Guided Bone Regeneration Group Research Articles

Guided bone regeneration improves defect fill and reconstructive outcomes in 3-wall peri-implantitis defects.

This multi-center, randomized clinical trial compared the long-term outcomes of guided bone regeneration (GBR) with open flap debridement (OFD) in treating peri-implantitis-related bony defects with ≥3 osseous walls over 36 months. The study aimed to evaluate the healing potential of GBR using a deproteinized bovine bone mineral (DBBM) graft and native bilayer collagen membrane (NBCM) compared to OFD without the use of graft materials. Sixty-six individuals diagnosed with peri-implantitis were randomly assigned to either GBR (34 patients) or OFD (32 patients). The OFD group served as the control, where inflamed tissue was removed and the implant surface decontaminated using 3% hydrogen peroxide, but no bone graft was placed. The GBR group received DBBM and NBCM for defect reconstruction. Radiographic defect fill (RDF), probing pocket depth (PPD), bleeding on probing (BOP), suppuration (SUP), mucosal recession (MREC), and patient-reported outcomes (PROs) were assessed over the study duration. Post-surgical care included azithromycin, ibuprofen, and chlorhexidine rinses. The study involved baseline assessments, surgical interventions, and follow-ups at 6, 12, and 36 months. Supportive peri-implant therapy was provided every 3 months during the additional 24-month follow-up. Primary outcome was RDF at 36 months. Secondary outcomes included PPD, BOP, SUP, MREC, and PROs. Descriptive statistics and ANCOVA models were used for analysis. At 36 months, GBR resulted in a mean RDF of 2.13 ± 1.26 mm, compared to 1.64 ± 1.54 mm with OFD (p = .18). No significant differences were found in PPD, BOP, SUP, REC, or PROs between the groups. Treatment success (defined as no additional bone loss, PPD ≤ 5 mm, no BOP, and no SUP) was achieved in 46.2% of GBR cases and 20% of OFD cases (p = 0.053). GBR provided improved short-term defect fill and higher treatment success compared to OFD, although the differences were not statistically significant. Both procedures maintained clinical parameters over 36 months, with similar patient satisfaction (PROs) observed for GBR and OFD. The adjunct use of DBBM and NBCM may offer clinical benefits for peri-implantitis cases with specific bony defect morphology.

Comparing Small Buccal Dehiscence Defects Treated with or without Guided Bone Regeneration. A Sub-Analysis of a RCT.

to assess clinical and radiographical outcomes of single tooth posterior implants with a dehiscence defect treated with or without guided bone regeneration (GBR). In a randomized clinical trial of 59 patients, single-tooth posterior implants were placed. For the subanalysis of 16 patients with a buccal dehiscence defect (≤ 5mm), the implants were randomly assigned to GBR or spontaneous healing (SH). In 8 patients, the implants were surrounded by native bone (Native bone). A transmucosal healing approach was chosen for all sites. Patients were examined at restoration delivery (RD) and at one year (1y). Measurements included: soft tissue thickness (STT), bone tissue thickness (BTT) and buccal contour, based on cone-beam computed tomography (CBCT), optical scans, clinical parameters. All data were analyzed descriptively. The mean STT at implant shoulder (IS) showed a gain of 0.15 mm (Q1: - 0.16, Q3: 0.49) for the GBR group and 0.03 mm (Q1: -0.49, Q3: 0.13) for the SH group. The mean BBT 1 mm below IS showed a loss of 0.25 mm (Q1: -0.85, Q3: -0.09) for the GBR group and 0.04 mm (Q1: -0.14, Q3: 0.17) for the SH group. All peri-implant soft tissue parameters indicated healthy peri-implant tissues with no clinically relevant differences between the groups. Patient-reported outcomes regarding pain one day after surgery were similar among the study groups. The present sub-analysis resulted in a similar buccal contour and similar radiographic outcomes as well as peri-implant health for sites treated with or without GBR.

Healing patterns of alveolar bone following ridge preservation procedures.

