helps restore the alveolar ridge dimensions. It utilises the principle of Guided Tissue Regeneration (GTR) for space maintenance within a bony defect. Different types of barrier membranes are being utilised along with various bone grafts in GBR. Thorough knowledge regarding the biology of bone is required before the initiation of any bone augmentation procedure. A combination of Collagen Membrane (CM) and graft material was found successful for GBR. Hence, this review focuses on presentation of best available evidence for various aspects of GBR.

An autogenous, demineralized, dentin matrix is a well-known osteo-inductive bone substitute that is mostly composed of type I collagen and is widely used in implant dentistry. This single case report describes a successful outcome in guided bone regeneration and dental implantation with a novel human-derived collagen membrane. The authors fabricated a dentin-derived-barrier membrane from a block-type autogenous demineralized dentin matrix to overcome the mechanical instability of the collagen membrane. The dentin-derived-barrier acted as an osteo-inductive collagen membrane with mechanical and clot stabilities, and it replaced the osteo-genetic function of the periosteum. Further research involving large numbers of patients should be conducted to evaluate bone forming capacity in comparison with other collagen membranes.

Objective To evaluate the influence of implant and prosthetic components on peri-implant tissue health. A further aim was to evaluate peri-implant soft-tissue changes following surgical peri-implantitis treatment. Materials and methods Group discussions based on two systematic reviews (SR) and one critical review (CR) addressed (i) the influence of implant material and surface characteristics on the incidence and progression of peri-implantitis, (ii) implant and restorative design elements and the associated risk for peri-implant diseases, and (iii) peri-implant soft-tissue level changes and patient-reported outcomes following peri-implantitis treatment. Consensus statements, clinical recommendations, and implications for future research were discussed within the group and approved during plenary sessions. Results Data from preclinical in vivo studies demonstrated significantly greater radiographic bone loss and increased area of inflammatory infiltrate at modified compared to non-modified surface implants. Limited clinical data did not show differences between modified and non-modified implant surfaces in incidence or progression of peri-implantitis (SR). There is some evidence that restricted accessibility for oral hygiene and an emergence angle of >30 combined with a convex emergence profile of the abutment/prosthesis are associated with an increased risk for peri-implantitis (CR). Reconstructive therapy for peri-implantitis resulted in significantly less soft-tissue recession, when compared with access flap. Implantoplasty or the adjunctive use of a barrier membrane had no influence on the extent of peri-implant mucosal recession following peri-implantitis treatment (SR). Conclusions Prosthesis overcontouring and impaired access to oral hygiene procedures increases risk for peri-implantitis. When indicated, reconstructive peri-implantitis treatment may facilitate the maintenance of post-operative peri-implant soft-tissue levels.

To date, there are no bioresorbable alternatives to non-resorbable and volume-stable membranes in the field of dentistry for guided bone or tissue regeneration (GBR/GTR). Even magnesium (Mg) has been shown to constitute a favorable biomaterial for the development of stabilizing structures. However, it has been described that it is necessary to prevent premature degradation to ensure both the functionality and the biocompatibility of such Mg implants. Different coating strategies have already been developed, but most of them did not provide the desired functionality. The present study analyses a new approach based on ion implantation (II) with PVD coating for the passivation of a newly developed Mg membrane for GBR/GTR procedures. To demonstrate comprehensive biocompatibility and successful passivation of the Mg membranes, untreated Mg (MG) and coated Mg (MG-Co) were investigated in vitro and in vivo. Thereby a collagen membrane with an already shown biocompatibility was used as control material. All investigations were performed according to EN ISO 10993 regulations. The in vitro results showed that both the untreated and PVD-coated membranes were not cytocompatible. However, both membrane types fulfilled the requirements for in vivo biocompatibility. Interestingly, the PVD coating did not have an influence on the gas cavity formation compared to the uncoated membrane, but it induced lower numbers of anti-inflammatory macrophages in comparison to the pure Mg membrane and the collagen membrane. In contrast, the pure Mg membrane provoked an immune response that was fully comparable to the collagen membrane. Altogether, this study shows that pure magnesium membranes represent a promising alternative compared to the nonresorbable volume-stable materials for GBR/GTR therapy.

