Hard and soft tissue augmentation with occlusive titanium barriers in jaw vertical defects: a novel approach

Fabio Perret,Mirko Andreasi Bassi,Mario Aimetti

doi:10.20517/2347-9264.2021.32

Abstract

Aim: The aim of this study was to evaluate hard and soft tissue changes following guided bone regeneration (GBR), with occlusive titanium barriers (OTB), in the rehabilitation of partially edentulous atrophic jaws. Vertical bone gain (VBG), horizontal bone width (HBW), and flap thickness (FT) changes, observed between the first and the second surgical stages, were evaluated. Methods: The study included 35 patients (9 men and 26 women; mean age 60 ± 10.53 years) in need of vertical bone augmentation for implant placement. Seventy implants were placed, 44 with a one-stage approach (Group A) and 26 with a two-stage approach (Group B). VBG, HBW, and FT were measured and statistically compared. Results: VBG for implants placed in Group B was significantly higher than those placed in Group A (P = 0.006). The increased HBW in Group B was highly significant compared to that exhibited in Group A (P = 0.000). A highly significant difference was found in FT before and after the GBR in the two groups considered together, for both the upper and lower jaws (P = 0.000 for both). Conclusions: OTBs are reliable devices in GBR, yielding predictable results in terms of bone augmentation. In almost all cases (94.3%), a spontaneous increase of the FT, at the second surgical phase, was observed. This could be due to the titanium surface features which increases spontaneously the thickness of soft tissues over the OTB.

Highlights

Alveolar bone loss, following dental extraction, can often limit the bone height and thickness available for aesthetic and prosthetic-driven implant placement[1,2]
guided bone regeneration (GBR) was proposed by Dahlin et al.[5] in 1988 to regenerate bone by using grafts and barriers allowing mechanical exclusion of undesirable soft tissue and, at the same time, favoring the osteogenic cellular growth into the osseous defect
A particulate graft composed of 50% xenograft and 50% autogenous bone is used, with the latter providing both the osteogenic and osteoinductive properties[9]

Summary

Introduction

Alveolar bone loss, following dental extraction, can often limit the bone height and thickness available for aesthetic and prosthetic-driven implant placement[1,2]. Among the different reconstructive techniques, guided bone regeneration (GBR) techniques seem to provide predictable and favorable results in long-term follow-up studies[4]. GBR was proposed by Dahlin et al.[5] in 1988 to regenerate bone by using grafts and barriers allowing mechanical exclusion of undesirable soft tissue and, at the same time, favoring the osteogenic cellular growth into the osseous defect. A particulate graft composed of 50% xenograft and 50% autogenous bone is used, with the latter providing both the osteogenic and osteoinductive properties[9]. The use of titanium-reinforced polytetrafluoroethylene (PTFE) barriers, in association with biomaterials, is well documented[9,10]. Despite the temporary exclusion of the periosteum contact[12], the presence of a non-resorbable barrier leads to bone volume gain, which prevents graft reabsorption[13]

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