Resorbable Collagen Membrane Research Articles

Mechanical properties of collagen membranes: Are they sufficient for orbital floor reconstructions?

IntroductionThe most common reconstruction materials for orbital floor fractures are PDS (polydioxanone) foil and titanium meshes. These materials have advantages and disadvantages. Therefore, new materials are needed to improve surgical outcomes. Materials and methodsThree resorbable collagen membranes (Smartbrane®, BioGide®, Creos®) were tested for their mechanical properties (puncture strength) in mint and artificially aged (3, 6, 8 weeks) conditions and were compared to PDS foil, titanium meshes (0.25 mm, 0.5 mm) and human orbital floors (n = 7). ResultsThe following puncture strengths were evaluated: human orbital floor, 0.81 ± 0.49 N/mm2; 0.25 mm titanium mesh, 5.36 ± 0.25 N/mm2; 0.5 mm titanium mesh, 16.08 ± 5.17 N/mm2; Smartbrane, 0.74 ± 0.31 N/mm2; BioGide, 1.65 ± 0.45 N/mm2; and Creos, 2.81 ± 0.27 N/mm2.After artificial aging, the puncture strengths were significantly reduced (p ≤ 0.05) at 3, 6 and 8 weeks as follows: Smartbrane, 0.05 ± 0.03 N/mm2, 0.03 ± 0.02 N/mm2, and 0.01 ± 0.01 N/mm2, respectively; BioGide, 0.42 ± 0.06 N/mm2, 0.41 ± 0.12 N/mm2, and 0.32 ± 0.08 N/mm2, respectively; and Creos, 2.02 ± 0.37 N/mm2, 1.49 ± 0.42 N/mm2, and 1.36 ± 0.42 N/mm2, respectively. ConclusionThe tested materials showed sufficient puncture strength for orbital floor reconstruction in mint condition. Moreover, after artificial aging, the Creos and BioGide membranes showed sufficient resistance, while Smartbrane showed equivocal data after eight weeks. Therefore, collagen membranes have adequate properties for further in vivo investigations for orbital floor reconstructions.

Resorbable dome device and guided bone regeneration: an alternative bony defect treatment around implants. A case series.

This case series presents the use of a resorbable "dome device" made of a slow, long-lasting resorbable suturing material to support the barrier creating and maintaining a secluded space to promote bone regeneration. Acellular dermal matrix or cross-linked resorbable collagen membrane, as barriers, combined with mineralized freeze-dried bone allograft, with simultaneous implant placement, were utilized in reconstructing non-space-making defects. Eight implants in six healthy patients were treated with a combination of these resorbable regenerative materials. Only one of seven was treated with a nonsubmerged approach. All sites remained completely covered and no implant exposure occurred during healing. At the 9- to 24-month reentry surgeries, the clinical bone density was equivalent to that of the native bone and the mean number of final exposed threads was 0.5. The mean buccal bone thickness achieved was 3.12 mm, with a mean total coverage of exposed threads in approximately 87.5% of the cases.

Posters

Background A fuctional outcome was and still remains the main purpose of a periodontal surgical procedure. However, as implants have been part of dental routine, the 'Esthetics' factor has been gradually more considerable in the soft tissue augmentation. The keyword for an esthetic result is usually 'predictability'. In other words, a plastic surgery technique that can be predictable and repeatable in its clinical outcome is needed. Aim/Hypothesis The aim of this poster is to present the double-partial thickness, coronally positioned, bucally slibing flap. This is an alternative flap technique for soft tissue augmentation and its main benefit is a more esthetic outcome in periodontal surgery. Material and methods A 28 year-old male patient, referred to our dental clinic with a failed apicoectomy treated #21. The treatment plan involved an implant restoration. Both hard and soft tissues were in need of augmentation. The tooth was extracted and a Biomet 3i implant was placed. For the soft tissues augmentation the double-partial thickness, coronally positioned, bucally slibing flap technique was performed, while for the hard tissues augmentation, DFDBA particles were utilized and stabilized with a resorbable collagen membrane. Results The surgical outcome was more than satisfactory. Hard and soft tissues dimensions were considerably improved and no surgical scars remained after the healing period. Conclusion and clinical implications ?he double-partial thickness, coronally positioned, bucally slibing flap is an effective plastic periodontal surgery technique. The esthetic outcome is considered to be the main advantage. However, it's a challenging technique and needs microsurgery equipment to be performed.