Autogenous and allogeneic demineralized dentin matrices (Auto-DDM and Allo-DDM, respectively) are currently used for guided bone regeneration (GBR). Buccal marginal bone (BMB) resorption is critical for successful implant integration. This study analyzed BMB resorption around dental implants for GBR between the control group (Auto-DDM graft) and experimental group (Allo-DDM graft). From 2014 to 2019, we enrolled 96 patients (59 males, 37 females, average 57.13 years) who received GBR (52 and 44 using Allo-DDM and Auto-DDM, respectively,) without a barrier membrane and a simultaneous single dental implantation (54 in the maxilla and 42 in the mandible). BMB height was measured immediately after GBR, at prosthetic loading, and 12 months after loading. BMB resorption was classified as initial resorption (between GBR and prosthetic loading) and functional resorption (during 12 months after prosthetic loading). The differences in the BMB levels of Auto-DDM and Allo-DDM were analyzed between the initial and functional resorption stages by independent sample t-test. Auto-DDM and Allo-DDM showed similar BMB changes in initial resorption (0.73 &plusmn, 0.97 and 0.72 &plusmn, 0.77 mm, respectively) and functional resorption (0.69 &plusmn, 0.81 and 0.48 &plusmn, 0.58 mm, respectively) without a significant difference between the maxilla and mandible. For GBR, Allo-DDM is comparable to Auto-DDM in terms of BMB resorption.

Dental implant therapy often requires bone augmentation to facilitate stable implantation with a predictable outcome. Traditionally, this is accomplished through guided bone regeneration (GBR), which is a series of surgical procedures that use barrier membrane technology to direct the growth of new hard and soft tissues in sites with insufficient volumes for the purpose of placing dental implants. GBR and implant placement can be performed in either one or two surgeries. This article will focus on a novel simultaneous approach that utilizes a custom milled cancellous allograft bone ring that is stabilized through the graft preparation and apical threads of the dental implant. Indications include simultaneous implant placement in a deficient sinus as well as horizontal and vertical four-, three-, two-, and one-wall defects.

Objectives Test the hypothesis of no difference in implant treatment outcomes after maxillary sinus floor augmentation with or without barrier membrane coverage of the lateral window. Material and Methods A MEDLINE (PubMed), Embase and Cochrane library search in combination with a hand-search of relevant journals was conducted. Human studies published in English until the 5th of July, 2019 were included. Randomised controlled trials and controlled trials with an observation period of minimum six months were included. Primary outcomes included survival of suprastructures and implants. Secondary outcomes included implant stability quotient, peri-implant marginal bone loss, bone regeneration, patient-reported outcome measures, biologic and mechanical complications. Results The electronic search and hand-searching resulted in 1068 entries. Six randomised controlled trials characterised by low to high risk of bias and one controlled trial with high risk of bias fulfilled the inclusion criteria. High implant survival rate was reported with both treatment modalities. Meta-analyses disclosed a mean difference of newly formed bone of 6.4% (confidence interval = 0 to 12.9) and non-mineralised tissue of -1.1% (confidence interval = -2.7 to 0.5), indicating more newly formed bone and diminished non-mineralised with barrier membrane coverage. Conclusions There seem to be no statistically significant differences in implant treatment outcomes after maxillary sinus floor augmentation with or without barrier membrane coverage of the lateral window. However, barrier membrane coverage increases percentage of newly formed bone and diminishes proliferation of non-mineralised tissue. Thus, barrier membrane coverage seems to be beneficial and also preventing displacement of the grafting material.

Gingival recession is defined as displacement of gingival margin apical to cementoenamel junction. Over the years gingival recession has been treated by a number of surgical techniques. Conventional mucogingival procedures such as the laterally positioned flap, free gingival graft, connective tissue graft and coronally positioned flap have been shown to be relatively successful in achieving root coverage. Gingival tissue regeneration (GTR) based root coverage has emerged as an alternative treatment because it demonstrates histologically new attachment formation. The aim of this study was to compare coronally positioned flap procedures in gingival recession defects with or without using a collagen barrier membrane.