Examine the histomorphometric bone composition, following alveolar ridge preservation techniques and unassisted socket healing. Forty-two patients (42) requiring a single rooted tooth extraction were randomly allocated into three groups (n = 14 per group): Group 1: Guided Bone Regeneration (GBR) using deproteinised bovine bone mineral (DBBM) and a porcine collagen membrane; Group 2: Socket Seal (SS) technique using DBBM and a porcine collagen matrix; Group 3: Unassisted socket healing (Control). Trephined bone biopsies were harvested following a 4-month healing period. Forty-two samples underwent Back-Scattered Electrons -Scanning Electron Microscopy (BSE-SEM) imaging, with 15 samples examined using Xray Micro-Tomography (XMT) (n = 6 for each GBR/SS and n = 3 Control). Images were analysed to determine the percentage (%) of connective tissue, new bone formation, residual DBBM particles and direct bone to DBBM particle contact (osseointegration). BSE-SEM analysis demonstrated that new bone formation was higher in the Control (45.89% ± 11.48) compared to both GBR (22.12% ± 12.7/p < .004) and SS (27.62% ± 17.76/p < .005) groups. The connective tissue percentage in GBR (49.72% ± 9), SS (47.81% ± 12.57) and Control (47.81% ± 12.57) groups was similar. GBR (28.17% ± 16.64) and SS (24.37% ± 18.61) groups had similar levels of residual DBBM particles. XMT volumetric analysis indicated a lower level of bone and DBBM particles in all test groups, when matched to the BSE-SEM area measurements. Osseointegration levels (DBBM graft and bone) were recorded at 35.66% (± 9.8) for GBR and 31.18% (± 19.38) for SS. GBR and SS ARP techniques presented with less bone formation when compared to unassisted healing. GBR had more direct contact/osseointegration between the DBBM particles and newly formed bone.

In vivo experimental study comparing alveolar ridge preservation versus guided bone regeneration after unassisted socket healing at intact and damaged sites in narrow alveolar ridges.

To compare bone regeneration and dimensional alteration of alveolar ridge at intact and damaged extraction sockets after alveolar ridge preservation (ARP) and implant placement versus unassisted socket healing followed by guided bone regeneration (GBR) with simultaneous implant placement. In 6 beagle dogs, 3 types of extraction sockets in the mandible were created: (1) intact sockets, (2) 1-wall defect sockets and (3) 2-wall defect sockets. The sockets were allocated to undergo either (1) ARP and implant placement 8weeks later (ARP group) or (2) GBR with simultaneous implant placement after 8weeks of unassisted socket healing (GBR group). After an additional healing period of 8weeks, bone regeneration and dimensional changes were evaluated radiographically and histologically. GBR showed superior bone formation and greater bone gains compared to ARP, regardless of the initial extraction-socket configuration. Although ARP maintained the preexisting alveolar ridge dimensions, peri-implant bone defects were still detected at 8weeks of follow-up. Histomorphometric analyses confirmed that GBR increased dimensions of the alveolar ridge compared to baseline, and the augmentation and bone regeneration were greater with GBR than with ARP. Early implant placement with ARP can mitigate alveolar ridge changes in the narrow alveolar ridge. However, early implant placement with simultaneous GBR creates the conditions for enhanced bone regeneration around the implant and greater ridge augmentation compared to ARP, irrespective of the extraction-socket configuration.

A Comparison of Guided Bone Regeneration vs. the Shell Technique Using Xenogeneic Bone Blocks in Horizontal Bone Defects: A Randomized Clinical Trial.

In cases of severe horizontal atrophy, implant placement requires bone reconstruction procedures. The aim of this randomized controlled trial is to compare the outcomes of bone augmentation with simultaneous implant placement using the shell technique to the outcomes of guided bone regeneration (GBR) in cases of severely horizontal bone atrophy. This study was designed as a monocentric, parallel-group, randomized controlled trial with a six-month follow-up. Among the primary outcomes of this study, peri-implant bone regeneration and peri-implant bone defect closure were selected. Forty-four patients were recruited and equally divided between two groups. In the GRB group, a horizontal regeneration of 2.31 ± 0.23 mm was observed opposed to a horizontal regeneration of 2.36 ± 0.17 mm in the shell group (p = 0.87). A volumetric increase was observed in both groups, with an increase of 0.30 ± 0.12 cm3 in the GBR group and an increase of 0.39 ± 0.09 cm3 in the shell group, highlighting a significant difference between the two groups (p = 0.02). In conclusion, bone augmentation with simultaneous implant placement using the shell technique or guided bone regeneration in horizontal bone atrophy are both predictable therapeutic options.

Modified alveolar ridge preservation to promote the osteogenesis of the distal surface of second molar after mandibular impacted third molar extraction: a preliminary study.