Clinical and radiographic evaluation of the efficacy of platelet-rich plasma combined with hydroxyapatite bone graft substitutes in the treatment of intra-bony defects in maxillofacial region

Objective. The aim of this study is to evaluate the efficacy of platelet-rich plasma (PRP) clinically and radiographically when combined with bovine derived hydroxyapatite (HA) bone grafting materials and resorbable collagen membranes for the treatment of intra-bony defects frequently seen at the distal aspect of mandibular second molars following the surgical extraction of fully impacted mandibular wisdom teeth. Study design. Eighteen patients were scheduled for post-operative visits at 1, 3 and 6 months post-operatively, probing depths were measured and digital panoramic radiographs were taken. Results. There were no significant differences on probing depths among two groups. Radiographic assessment also showed no significant difference among groups at 1st and 6th month intervals, while 3 months post-operatively the amount of radiographic density at the PRP side was significantly higher. Conclusion. Combined use of PRP and bovine-derived HA graft materials for the treatment of intra-bony defects might be an appropriate approach when the main goal is providing earlier bone regeneration.

Soft and hard tissue modifications at immediate transmucosal implants (with Laser-Lok microtextured collar) placed into fresh extraction sites: a 6-month prospective study with surgical reentry.

Histologic and clinical studies confirm that laser-microtextured implant collars favor the attachment of connective fibers and reduce probing depth and peri-implant bone loss when compared with machined collars. This prospective study aimed at assessing the alveolar dimensional changes after immediate placement of a transmucosal implant with a Laser-Lok microtextured collar associated with bone regenerative procedures. Thirteen implants were placed immediately into single-rooted extraction sockets. Peri-implant defects were treated with bovine-derived xenografts and resorbable collagen membranes. At 6-month surgical reentry, the Laser-Lok microtextured collar provided more favorable conditions for the attachment of hard and soft tissues and reduced the alveolar bone loss.

Resorbable collagen membranes: histopathologic features.

Resorbable collagen membranes (RCMs) are commonly used by oral surgeons, periodontists, and endodontists for multiple purposes. We report 6 cases of RCMs that did not resorb as expected and describe the histopathologic features. Cases of an unusual fibrillar foreign material were noted in biopsy specimens curetted from bone. Hematoxylin-eosin and Masson trichrome stains were performed. Clinicians were contacted for detailed clinical information. There were 3 men and 3 women. RCMs presented as hyalinized, paucicellular, delicate eosinophilic fibrils or a meshwork without a foreign body reaction. They were refractile and stained for Masson trichrome as expected. These RCMs persisted longer than expected (2-6 weeks) in 3 cases and may have retarded healing in 5 cases. Although RCM is supposed to be fairly rapidly resorbable, this material sometimes persists within wound sites without any obvious foreign body reaction and may retard healing.

Two dimensional alveolar ridge augmentation using particulate hydroxyapatite and collagen membrane: A case report

BackgroundRidge augmentation procedures require bone regeneration outside of the existing bony walls or housing and are therefore often considered to be the most challenging surgical procedures. The bony deficiencies can be managed with GBR techniques involving bone grafting material and membrane while vertical augmentation may require the use of space-creating support mechanisms. Non-degradable membranes have been used for ridge augmentation with encouraging results however; requirement of second surgery for its removal and associated infection on exposure may compromise the desired results. These problems can be overcome by employing resorbable collagen membranes. Different bone graft materials are also used in combination with resorbable membranes, for prevention of membrane collapse and maintenance of space, as they lack sufficient rigidity. Particulate hydroxyapatite bone graft may be better alternative, because it treats the underlying bone defect to restore the natural support of the tissue architecture. Moreover, its use avoids potential donor site complications associated with autogenous block grafts. MethodPatient described in this report presented with missing right maxillary incisor with ridge deficiency. A treatment approach involving localised ridge augmentation with particulate hydroxyapatite and collagen membrane was used. ResultSix month post-operative periapical radiograph demonstrated a significant vertical bone fill. ConclusionThe clinical and radiographic findings of the present case suggests that HA in conjunction with a resorbable collagen membrane may be an acceptable alternative to the autogenous block graft and non-resorbable membrane in the treatment of compromised alveolar ridge deficiencies.