Aim or Purpose To evaluate the clinical performance of a new Australian bioactive collagen membrane (BCM) in guided bone regeneration (GBR) for bone defects surrounding dental implants. Materials and Methods We used this BCM in patients who required dental implant treatment with GBR. Patients who fulfilled the eligibility criteria (N = 20) received dental implants (N=27) with GBR using the BCM and void filling material (natural bone mineral). Implant sites were allowed to heal for approximately 6 months before re-entry surgery (two-stage; N=10) or restoration (single-stage; N=10). Mucosal tissue conditions and evidence of wound dehiscence or membrane exposure were recorded during the healing period. The quality of newly formed bone was assessed using the QT Scale at the time of re-entry surgery. Vertical (defect height) and horizontal (facial bone wall thickness) dimensions were measured immediately after implant placement (baseline) and prior to re-entry surgery/restoration by CT scan. Results The BCM demonstrated excellent handling properties during surgery and retained its barrier structure over 4 months with no adverse tissue reactions, adverse events or membrane exposures. CT scans showed evidence of accelerated mature bone formation necessary for implant stability. Conclusions The results of this study indicate that this new bioactive collagen membrane is able to preserve and restore bone volume required for successful functional and aesthetic outcomes in dental implant treatment.

This study investigated the dimensional change and microstructure of intraoral bone block grafts covered with platelet-rich fibrin (PRF) and a barrier membrane in ridge augmentation. Seven patients were included, with 18 implant sites (10 ramus and 8 symphysis). The average final ridge width gains in the ramus from cast-based measurement (3.86 ± 0.87 mm) and cone beam computed tomography measurements (3.63 ± 1.38 mm) were not different from the symphysis (3.36 ± 2.26 mm and 3.44 ± 1.52 mm, respectively). Ridge width reduction of the ramus (-10.46 ± 10.55%) was higher than the symphysis (-5.04 ± 2.08%). The ramus showed bone volume fractions from the microcomputed tomography (84.66 ± 8.36%) and percentage of bone area from histomorphometry (80.29 ± 12.03%) that were comparable to those for the symphysis (83.13 ± 8.1% and 84.98 ± 14.50%, respectively). The dimensional change of the intraoral block graft covered with PRF and a resorbable membrane was minimal, and the symphysis graft was less resorbed than the ramus graft. Nevertheless, their microstructures were comparable.

We evaluated the effectiveness of the open membrane technique using a high-density polytetrafluoroethylene (dPTFE) membrane with freeze-dried bone allografts in damaged sockets for alveolar ridge preservation (ARP). This retrospective study included 26 sites from 20 patients who had received ARP for the placement of dental implants. ARP was conducted using dPTFE membrane with allografts on the day of extraction without primary closure. When the membrane was removed after 4 weeks, the newly formed reddish tissue at the grafted site was checked (first outcome, clinical evaluation). Four months after membrane removal, a core biopsy was performed from the center of the grafted site before implant placement (second outcome, histomorphometric evaluation). Radiographic measurements of alveolar bone changes between implant prosthesis delivery and the 1-year follow-up were obtained (third outcome, radiographic evaluation). A total of 23 sites from 18 patients had no complications during the follow-up period. Three sites from two patients were excluded because of early membrane removal. Newly formed reddish tissue was found at 15 sites, and partially formed tissue was found at 8 sites. Although we were unable to harvest bone core from all sites, histomorphometric analysis in 11 patients indicated that the mean area of new bone was 28.48% ± 6.60%, that of the remaining graft particle was 27.68% ± 9.18%, and that of fibrous tissue was 43.84% ± 6.98%. The mean loss of marginal bone was 0.13 ± 0.06 mm at the mesial area and 0.15 ± 0.06 mm at the distal area, as assessed using radiographic evaluations. The results of this nonrandomized study suggest that this technique may be an appropriate procedure for ARP. Further studies with a control group and more subjectives can be designed based on this study.

