The role of barrier membranes for guided bone regeneration and restoration of large bone defects: current experimental and clinical evidence

Abstract

Treatment of large bone defects represents a great challenge in orthopedic and craniomaxillofacial surgery. Although there are several methods for bone reconstruction, they all have specific indications and limitations. The concept of using barrier membranes for restoration of bone defects has been developed in an effort to simplify their treatment by offering a sinlge-staged procedure. Research on this field of bone regeneration is ongoing, with evidence being mainly attained from preclinical studies. The purpose of this review is to summarize the current experimental and clinical evidence on the use of barrier membranes for restoration of bone defects in maxillofacial and orthopedic surgery. Although there are a few promising preliminary human studies, before clinical applications can be recommended, future research should aim to establish the 'ideal' barrier membrane and delineate the need for additional bone grafting materials aiming to 'mimic' or even accelerate the normal process of bone formation. Reproducible results and long-term observations with barrier membranes in animal studies, and particularly in large animal models, are required as well as well-designed clinical studies to evaluate their safety, efficacy and cost-effectiveness.

Bioabsorbable Barrier Membrane Combined with rhBMP-2 Improved Bone Formation in an Experimental Model of Compromised Healing But Was Not Superior to rhBMP-2 Alone

“…In a comprehensive review of barrier membranes, Dimitriou et al concludes that several questions still remain to be answered. The additive use of bone graft and the definition of the ideal membrane are unsolved issues and efficacy, safety, and cost effectiveness of barrier membranes must be established before clinical use can be recommended [14]. We found that the combination of rhBMP-2 and a barrier membrane prevented non-union formation and initiated the production of competent bone.…”

Salicylic Acid-Based Polymers for Guided Bone Regeneration Using Bone Morphogenetic Protein-2

“…Biodegradable and bioresorbable membranes have been tested for guided bone regeneration efficacy in various animal models, including long bone segmental defects. 20 Given the established efficacy of using membranes for guided bone regeneration, we considered whether a similar approach could be used to limit or restrict BMP-2 activity to a defined volume of interest. Nonsteroidal anti-inflammatory drugs (NSAIDs) can delay or prevent bone formation by inhibiting cyclooxygenase-2 (COX-2).…”

Polylactide/polycaprolactone asymmetric membranes for guided bone regeneration

“…One of the possibilities is guided bone regeneration (GBR) when porous membranes are used as mechanical barriers separating the space around the defect. Thanks to such a separation, during the healing process the bone tissue defect is separated from the soft tissue which has much bigger regenerative potential (1,3).…”

“…Even though many elements of human body, including bone tissue, are capable of regeneration, this ability does not apply to so-called "critical size defects" (CSD) (1,2). Thus, in the case of critical size defects it is necessary to support natural regenerative mechanisms of the human body.…”