The objective of the retrospective study was to explore whether the use of a modified alveolar ridge preservation technique impacts osteogenesis on the distal surface of the second molar after mandibular third molar (M3) extraction. A total of 54 patients were enrolled in this study and divided into three different groups, including modified alveolar ridge preservation (MARP) group, traditional tooth extraction (TRA) group, and classical guided bone regeneration (GBR) group. In this study, MARP was designed with the highlights of the preservation of the alveolar bone superior and lingual to M3. These patients chose different surgical methods according to their own wishes for past infection or in order to prevent pericoronitis, and the operation time and surgical cost of each group were recorded. The periodontal conditions of the ipsilateral mandibular second molar (M2) and the height of its distal alveolar bone were measured during the postoperative follow-up. The probing depth, clinical attachment level, and osseous defect depth on the distal surface of the ipsilateral M2 in the MARP group were better than those of the TRA group at any time of the follow-up (P < 0.05 for all), but there was no statistical difference in the measurements when compared to the GBR group at 6months after operation (P > 0.05 for all). Thus, MARP therapy not only improves the regeneration of periodontal osseous defects distal to the M2 after M3 extraction but also reduces the operation time and surgical cost. This paper introduces a modified surgical method that can not only economically and effectively remove the impacted mandibular third molar but also obtain stable osteogenesis.

Randomized controlled pilot study comparing small buccal defects around dental implants treated with a subepithelial connective tissue graft or with guided bone regeneration.

To compare subepithelial connective tissue grafts (SCTG) versus guided bone regeneration (GBR) for the treatment of small peri-implant dehiscence defects in terms of profilometric (primary outcome), clinical, and patient-reported outcome measures (PROMs). Sixteen patients who presented with small buccal bone dehiscences (≤3 mm) following single implant placement were recruited. Following implant placement, buccal bone defect sites were randomly treated either with a SCTG or GBR. Six patients who lacked bone dehiscences after implant placement were assigned to a negative control. Transmucosal healing was applied in all patients. Patients were examined prior (T1) and after (T2) implant placement, at suture removal (T3), at implant impression (T5), at crown delivery (T6), and 12 (T7) months after crown delivery. Measurements included profilometric outcomes, marginal bone levels, buccal bone and soft tissue thickness, PROMs, and clinical parameters. All data were analyzed descriptively. The median changes in buccal contour as assessed by profilometric measures between T1 and T5 showed a decrease of 1.84 mm for the SCTG group and 1.06 mm for the GBR group. Between T2 and T7, the median change in the buccal contour amounted to 0.45 mm for SCTG and -0.94 mm (=loss) for GBR. Patients' pain perception tended to be higher in SCTG than in GBR. All peri-implant soft tissue parameters showed healthy oral tissues and no clinically relevant differences between groups. Within the limitations of this pilot study, treating small peri-implant dehiscence defects with a SCTG might be a viable alternative to GBR. The use of a SCTG tended to result in more stable profilometric outcomes and comparable clinical outcomes to GBR. However, patient-reported outcome measures tended to favor GBR.

Guided Bone Regeneration Effects on Bone Quantity and Outcomes of Dental Implants in Patients With Insufficient Bone Support: A Single-Center Observational Study.

Background Guided bone regeneration (GBR)is used to influence on stabilization of dental implants in patients with insufficient bone quantity and anatomical problems.But many studies using GBR resulted in divergent results according to the efficiency of new bone quantity formation and implant survival. This research aimed to study the effects of GBR on the increase of bone quantity and short-term stabilization of dental implants in patients with insufficient bone support. Methodology The study included 26 patientsthat underwent the procedure for 40 dental implants from September 2020 to September 2021. In each case, the vertical bone support was intraoperatively measured, through the MEDIDENT Italia paradontal millimetric probe (Medident Italia, Carpi, Italy). The vertical bone defect was considered when the mean vertical depth between the abutment junction and the marginal bone wasgreater than 1mm up to 8mm. In the group with the presence of the vertical bone defect, GBR technique was used duringthe procedure of dental implantsrealized with synthetic bone graft, resorbable membrane, and platelet-rich fibrin (PRF), and the group was considered the study (GBR) group. The group of patients with no vertical bone defects(less than 1mm) and no need for any GBR technique usewas considered the control (no-GBR) group. The bone support was evaluated again intraoperatively after six months in both groups when the healing abutmentswere positioned. The vertical bone defect for each group in baseline and after six months is presented as mean±SD and compared using a t-test. A t-test for Equality of Means was used to calculate the mean depth difference (MDD) between baseline and six months values in each group (GBR and no-GBR) and also between both groups. P-value ≤ 0.05 is considered statistically significant. Results Overall 40 dental implants were placed, 20 of them were included in the GBR group and 20 in the no-GBR group. In the GBR group, a statistically significant greater mean vertical bone defect in baseline (day 1), compared to the no-GBR group was found (-4.46±2.76 vs -0.27±0.22; MDD = -4.19 [-5.44 to -2.94] p<0.001). At six months of follow-up in the GBR group, a new bone around the implant was formed, presenting a significantly lower bone defect compared to the baseline measure (-0.39±0.43 vs -4.46±2.76; MDD = -4.07 mm [-5.37 to -2.78]p<0.001). In six months, no statistically significant difference between GBR and no-GBR group in bone support was found (-0.39±0.43 vs -0.27±0.22; MDD = -0.19 [-0.40 to -0.03] p=0.10). In each group, only one implant failure was observed. Conclusions The use of GBR showed an important reduction of vertical depth defect between healing abutment and marginal bone predisposing similarshort-term stability and survival of dental implants. The use of GBR techniques could be essential in the stabilization of dental implants in patients with insufficient bone support.