Introduction: To the best of the authors’ knowledge, this is the first case report to describe the use of a perforated resorbable barrier membrane (PRBM) to enhance lateral bone augmentation for implant site development.Case Presentation: A 41-year-old female presented to the Advanced Specialty Education Program in Periodontics at Stony Brook University, Stony Brook, New York, for implant consultation regarding a missing maxillary right lateral incisor. The tooth had been lost as a result of trauma 10 years prior to presentation. Clinical examination and radiographs showed significant horizontal ridge deficiency (

Periodontal disease is categorized by the destruction of periodontal tissues. Over the years, there have been several clinical techniques and material options that been investigated for periodontal defect repair/regeneration. The development of improved biomaterials for periodontal tissue engineering has significantly improved the available treatment options and their clinical results. Bone replacement graft materials, barrier membranes, various growth factors and combination of these have been used. The available bone tissue replacement materials commonly used include autografts, allografts, xenografts and alloplasts. These graft materials mostly function as osteogenic, osteoinductive and/or osteoconductive scaffolds. Polymers (natural and synthetic) are more widely used as a barrier material in guided tissue regeneration (GTR) and guided bone regeneration (GBR) applications. They work on the principle of epithelial cell exclusion to allow periodontal ligament and alveolar bone cells to repopulate the defect before the normally faster epithelial cells. However, in an attempt to overcome complications related to the epithelial down-growth and/or collapse of the non-rigid barrier membrane and to maintain space, clinicians commonly use a combination of membranes with hard tissue grafts. This article aims to review various available natural tissues and biomaterial based bone replacement graft and membrane options used in periodontal regeneration applications.

Background: The aim of this study was to investigate the possible use of Polypropylene mesh implant and A-PRF membrane for covering the defects of the lateral and back wall of the maxillary sinus after its traumatic damages. Materials: non-resorbable Polypropylene mesh implant was used in 10 patients as a barrier membrane for prevention of adipose tissue herniation into maxillary sinus. Method: 3 D CT was used for assessment of bone fragments position and volumetric parameters of the maxillary sinus before and after surgical repair. Result: Postoperative 3-D CT after 2 months demonstrated effective reestablishment of anatomical configuration of sinus and its volume, absence of pathological inflammatory changes of the sinus mucosa. Conclusion: Polypropylene mesh implant provides effective barrier between soft tissues and maxillary sinus, due to its strength characteristic and biocompatibility.

Aim The present study was primarily designed to evaluate the outcome of guided bone graft regeneration in peri-implant defects by combining recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and granules of beta-tricalcium phosphate (B-TCP) mounted by resorbable biomesh membrane. Secondary objective was to determine the value of resorbable barrier membrane to improve the efficacy of the growth factormediated regeneration. Materials and methods A randomized controlled study comprised 14 participants (8 males and 6 females, mean age 37 years, range 19—55 years), in which a total of 15 implants (10 in maxilla and 5 in the mandible) were placed. Fifteen implant sites were randomly divided by picking a code into three groups: Test group I (n = 5) ß-TCP + rhPDGF (0.3 mg/mL) + biomesh, test group II (n = 5) ß-TCP + rhPDGF, and control (n = 5) ß-TCP + biomesh. The experimental site was examined clinically for the gingival status and radiographically for the bone status. Results Statistically significant difference in preoperative and postoperative measurements was observed for test groups I and II in all the parameters except width; in contrast, there was no significant difference observed for the control group from baseline to 5 months postoperatively. On intergroup comparison, statistically significant difference was observed between test group I vs control group and test group II vs control group, but it was not significant between test groups I and II, which was further confirmed using global performance scale score. Conclusion It concluded that rhPDGF-BB and ß-TCP mounted by resorbable biomesh membrane played a synergistic role in the management of peri-implant defects. Clinical significance Bone regenerated using ß-TCP with rhPDGF-BB in the reversal of peri-implant defects. How to cite this article Arora R, Verma UP, Dixit J, Lal N. Synergistic Effects of Growth Factor, Bone Graft, and Resorbable Barrier Membrane in Management of Dehiscence and Fenestration of Dental Implants. World J Dent 2017;8(3):177-182.

Recession on the lingual aspect of mandibular incisors may occur in patients with history of tongue piercing and other factitious traumatic habits. Treatment of these areas is challenging due to the site-specific anatomical features of the region. This case report presents a novel approach for a specific type of mandibular lingual defect caused by tongue piercing. A nonresorbable titanium-reinforced barrier membrane combined with an allograft and enamel matrix derivatives was used to promote regeneration of periodontal attachment. Reentry surgery for membrane removal was performed at 8 weeks. The time from initial surgery to final follow-up was 18 months.