Retracted: Enhanced bone regeneration with a novel synthetic bone substitute in combination with a new natural cross‐linked collagen membrane: radiographic and histomorphometric study

4Bone is a fully synthetic bioactive bone substitute composed of 60% hydroxyapatite (HA) and 40% beta-tricalcium phosphate (ß-TCP). This study aimed to investigate the effect of resorbable collagen membranes (RCM) on critical size defects in rabbit tibiae filled with this novel biphasic calcium phosphate at 15, 30, 45, and 60 days by radiological and histomorphometric analysis. Three critical size defects of 6 mm diameter were created in both tibiae of 20 New Zealand rabbits and divided into three groups according to the filling material: Group A (4Bone), Group B (4Bone plus RCM), and Group C (unfilled control group). At each of the four study periods, five rabbits were sacrificed. Anteroposterior and lateral radiographs were taken. Samples were processed for observation under light microscopy. At the end of treatment, radiological analysis found that cortical defect closure was greater in Group B than Group A, and radiopacity was clearly lower and more heterogeneous in Group A cortical defects than in Group B. There was no cortical defect closure in Group C. Histomorphometric evaluation showed significant differences in newly formed bone and cortical closure in Group B compared with Groups A and C, with the presence of higher density newly formed bone in cortical and medullar zones. Biphasic calcium phosphate functioned well as a scaffolding material allowing bone ingrowth and mineralization. The addition of absorbable collagen membranes enhanced bone gain compared with non-membrane-treated sites. This rabbit study provides radiological and histological evidence confirming the suitability of this new material for guided tissue regeneration of critical defects.

Bone Regeneration in Patients With Localized Chronic Periodontitis

The principles of guided tissue regeneration (GTR) are the basis for regenerative treatment of bone defects by inserting collagen membranes to produce tissue gain. Patient had lost teeth #11 and #12 through vestibular bone resorption caused by localized chronic periodontitis. GTR using allogenic bone graft beef granules and coated resorbable collagen membranes was planned. This technique stimulates adjacent tissues to reconstitute tissues in the region of interest, allowing the future placement of an osseointegrated implant.

Mandibular Ridge Expansion Using a Horizontal Bone-Splitting Technique and Synthetic Bone Substitute: An Alternative to Bone Block Grafting?

Inadequate bone width in atrophic edentulous jaws is a challenge for successful oral rehabilitation with endosseous dental implants. The aim of this clinical study was to evaluate the effectiveness of a new method for ridge expansion with sagittal splitting using a new surgical device (Crest-Control Bone Splitting System, Meisinger) and to determine whether it is necessary to fill the expansion area with bone substitute to maintain the expanded bone volume. During a 3-year period, a prospective study was performed in 32 patients (59% women, 41% men). All participants needed implants in the horizontally atrophied edentulous mandible and were treated in a private practice and a hospital. The only inclusion criteria were a mandibular ridge width between 3 and 4 mm and ridge height of at least 11 mm. Expansion with horizontal splitting of the ridge was performed simultaneously with implant placement. In 17 of the 32 arches, selected alternately, the expanded ridges were filled with a biphasic calcium phosphate (hydroxyapatite 60% and beta-tricalcium phosphate 40%) synthetic bone substitute (SBS 60/40). The other 15 expanded arches were left unfilled. All areas were covered with a resorbable collagen membrane (Bio-Gide, Geistlich). Results were analyzed with the Mann-Whitney and Kruskal-Wallis tests (α=.05). There was a significant difference (α=.02) between the patients who received SBS 60/40 (17 cases) and those who did not (15 cases). The ridges that received SBS 60/40 after expansion showed no bone resorption. Horizontal expansion of the ridge is easily reproducible. In this study, in very narrow ridges, a lack of bone substitute resulted in significant resorption of 3- to 4-mm-wide crests (5%), even after expansion. A bone substitute should be placed to maintain the alveolar bone walls after expansion.

Prognosis of closure of large sinus membrane perforations using pedicled buccal fat pads and a resorbable collagen membrane: case series study

For large membrane perforations that develop during sinus-bone grafting, we performed repairs using a pedicled buccal fat pad and a resorbable collagen membrane simultaneously with the bone graft. This study included eight patients. Postoperative maxillary sinusitis developed in two patients, which we managed with incision and drainage, and antibiotics. Ultimately, six patients received 12 implants, three of which failed (75% success). Implant replacement was performed after the removal of the failed replacement, at which point the prosthetic treatment was considered complete. In all of the six cases that we were able to follow-up with, the sinus-bone graft was healing favorably. We observed that the sinus bone height decreased gradually with time. Based on these case series, we conclude that our procedure of repairing large sinus-membrane perforations with a pedicled buccal fat pad and a collagen membrane is a reliable technique.

Membrane-assisted mineral trioxide aggregate apical plug for management of traumatized immature anterior teeth: Clinical case reports

Apexification using calcium hydroxide has many disadvantages, such as, it needs more time for the treatment, chance for fracture of the tooth, and incomplete calcification of the bridge. There are many alternative treatments introduced, which have gained popularity, such as, forming an apical plug using mineral trioxide aggregate (MTA), for excellent results. In cases of wide open apices, it is difficult to limit the restoration to the working length, as such situations lead to the apical extrusion of the material into the periapical region, which prevents further healing. Such conditions can be best treated with the use of a resorbable collagen membrane, which limits the restoration till the working length and prevents the extrusion of the material beyond the apex. The present case reports highlight the non-surgical management of immature teeth by using a membrane as a barrier, with an MTA apical plug, followed by crown rehabilitation.

