Effect of cross‐linked vs non‐cross‐linked collagen membranes on bone: A systematic review

Abstract

The aim of this study was to conduct a systematic review to compare the clinical outcomes of two different resorbable collagen membranes in terms of regenerated bone volume, postoperative complications and membrane degradation during bone regeneration procedures. Randomized controlled trials (RCT) or controlled trials (CT) that compared both techniques were reviewed on four electronic databases up to December 2015, a manual search was performed on the bibliography of the collected articles and the authors were contacted for additional references if undetected on the electronic and manual search. Membrane exposure was evaluated as a dichotomous outcome and the statistical unit was the membrane. The results were presented as relative risk (RR) with a 95% confidence interval. Eight RCTs and one CT were included in this study. The majority of the studies depicted a bone augmentation area, which ranged from 46.15% to 94.6% for the non-cross-link membranes and from 44% to 92.6% for the cross-link membranes at the 4-6 month re-entry surgery. From a total of 289 patients, a forest plot concerning the membrane exposure was constructed using the obtained RR of the included studies. The overall RR was 1.43 (95% CI: 0.85-2.39) with no statistically significant differences between the two groups, although with a marginal tendency towards higher exposure in the cross-link membrane group. This systematic review suggests the different membranes present themselves as appropriate for bone regeneration procedures, although cross-link membranes present higher rates of postoperative complications. However, more RCT with higher sample sizes are needed to evaluate the different membranes. The suggested lack of clinical differences between the compared membranes suggest that further cost-benefit ratio, tissue integration and postoperative complication oriented studies should be performed so that clinicians can take a patient-centred, evidencebased decision. K E Y W O R D Sbone grafting, membranes, regeneration, systematic review/meta-analysis

Selection of Collagen Membranes for Bone Regeneration: A Literature Review

“…It has been suggested that a 1-month barrier function time for each millimeter of bone regeneration is needed [43]. Garcia et al [44] in their study state that GBR procedures through resorbable CM achieve volumetric bone gains with no statistical significance between the cross-linked and the non-cross-linked membranes. Moses et al [45] also reported no substantial difference in preserving hard and soft tissue volume between cross-linked and non-cross-linked membranes.…”

Lateral onlay grafting using different combinations of soft‐type synthetic block grafts and resorbable collagen membranes: An experimental in vivo study

“…Cha et al () demonstrated the high biocompatibility and absence of a foreign body reaction when using a cross‐linked membrane. However, Jiménez Garcia, Berghezan, Caramês, Dard, and Marques () found no difference between cross‐linked and non‐cross‐linked membranes in terms of the regenerated bone volume.…”

In vitro observation of macrophage polarization and gingival fibroblast behavior on three‐dimensional xenogeneic collagen matrixes

“…Jiménez Garcia et al performed a systematic review of the effects of cross‐linked versus noncross‐linked collagen membranes on guided bone regeneration (GBR) techniques (Jiménez Garcia, Berghezan, Caramês, Dard, & Marques, ). Both types of collagen membranes achieved good volumetric bone gains without statistical significance between the cross‐linked and the noncross‐linked collagen membranes; however, the comparison of postoperative complications showed higher rates of postoperative complications, including membrane exposure, for cross‐linked membranes (Jiménez Garcia et al, ). This might be explained by interference with the inflammatory response and soft tissue healing, resulting in tissue integration and possibly bone regeneration (Rothamel et al, ).…”