Efficacy of spongy xenogeneic scaffold loaded with simvastatin in the treatment of severe alveolar horizontal defect: A clinical and histological study.

Bone tissue engineering offers several advantages for repairing skeletal defects. In this study, we designed and fabricated a scaffold for bone tissue engineering in patients with horizontal alveolar defect. The items included in the fabrication of the scaffold were xenogenic bone graft, gelatin as a substrate to improve the physical integrity of scaffold, and simvastatin to stimulate osteogenesis (10 mg per 1 g of xenograft). Fourteen patients with a horizontal defect in the alveolar ridge were enrolled in the study. Seven patients underwent routinely guided bone regeneration (GBR) using xenogenic bone graft plus collagenous membrane, and seven patients were treated with the scaffolds. After four months of follow-up after surgery, both the scaffold and GBR groups were examined for changes in the width of alveolar ridge and histologically for the quantity of newly produced bone. The newly designed scaffold showed superior osteoconduction characteristics to routine GBR materials, which were used in this study. The difference in the quantity of the newly produced bone between the scaffold group and GBR group was significant and higher for the scaffold group. Regarding newly produced bone percentage, the scaffold group showed a mean of 20.93 and the GBR group presented a mean of 13.25% (P = 0.004). Also, the mean value for the duration of surgery for GBR was 45 minutes and for scaffold was 22 minutes, which was significantly lower in the scaffold group (P < 0.001). The newly designed scaffold is a suitable treatment modality for bone tissue engineering.

Vertical augmentation of the atrofic posterior mandibular ridges with onlay grafts: Intraoral blocks vs. guided bone regeneration. Systematic review.

The high resorption rate of intra-oral Onlay block grafts, coupled with morbidity and limited bone availability, means that the use of guided bone regeneration (GBR) may be preferable for vertical augmentation of mandibular atrophic posterior sectors. Aims: To evaluate the bone gain and surface resorption of the intraoral Onlay block graft compared to the GBR; as well as to study postoperative complications, survival and success rates of dental implant, and peri-implant marginal bone loss. An electronic search was performed in the PubMed, Scopus, and Web Of Science databases on bone augmentation with intraoral autologous onlay block graft or GBR until December 2021. Of 214 potentially eligible papers, 11 complied with the inclusion criteria: 5 studies on block graft technique, 5 on GBR technique and 1 was a comparison of both treatment groups. In the block graft group, the mean vertical bone gain was 4.05mm with a mean resorption of 0.84mm (17.70%); the complication rate was 20%; the survival and success rates were 100% and 92.23% respectively and the mean peri-implant bone loss was 0.22mm at 12 months. For the GBR group, the mean bone gain was 4.7mm with a mean resorption of 0.33mm (15.08%); the complication rate was 11.6%; the survival rate was 100% and the mean peri-implant bone loss was 0.95mm at 12 months. Despite the limitations, the GBR technique seems to achieve greater bone gain with less superficial resorption as well as fewer complications, but it presents a greater peri-implant loss at 12 months. Key words:Onlay block graft, Guided Bone Regeneration, intraoral bone, augmentation procedure.