Immunohistochemial study on the expression of von Willebrand factor (vWF) after onlay autogenous iliac grafts for lateral alveolar ridge augmentation.

IntroductionThe main problems of autogenous bone transplants are their unpredictable atrophy and their loss of structure. One key factor lies in the poor revascularization of simple onlay grafts. The the aim of this study was to evaluate the revascularization processes in autogenous bone grafts from the iliac crest to the alveolar ridge.MethodsIn a sheep model, autogenous bone grafts were harvested from the iliac crest. A combination of a resorbable collagen membrane (CM) and deproteinized bovine bone material (DBBM) was used to modify the bone graft (experiment 2). This was compared with a simple onlay bone graft (control group, experiment 1). The amount of vessels in bone and connective tissue (CT), and the amount of CT were analyzed. The expression of von Willebrand factor (vWF) was compared between the two experimental groups using immunohistochemical analysis.ResultsThe ratio of the amount of vessels in bone and CT changed over time, and more vessels could be detected in bone at 12–16 weeks of graft healing. The number of vessels were significantly higher in experiment 2 than in experiment 1. More CT was found in experiment 1, whereas the amount of CT in both experiments decreased over time.ConclusionThis study shows a more intensive and extensive revascularization in experiment 2, as significantly more vessels were detected. The decreased amount of CT in experiment 2 clarifies its clinical superiority.

Guided Tissue Regeneration Using a Collagen Barrier and Bone Swaging Technique in Noncontained Infrabony Defects

This clinical study evaluated the effectiveness of guided tissue regeneration using a resorbable collagen membrane and bone swaging in noncontained infrabony defects by assessing changes in probing pocket depth, probing attachment level, and radiographic bone level after 6 months, 1 year, and 2 years. Postsurgical clinical and radiographic measurements were statistically significantly different from presurgical measurements. The rate of bone fill was positively associated with the baseline depth of the bone defect but not associated with the width. The noncontained infrabony defects treated with this combined regenerative method improved clinically and radiographically.

A Prospective, Randomized, Controlled, Multicenter Evaluation of Extraction Socket Preservation Comparing Two Bovine Xenografts: Clinical and Histologic Outcomes

The aim of this prospective, randomized, controlled, multicenter study was to evaluate and compare the histologic and histomorphometric aspects of extraction sockets grafted with two commercially available bovine bone xenografts: Endobon (test group) and Bio-Oss (control group). The study was designed to ensure that baseline variables between groups were as similar as possible to allow for a direct comparison of graft healing characteristics. Thirty-eight patients contributed 62 augmented extraction sites to the study. All sites were grafted with one type of bovine bone mineral and covered with a resorbable collagen membrane for 6 months of healing prior to implant placement surgery. The histologic outcomes between the two treatment groups are similar, with de novo bone (mean ± SD) for the test group at 28.5% ± 20% and for the control group, 31.4% ± 18%. Histologic specimens also include membrane remnants. All but two implants integrated successfully after 1 year of follow-up. This investigation provides support for the efficacy of bovine bone xenograft for socket preservation when subsequent implant placement is planned.

Retracted: Influence of Biphasic β‐TCP with and without the use of collagen membranes on bone healing of surgically critical size defects. A radiological, histological, and histomorphometric study

The aim of this study was to investigate, by means of radiological and histomorphometric analysis, the effect of resorbable collagen membranes on critical size defects (CSD) in rabbit tibiae filled with biphasic calcium phosphate. Three CSD of 6mm diameter were created in both tibiae of 20 New Zealand rabbits and divided into three groups according to the filling material: Group A (Ossceram), Group B (Ossceram plus Alveoprotect membrane), and Group C (unfilled control group). Five animals from each group were sacrificed after 15, 30, 45, and 60days. Anteroposterior and lateral radiographs were taken. Samples were processed for observation under light microscopy. At the end of treatment, radiological analysis found that cortical defect closure was greater in Group B than Group A, and radiopacity was clearly lower and more heterogeneous in the Group A cortical defects than in Group B. There was no cortical defect closure in Group C. Histomorphometric evaluation showed significant differences in newly formed bone and cortical closure in Group B compared with Groups A and C, with the presence of higher density newly formed bone in cortical and medullar zones. There was no cortical defect closure or medullar bone formation in Group C. Biphasic calcium phosphate functioned well as a scaffolding material allowing mineralized tissue formation. Furthermore, the addiction of absorbable collagen membranes enhanced bone gain compared with non-membrane-treated sites.