Aim. The study aims to clinically and radiographically compare the bucco-lingual crestal bone changes after immediate and delayed placement of implants. Methods. Two groups that consisted of fifty implants were considered for this study. In group A the implants were placed immediately post extraction, whereas, in group B implants placement were delayed by four to six weeks. All the implants were submerged within the alveoli confines. Bone grafts were only placed if the jumping distance was more than 1.5 mm. Barrier membrane was not placed in any of the cases. Bucco-lingual width was measured at the time of implant placement and during abutment placement after four to six weeks. Primary flap closure was ensured in all the cases. Results. Thirty-one implants were placed in the mandible and nineteen were placed in the maxilla. All the implants achieved osseointegration. Immediate implant group showed a mean width of 8.80 mm (SD2.280) at the time of implant placement whereas, 7.60 mm (SD 1.871) after six months. Delayed implant group showed a mean width of 8.40 mm (SD1.673) at the time of implant placement, and 7.40 mm (SD 1.658) after six months. Intragroup showed statistically significant data (P

Objective. The aim of the study is to evaluate the effects of multilaminated small intestinal submucosa (mSIS) combined with bone substitute material to repair peri-implant defects during guided bone regeneration procedures. Methods. Twelve implants were placed in bilateral lower premolars of three beagle dogs, and a peri-implant buccal bone defect (3 mm width and 4 mm height) was created at each implant site. A total of 12 sites were filled with a particulate bone substitute material and then randomly divided into three treatment groups: covered by mSIS membrane (mSIS group), covered by collagen membrane (BG group), and no treatment (control group), each group of four sites. After 12 weeks of healing, all of the animals were euthanized and dissected blocks were obtained for micro-computed tomography (micro-CT) and histological analyses. Results. Micro-CT results revealed similar horizontal width of augmented tissue and new bone formation between mSIS and BG groups (P<0.05). Histological analyses revealed that the differences in horizontal widths of newly formed bone and bone-to-implant contact between mSIS and BG groups were not significant (P>0.05). All of these parameters were significantly different from those in the control group (P<0.05). Conclusions. These findings confirmed that mSIS combined with the bone substitute material enhanced bone regeneration in peri-implant defects, in a manner similar to that of a collagen membrane.

BACKGROUND AND AIMS: Bone augmentation procedures to enable dental implant placement are frequently performed. The remit of this working group was to evaluate the current evidence on the efficacy of regenerative measures for the reconstruction of alveolar ridge defects.MATERIAL AND METHODS: The discussions were based on four systematic reviews focusing on lateral bone augmentation with implant placement at a later stage, vertical bone augmentation, reconstructive treatment of peri-implantitis associated defects, and long-term results of lateral window sinus augmentation procedures.RESULTS: A substantial body of evidence supports lateral bone augmentation prior to implant placement as a predictable procedure in order to gain sufficient ridge width for implant placement. Also, vertical ridge augmentation procedures were in many studies shown to be effective in treating deficient alveolar ridges to allow for dental implant placement. However, for both procedures the rate of associated complications was high. The adjunctive benefit of reconstructive measures for the treatment of peri-implantitis-related bone defects has only been assessed in a few RCTs. Meta-analyses demonstrated a benefit with regard to radiographic bone gain but not for clinical outcomes. Lateral window sinus floor augmentation was shown to be a reliable procedure in the long-term for the partially and fully edentulous maxilla.CONCLUSIONS: The evaluated bone augmentation procedures were proven to be effective for the reconstruction of alveolar ridge defects. However, some procedures are demanding and bear a higher risk for postoperative complications. This article is protected by copyright. All rights reserved.

Thirty-eight patients (aged 25 to 74) requesting extraction-socket and sinus augmentation procedures (27 and 11 patients, respectively) prior to implant placement volunteered to participate in this case series protocol. Surgical sites were grafted with either biphasic calcium phosphate (BCP) + collagen (for extraction-socket augmentation) or BCP with a collagen barrier membrane (for maxillary sinus augmentation). All patients completed the 1-year postloading follow-up, which consisted of clinical and radiographic evaluations. No implants were lost, and both healthy soft tissue support and good radiographic evidence of supporting bone were found around implants. The result of this short-term evaluation of implants placed in areas grafted with alloplasts seemed to be favorable and promising.