Comparison of Allogeneic Bone Plate and Guided Bone Regeneration Efficiency in Horizontally Deficient Maxillary Alveolar Ridges

(1) Background: Bone Lamina Technique and Guided Bone Regeneration (GBR) are commonly used for horizontally-deficient maxillary ridge reconstruction, although more detailed evaluation to assess the differences between such techniques is necessitated. (2) Methods: In this retrospective study, patients having a horizontal bone width of ≤4 mm in the maxilla, who were treated with Cortical Strut (CS), were collected to represent the “test group”, and those treated with GBR with no CS involvement represented the “control group”. A 1:1 mixture of autogenous bone (AB) and anorganic bovine bone (ABB) with resorbable collagen membrane was applied to both groups. Volumetric changes between groups were measured with cone-beam computed tomography (CBCT). The primary outcome represented volumetric graft resorption rate whilst the secondary outcomes represented any probable complications and implant insertion torque. (3) Results: A total of 36 patients were included in this study (36 grafted sites; 18 for CS group and 18 for GBR group). Mean bone graft volume reduction in the CS and GBR groups was 8.26 ± 1.60% and 14.36 ± 3.55%, respectively. The GBR group showed significantly more bone resorption than the CS group (p &lt; 0.001). Complications and insertion torque were similar between the groups (p &gt; 0.05). (4) Conclusions: Both CS and GBR techniques for hard-tissue augmentation provided sufficient bone graft mass volume for implant insertion, whereas CS demonstrated lower resorption rate at maxillary augmented sites, compared to GBR.

Ridge augmentation using autologous concentrated growth factors enriched bone graft matrix versus guided bone regeneration using native collagen membrane in horizontally deficient maxilla: A randomized clinical trial.

Facial resorption of maxillary alveolar ridges is a challenging situation for implant rehabilitation, which mandates a preparatory surgery of bone augmentation. Guided bone regeneration using a 1:1 mixture of autogenous particulate and anorganic bovine bone mineral (ABBM) showed reliable outcomes in treating horizontally deficient ridges. Twenty-eight patients were randomly assigned into two groups; in the control group, the 1:1 mixture of particulate autogenous bone and ABBM was covered with native collagen membrane, while in the study group, it was mixed with autologous fibrin glue (AFG) to make a sticky bone that was covered by concentrated growth factor (CGF) membrane. For each proposed implant site, the average bone width gain was calculated preoperatively, immediately after augmentation and after 6 months. Implants were placed after 6 months and the implant stability quotient (ISQ) was measured after insertion and after 6 more months. The graft consolidation period went uneventful in both groups; however, two cases in the sticky bone group showed total resorption of the graft upon re-entry. The mean horizontal bone width after 6months was 9 mm ± 0.71 in the guided bone regeneration (GBR) group which was higher than 7.9 mm ± 0.92 for the sticky bone group. The mean primary stability was higher in the GBR group; 67.19 ± 2.23 compared to 66.7± 3.22 for the sticky bone group, while the mean secondary stability was higher in the sticky bone group; 72 ± 2.15 compared to 71.7± 2.27 for the GBR group. Results of Shapiro-Wilk's for bone width data and model residuals were both statistically not significant (p> 0.05). Comparing CGF membrane versus native collagen membrane as barriers for GBR showed no statistically significant difference regarding bone gain. However, from a clinical point of view, CGF membrane is not a predictable barrier for guided bone regeneration.

Alveolar ridge preservation with guided bone regeneration or socket seal technique. A randomised, single-blind controlled clinical trial.

ObjectivesTo compare radiographic bone changes, following alveolar ridge preservation (ARP) using Guided Bone Regeneration (GBR), a Socket Seal (SS) technique or unassisted socket healing (Control).Material and methodsPatients requiring a single rooted tooth extraction in the anterior maxilla, were randomly allocated into: GBR, SS and Control groups (n= 14/). Cone Beam Computed Tomography (CBCT) images were recorded post‐extraction and at 4 months, the mid‐buccal and mid‐palatal alveolar ridge heights (BARH/PARH) were measured. The alveolar ridge width, cross‐sectional socket and alveolar‐process area changes, implant placement feasibility, requirement for bone augmentation and post‐surgical complications were also recorded.ResultsBARH and PARH was found to increase with the SS (0.65 mm ± 1.1/0.65 mm ± 1.42) techniques, stabilise with GBR (0.07 mm ± 0.83/0.86 mm ±1.37) and decrease in the Control (−0.52 mm ± 0.8/−0.43 mm ± 0.83). Statistically significance was found when comparing the GBR and SS BARH (p = .04/.005) and GBR PARH (p = .02) against the Control. GBR recorded the smallest reduction in alveolar ridge width (−2.17 mm ± 0.84), when compared to the Control (−2.3 mm ± 1.11) (p = .89). A mid‐socket cross‐sectional area reduction of 4% (−2.27 mm2 ± 11.89), 1% (−0.88 mm2 ± 15.48) and 13% (−6.93 mm2 ± 8.22) was found with GBR, SS and Control groups (GBR vs. Control p = .01). The equivalent alveolar process area reduction was 8% (−7.36 mm2 ± 10.45), 6% (−7 mm2 ± 18.97) and 11% (−11.32 mm2 ± 10.92). All groups supported implant placement, with bone dehiscence noted in 57% (n = 4), 64%(n = 7) and 85%(n = 12) of GBR, SS and Control cases (GBR vs. Control p = .03). GBR had a higher risk of swelling and mucosal colour change, with SS associated with graft sequestration and matrix breakdown.ConclusionGBR ARP was found to be more effective at reducing radiographic bone dimensional changes following tooth extraction.

