Horizontal Augmentation of Chronic Mandibular Defects by the Guided Bone Regeneration Approach: A Randomized Study in Dogs

Abstract

Various biomaterial combinations have been studied focusing on their ability to stabilize blood clots and maintain space under soft tissue to support new bone formation. A popular combination is Deproteinized Bovine Bone Mineral (DBBM) placed with a native collagen membrane (NCM) tacked to native bone. In this study, we compared the outcome of this treatment option to those achieved with three different graft/membrane combinations with respect to total newly occupied area and the mineralized compound inside. After bi-lateral extraction of two mandibular premolars in five adult beagles L-shaped alveolar defects were created. A total of 20 defects healed for 6 weeks resulting in chronic type bone defects. At baseline, four options were randomly allocated to five defects each: a. DBBM + NCM with a four-pin fixation across the ridge; b. DBBM + RCLC (ribose cross-linked collagen membrane); c. DBBM + NPPM (native porcine pericardium membrane); and d. Ca-sulfate (CS) + RCLC membrane. Membranes in b/c/d were not fixed; complete tensionless wound closure was achieved by CAF. Termination after 3 months and sampling followed, and non-decalcified processing and toluidine blue staining were applied. Microscopic images obtained at standardized magnification were histomorphometrically assessed by ImageJ software (NIH). An ANOVA post hoc test was applied; histomorphometric data are presented in this paper as medians and interquartile ranges (IRs). All sites healed uneventfully, all sites were sampled and block separation followed before Technovit embedding. Two central sections per block for each group were included. Two of five specimen were lost due to processing error and were excluded from group b. New bone area was significantly greater for option b. compared to a. (p = 0.001), c. (p = 0.002), and d. (p = 0.046). Residual non-bone graft area was significantly less for option d. compared to a. (p = 0.026) or c. (p = 0.021). We conclude that collagen membranes with a prolonged resorption/barrier profile combined with bone substitutes featuring different degradation profiles sufficiently support new bone formation. Tacking strategy/membrane fixation appears redundant when using these biomaterials.

Barrier Membranes for Guided Bone Regeneration (GBR): A Focus on Recent Advances in Collagen Membranes

“…Another important disadvantage of this material class is the rapid fragmentation and degradation after gingival dehiscence with membrane exposure and related decreased bone regeneration [ 2 ].Thus, various methods such as physical/chemical/enzymatic and crosslinking strategies such as ultraviolet (UV) radiation, genipin (Gp), and glutaraldehyde treatments have been analyzed, to extend both the degradation time and mechanical properties of collagen membranes for overcoming the current material deficiencies [ 19 , 20 ]. In addition, collagen membranes are often combined with different agents such as bone grafts or resorbable stabilizing structures such as magnesium meshes to increase their regenerative capacities and to prevent membrane collapse and volume stability [ 21 , 22 ]. A further focus for improvement of the performance of a resorbable barrier membrane is to have influence on their “bioactivity”, including factors such as transmembraneous vascularization or different approaches for “immunomodulating” properties such as influence on macrophage phenotypization [ 19 , 23 ].…”

Combined Sinus Grafting and Lateral Augmentation by a Hyaluronic Acid-Facilitated Guided Bone Regeneration Protocol – Case Series Supported by Human Histologic Analysis

“…To overcome this limitation, we used "sticky bone" defects. ribose cross-linked collagen membrane served as a suffi cient barrier between the augmented site and the soft tissue, characterized by promoting signifi cantly more new bone formation and less residual graft particles compared to a native collagen membrane, even without additional fi xation at surgery [52]. A higher number of treated patients is required to substantiate these observations.…”

“…The authors compare the outcome from the μCT analysis of the core biopsies retrieved at implant placement to the CBCT data. According to the data from an animal study[52] the radiographically based analysis alone should be treated with caution once xenograft particulate material is the substitute of choice.Besides the sophisticated bone graft combination, one more factor accounts for the treatment success of our modifi ed GBR protocol in lateral and vertical augmentation.The use of a slow-resorbing ribose crosslinked collagen membrane instead of a fast-resorbing conventional native collagen membrane may additionally promote the integration of the substitute into newly formed bone. A recent animal study confi rms the impact of membrane longevity towards new bone formation in lateral augmentation of chronic bone…”

Impact of Cross-Linked Hyaluronic Acid on Osteogenic Differentiation of SAOS-2 Cells in an Air-Lift Model

“…Several groups claimed from their studies that the GTR membrane materials per se differentially affect cell proliferation and differentiation in the process of periodontal tissue regeneration [ 43 , 44 , 45 , 46 ]. We can speculate that the loosely arranged collagen structure of the NPPM membrane was more efficiently saturated by the viscous xHyA gel than the very condensed RCCM material [ 47 ]. In saying this, we conclude that the NPPM became a kind of “container” device for xHyA, continuously delivering it to the cells seeded upon.…”