Clinical and histological evaluations of alveolar ridge augmentation using a novel bi-layered porous polyethylene barrier membrane

Abstract

Guided bone regeneration (GBR) is an effective alveolar ridge reconstruction technique used before or at implant placement. The combination of various barrier membranes and bone substitutes has been employed. This study aimed to perform a preliminarily evaluation of the safety and performance of a new nonabsorbable bi-layered porous polyethylene (PPE) membrane, in combination with a freeze-dried cortical bone allograft in posterior mandibular ridge augmentation. Fifteen adults who had combined posterior mandibular defects were included for ridge augmentation via GBR using PPE membrane and allograft before implant placement. The keratinized mucosa width (KW), ridge width (RW), ridge height (RH), distance from measurement matrix to bone (DMB), and horizontal alveolar width at 14.0 mm apical to the occlusal plane (HAW) were clinically measured at 15 intended implant sites before and after the augmentation. Fifteen biopsy specimens were harvested at the implant sites for histological analysis. All the subjects completed the whole study. The KW and RH showed minor gains by 0.2 ± 1.4 mm and 0.9 ± 2.3 mm respectively; however, no statistically significant differences were found between, before, and after the augmentation (P > 0.05). In contrast, the RW and HAW significantly increased by 4.8 ± 1.6 mm and 2.3 ± 1.7 mm, respectively, (P ≤ 0.001), while DMB significantly decreased by 1.0 ± 0.8 mm after treatment (P < 0.001). Histological analysis revealed that allograft underwent active bone remodeling. The PPE membrane was adequately safe and efficient to use with allograft in GBR for the reconstruction of combined ridge defects. Although some complications were observed, these were manageable and subsequently lead to successful implant placement for all the subjects. However, further randomized controlled trials are still needed to confirm these findings.

Healing complications and their detrimental effects on bone gain in vertical‐guided bone regeneration: A systematic review and meta‐analysis

“…(Table 2). Twenty one studies recruited participants based on specific restrictions in terms of smoking habits (excluded all current smokers 42,50,56,60,62,64,65 ; smokers who smoked >10 cigarettes a day 46,47,51–53,61,63,66,68 ; >15 cigarettes a day 40 ; >19 cigarettes a day 17 ; >20 cigarettes a day 43,44,49 ). Nineteen studies recruited participants based on specific exclusion criteria based on periodontal disease status or oral hygiene (excluded patients with full mouth plaque score and bleeding score ≥ 20% 17 ; >25% 51,52,61 ; poor oral hygiene 42,63 ; active or uncontrolled periodontal disease 40,45–47,50,53,55,56,60,65,66,68 ), and two studies had participants with periodontitis undergo periodontal therapy prior to any GBR procedure or implant placement 41,55 …”

“…All but two studies reported on the mean age or age range of the participants. 51,60 Five randomized clinical trials, 39,41,42,44,45 one prospective cohort study, 47 and six case series 17,57,60,62,63,66 were registered and approved by an ethics committee.…”

“…A total of 12 studies used a staged GBR approach only, 17,39,42,44,45,54,56,[62][63][64][65][66] 11 studies used a simultaneous GBR approach. 41,43,46,49,51,55,[59][60][61]67,68 Eight studies included both simultaneous and staged GBR approaches, 40,47,48,50,52,53,57,58 with the latter being used when presented with more severe osseous defects and in cases where primary implant stability could not be predictably achieved at the bone grafting stage.…”

“…Sixteen studies combined the use of a resorbable membrane with a space maintainer, either with a titanium mesh, 39,41,54,60 an osteosynthesis plate, 43,44,49 an autogenous bone plate, 17,66 tenting screws (in staged GBR cases), 42,45,47,63 or the implants themselves (in simultaneous GBR cases). 47,55,67 The resorbable membranes used were either non-cross-linked collagen membranes, 17,39,[42][43][44][45]49,60,66,67 cross-linked collagen membranes, 41,54 or synthetic polyester membrane.…”

“…47,55,67 The resorbable membranes used were either non-cross-linked collagen membranes, 17,39,[42][43][44][45]49,60,66,67 cross-linked collagen membranes, 41,54 or synthetic polyester membrane. 63 Twenty four studies used non-resorbable membranes, and were either titanium-reinforced expanded polytetrafluoroethylene (e-PTFE) 40,43,46,[48][49][50][51][52][53]58,59,61,62,64,68 or titanium-reinforced dense polytetrafluoroethylene (d-PTFE) 41,46,56,57,65 membranes. In cases of staged GBR with the use of non-resorbable membranes, seven studies used tenting screws for additional space maintenance, 40,48,52,53,56,57,64 while four did not.…”