Radiographic bone volume alteration after jaw cyst enucleation with or without simultaneous bone grafts: A prospective randomized study.

This study was aimed to evaluate bone healing after jaw cyst enucleation with or without bone substitutes by cone beam computed tomography, and to analyze potential influence factors for bone formation as well. Sixty seven jaw cyst patients were randomly assigned to two groups. Thirty three patients in control group accepted cystectomy without any filling material. The rest 34 bone cavities which filled with xenograft (DBBM, Bio-Oss®) and covered by absorbable membrane (Bio-Gide®) were included in the guided bone regeneration (GBR) group. All patients were examined with cone bean computerized tomography before operation, 3 and 6months after surgery. Linear regression analysis was applied to evaluate the influence factors of bone healing. There was no significant difference in bone formation rate at 3months after enucleation, with shrinkage rate (SR) of cystic lesion in control group and GBR group of 26.43 ± 14.98% and 20.78 ± 10.80%, respectively (p > 0.05). Larger shrinkage area in GBR group was detected on postoperative radiographs after 6months with SR of 60.11 ± 19.23%, when compared to those in patients without filling (6months SR: 48.63 ± 19.39%, p=0.018, <0.05). Linear regression analysis showed that cyst size was negatively correlated with bone formation. GBR with bovine xenograft and absorbable membrane showed considerable bone regeneration property in the healing of jaw cystic defects after enucleation of radicular cysts. Cyst size showed a suppressive influence on bone formation.

Periosteal Pocket Flap technique for lateral ridge augmentation. A comparative pilot study versus guide bone regeneration

BackgroundImplant rehabilitation of posterior mandibular defects is frequently associated to a horizontal bone loss. There exist several regenerative techniques to supply this bone deficiency, one of which is the Periosteal Pocket Flap Technique (PPF) proposed by Steigmann et al. to treat small horizontal bone defects. The present study proposes a modification of this technique based on the concurrent use of PPF with the use of xenogeneic and autologous bone and Plasma Rich in Growth Factors (PRGF). The aim of this study is to evaluate clinical and radiographic outcomes of the PPF with the use of xenogeneic and autologous bone and PRGF in comparison with conventional Guided Bone Regeneration (GBR) procedures. MethodsNine patients were enroled in the study (7 women and 2 men, mean age: 53 ± 2.74 years) and allocated to PPF or GBR. In both groups implant placement was performed simultaneously to bone regeneration. Preoperative CBCT scans were performed for each patient. Surgical time and postoperative pain were recorded, as well as tissue healing. Moreover, horizontal bone gain (mm), graft surface area (mm2) and graft volume (mm3) were evaluated. ResultsNine surgeries were performed: 6 PPF and 3 GBR. Regarding clinical outcomes, operative time was significative greater in GBR group than in PPF group (51.67 ± 3.51 min vs. 37 ± 5.69 min; p = 0.008). Postoperative pain was higher in GBR compared to PPF (p = 0.011). Regarding radiographical results, there were not significant differences in horizontal bone gain (PPF: 9.43 ± 1.8 mm; GBR: 9.28 ± 0.42 mm), surface area (PPF: 693.33 ± 118.73 mm2; GBR: 655.61 ± 102.43 mm2), and volume (PPF: 394.97 ± 178.72 mm3; GBR: 261.66 ± 118 mm3) between groups. ConclusionsThis prospective study demonstrates that the combination of autograft/xenograft and PRGF in PPF technique is a simpler, cheaper, and faster technique than GBR technique for achieving moderate lateral bone augmentation in implant treatment. Future randomised clinical studies are needed to confirm the results.

A randomized controlled trial comparing guided bone regeneration to connective tissue graft to re-establish buccal convexity at dental implant sites: Three-year results.

