Long-Term Results after Guided Bone Regeneration with Resorbable and Microporous Titanium Membranes

Abstract

Summary From the patient's perspective, use of resorbable membranes has some advantages over treatment with titanium devices. First, there is a clear tendency for less impairment of wound healing caused by membrane appliance. Delayed exposures are never seen, and placement of intermediate dentures causes no complications. There are fewer restrictions in diet and less discomfort of treatment caused by exposure of resorbable membranes than have been observed in the titanium group. Finally, no retrieval of membranes is necessary. A negative aspect that can limit treatment outcome has been the ineffective management of early exposures in resorbable membranes. In such cases, the authors advocate for membrane removal as therapy of choice. In contrast, neither temporary symptoms such as mucosal edema nor the more frequent finding of membrane collapse has too much clinical relevance. From the surgeon's perspective, microperforated titanium membranes might deliver a slightly better performance than resorbable membranes. The authors' histologic data demonstrate increased graft maturity and decreased soft tissue formation within the graft. Bone shield placement clearly requires a more accurate intraoperative adaption to the anatomic situs than does resorbable membranes. Even minor disadaption causes undesired plication of devices. The authors suggest placement of titanium bone shields in the hands of somewhat experienced surgeons. Failed mucosal healing and delayed exposure of titanium membranes have been observed after placement of intermediate dentures. Treatment was effective in most cases by local antiseptic care. Although pain, shortening of follow-up intervals, dietary restrictions, and overall discomfort during treatment have been the consequences for patients. Patients should refrain from permanent placement of intermediate dentures after bone shield placement, if possible. It is fact that guided bone regeneration can be engaged effectively in restorative bone surgery. Resorbable and nonresorbable devices enabled successful placement of dental implants. The authors cannot make a definitive statement whether resorbable or nonresorbable barrier materials meet best therapeutic requirements. The optimal choice of which material to use depends on several factors, such as basic local status, the treatment schedule, the patient's compliance, and the surgeon's experience. The authors still believe that the ideal material for guided bone regeneration has not been found yet. Liquid resorbable barrier materials could be engaged that meet physical requirements needed for proper stress resistance at the grafted site once they harden. Alternative remedies should demonstrate adequate kinetics of degradation and should cut down on complications caused by improper adaption. Further improvements in feasibility reliability, and predictability of reconstructive procedures on behalf of the patient are the task. Further studies are needed to achieve that goal.