To compare guided bone regeneration (GBR) to connective tissue graft (CTG) in terms of increase in buccal soft tissue profile (BSP) at three-year follow-up when applied at the buccal aspect of single implant sites demonstrating a minor horizontal alveolar defect. Patients with a single tooth gap in the anterior maxilla and horizontal alveolar defect were enrolled in a single-blind RCT. All sites had a bucco-palatal bone dimension of at least 6mm, received a single implant at least 3months after tooth removal and were randomly allocated to the control (GBR) or test group (CTG) to re-establish buccal soft tissue convexity. Primary outcome was linear increase in BSP, meaning increase at the buccal aspect of the implant, based on superimposed digital surface models. Secondary outcomes were buccal bone and buccal soft tissue thickness, aesthetic and clinical parameters. Twenty-one patients were included per group at baseline. After three years, three patients in the GBR group and four in the CTG group were not willing to return for re-assessment. Hence, the final sample included 9 females/9males (mean age 52) in the GBR group and 8 females / 9males in the CTG group (mean age 49). The changes in BSP over time were not significantly different between GBR and CTG (p=0.629). At three years, sites treated with GBR demonstrated 1.06mm (95% CI: 0.83; 1.28) increase in BSP, whereas sites treated with CTG showed 0.99mm (95% CI: 0.65; 1.35) increase in BSP (p=0.699) compared to baseline. There were no significant differences between the groups for any of the parameters except for Mucosal Scarring Index, which was 1.63 (95% CI: 0.73; 2.53) lower for CTG (p=0.002) at study termination. There was no significant difference in linear increase in BSP between GBR and CTG after three years. Hence, clinical decision-making should be based on other factors.

Treatment of Implant Labial Soft Tissue Dehiscence with Guided Treatment of Implant Labial Soft Tissue Dehiscence with Guided Bone Regeneration vs Subepithelial Connective Tissue Graft. A Bone Regeneration vs Subepithelial Connective Tissue Graft. A Randomized Clinical Trial

Objective: Background: Implant soft tissue dehiscence is a frequently reported esthetic complication, that more often than not affects the functional integrity of the dental implant with eventual loss of osteointegration. Many treatment modalities with different success rates have been proposed aiming to solve this complication or prolong the survival of the dental implant, of which are guided bone regeneration and soft tissue regeneration around the affected implants. Patients and Methods: This prospective study was carried in the hospital of Future University. 11 Patients (1 Male – 10 Females) with 20 Maxillary implant sites demonstrating soft tissue dehiscence were randomly allocated to either a guided bone regeneration (GBR) group (Control) in which patients received a mixture of autogenous and xenogeneic bone graft substitute covered by a native collagen membrane fixated with titanium tacks over the affected implants or a connective tissue graft and coronal flap advancement (CTG + CAF) group (Intervention) in which patients received a de-epithelialized connective tissue graft harvest from the anterio-lateral hard palate combined with a coronally advanced flap. Recession levels were measured at baseline and at 1,3 and 6 months post operatively, while probing depths and bleeding indices were measured at baseline and 6 months post operatively and patient satisfaction levels were recorded through a visual analogue scale (VAS) questionnaire 6 months post operatively after completion of the follow up period. Results: Out of the 11 patients (1 Male – 10 Females) enrolled in this study, no major post-operative complications were encountered, the most common complication was post-operative swelling and edema that usually peaked 48 hours after surgery, which was more evident in the GBR group. Soft tissue recession levels measured from implant platform to gingival margin was significantly higher at baseline in GBR group compared to CTG+CAF group (P=0.042). While there was no significant difference in soft tissue levels between both groups at 1 month (P=0.362), 3 months (P=0.240) and 6 months (P=0.097). There was no statistically significant difference in VAS mean values between GBR and CTG+CAF groups (P=0.510). Conclusion: Based on the results of our study, we concluded that both treatment modalities provided satisfactory and stable results with major improvements in all clinical outcomes after 6 months compared to baseline measurements, however, GBR provided slightly superior clinical outcomes, compared to CTG + CAF

Radiographic Evaluation of the Alveolar Ridge Splitting Technique Combined with Guided Bone Regeneration vs Guided Bone Regeneration Alone in the Anterior Maxilla: A Retrospective Controlled Study.

This study aimed to estimate the radiographic outcomes of the alveolar ridge splitting (ARS) technique combined with guided bone regeneration (GBR) and compare its efficacy with GBR alone in maxillary anterior narrow ridges. Forty patients with 51 implants in the ARS group and 40 patients with 49 implants in the GBR group were included. The buccal bone thickness (BBT) at 0 to 4 mm from the implant shoulder immediately and 6 months postoperative were analyzed using cone beam computed tomography. The BBT at both time points had no statistical disparities between the two groups (P > .05). However, BBT changes indicated significant disparities, with more BBT preservation in the ARS group (P < .05). Compared with GBR alone, the ARS technique combined with GBR, despite obvious buccal bone diminution, could be a reliable modality for treating ridge width deficiency in the anterior maxilla.

Esthetics and Patient-Reported Outcomes of Implants Placed with Guided Bone Regeneration and Complete Native Bone: A Prospective Controlled Clinical Trial.

When encountering a buccal bone defect during implant placement, guided bone regeneration (GBR) is a well-accepted method for bone reconstruction. However, it is still unclear if the esthetic and patient-reported outcomes are comparable to implants placed in native bone. The purpose of this prospective trial was to compare implants placed with a GBR procedure for a small (≤ 4 mm) buccal defect with implants placed completely in native bone (control). Patients were allocated to the GBR group or control group during implant placement in the esthetic zone. Implants were placed after at least 12 weeks of healing of the extraction sockets. A buccal bone defect of ≤ 4 mm resulted in allocation to the GBR group. Follow-up was performed until 12 months after loading. Outcome measurements were as follows: esthetic scores, patient-reported outcome measurements, implant survival and complications, clinical indices, and radiographic measurements. In total, 45 patients were included, of which 23 underwent a GBR procedure after implant placement, and in 22 patients no GBR was necessary. No significant differences in esthetic outcomes were seen between the two groups. At the final follow-up, a mean pink esthetic score (PES) of 7.8 (SD: 1.5) was seen for the GBR group and 8.4 (SD: 1.4) for the control group. Regarding the white esthetic score (WES), a mean of 9.1 (SD: 1.0) was found for both groups. Patients of both groups were equally satisfied with their mucosa and crown. A mean visual analog score (VAS) for the soft tissues of 8.6 (SD: 1.0) in the GBR group and 8.8 (SD: 0.9) for the control group was noted. A mean VAS of 9.2 (SD: 0.8) was noted for the crown in the GBR group and 8.6 (SD: 2.0) in the control group. Implant survival was 100%, and there were no significant differences in complications, plaque/bleeding/gingiva indices, width of attached mucosa, and marginal bone loss. Implants placed in the esthetic zone with GBR or complete native bone coverage showed successful esthetic outcomes and satisfied patients with predictable clinical and radiographic parameters after more than 1 year of loading. Within the limits of this study, GBR for a small buccal bone defect seems to be a reliable technique with good esthetics and patient-reported outcomes.

Long-term clinical and radiographic results after treatment or no treatment of small buccal bone dehiscences at posterior dental implants: A randomized, controlled clinical trial.

To test whether or not buccal vertical bone dehiscences (≤5mm) around posterior implants left for spontaneous healing (SH) result in the same clinical and radiologic outcome as dehiscences treated with guided bone regeneration (GBR) at 7.5years after implant placement (IMPL). Twenty-two patients receiving 28 posterior implants with a small non-contained buccal bone dehiscence (≤5mm) were randomly assigned to the SH or the GBR group. Implants were loaded at 6months. Clinical parameters (probing depths, sulcus bleeding index, plaque index) and approximal marginal radiographic bone levels were assessed regularly up to at least 6.8years. The vertical extension of the dehiscences was measured clinically at IMPL and abutment connection and radiographically on cone beam computed tomographys at a mean follow-up time of 7.5years. Twenty patients with a total of 26 implants were recalled at 7.5years (9.1% dropout). The implant/crown survival rates were 100% in both groups. Stable peri-implant tissues were observed in both groups showing only minimal signs of inflammation. During the entire study period (IMPL-7.5-year follow-up), the median buccal vertical bone gain measured 1.61mm for the GBR group and 0.62 for the SH group showing no significant difference between the groups. Also, at 7.5years, the median approximal marginal bone levels (GBR: 0.53; SH: 0.68) were not significantly different between the two groups (p=.61) while the remaining median buccal vertical dehiscences were larger in the SH group (2.51mm) compared to the GBR group (1.66mm; p=.02). Implants with small non-contained buccal bone dehiscences exhibited high implant survival rates and healthy peri-implant tissues at 7.5years. In the GBR group, the buccal vertical bone levels were higher compared to the SH group but remained stable over the entire study period for both treatments.