Efficacy of Guided Bone Regeneration Using Composite Bone Graft and Resorbable Collagen Membrane in Seibert's Class I Ridge Defects: Radiological Evaluation

The purpose of the study was to evaluate radiologically the efficacy of guided bone regeneration using composite bone graft (autogenous bone graft and anorganic bovine bone graft [Bio-Oss]) along with resorbable collagen membrane (BioMend Extend) in the augmentation of Seibert's class I ridge defects in maxilla. Bone width was evaluated using computerized tomography at day 0 and at day 180 at 2 mm, 4 mm, and 6 mm from the crest. There was a statistically significant increase in bone width between day 0 and day 180 at 2 mm, 4 mm, and 6 mm from the crest. The results of the study demonstrated an increase in bone width of Seibert's class I ridge defects in the maxilla of the study patients.

A Novel Combined Surgical Approach to Vertical Alveolar Ridge Augmentation with Titanium Mesh, Resorbable Membrane, and rhPDGF-BB: A Retrospective Consecutive Case Series

The purpose of this case series was to report the clinical outcomes and histologic findings of vertical ridge augmentation using a combination of titanium mesh, resorbable collagen membrane, and recombinant human platelet-derived growth factor BB (rhPDGF-BB). Nineteen patients were included, and autogenous bone and anorganic bovine bone particles were used. The bone graft was mixed with rhPDGF-BB and loaded onto the bony defect up to the level of the adjacent alveolar crest. A pre-adapted titanium mesh was placed over the grafted region and covered with a resorbable collagen membrane, leaving no areas of the grafted region exposed. Seventeen patients exhibited good soft tissue healing. Postoperative flap dehiscence occurred relatively early in the healing period in one patient, whereas the covering collagen membrane was exposed during the later phase of the healing period in another. During reentry surgery for removal of the titanium mesh, three patients with favorable soft and hard tissue healing underwent bone biopsies for histologic evaluation of the augmented tissue just below the titanium mesh. The mean vertical height of augmented bone was 8.6 ± 4.0 mm. This report demonstrates the remarkable efficacy of guided bone regeneration using a combination of titanium mesh, resorbable collagen membrane, and rhPDGF for vertical ridge augmentation, thus expanding the indications for implant therapy and allowing recovery of the three-dimensional esthetic architecture in a severely absorbed alveolar ridge.

Reconstruction of Small Orbital Floor Fractures With Resorbable Collagen Membranes

Orbital floor fractures are the most common facial fractures. The goals of orbital floor fracture repair are to free incarcerated or prolapsed orbital tissue from the fracture defect and to span the defect with an implant to restore the correct anatomy of the orbital floor and the pretrauma orbital volume. No consensus exists on the choice of implants to be used for orbital floor reconstruction, and several implant materials are available.Our study intended to evaluate, for the first time, the effectiveness and complications related to the use of a resorbable collagen membrane in the reconstruction of small pure blow-out fractures. From October 2008 to November 2010, 23 patients who underwent reconstruction of the orbital floor using a resorbable collagen membrane following fracture were included in this study. At the 6-month follow-up, only 2 patients (9%) reported postoperative complications secondary to the operative procedure (surgical approach, orbital floor dissection), but these were not directly related to the use of the membrane. In 12 cases, a computed tomography scan revealed new bone formation beneath the membrane.On the basis of this data, we believe that the use of a resorbable collagen membrane is a safe and effective alternative for reconstruction of small (<3 cm(2)) pure orbital floor fractures.

Expression of growth factors during the healing process of alveolar ridge augmentation procedures using autogenous bone grafts in combination with GTR and an anorganic bovine bone substitute

This study aims to evaluate the expression of various immunohistochemical growth factors and vascularization markers in augmentation on the mandible comparing onlay bone grafts and Guided Bone Regeneration (GBR). Using a sheep in vivo model, autogenous bone grafts were harvested from the iliac crest. A combination of a resorbable collagen membrane (CM) and a Deproteinized Bovine Bone Material (DBBM) was performed. This modification of the host side was compared with an onlay bone graft control group. Expression of different vascularization markers was compared between these groups. The expression of revascularization markers was significantly higher within the modification of the host side using GBR and DBBM. Regarding different graft regions, a significantly higher expression within the bone graft using GBR and DBBM could be observed in staining on bone morphogenetic protein-2 (BMP-2) (5.75 vs. 3.55), vascular endothelial growth factor (VEGF) (3.08 vs. 1.64), VEGF Receptor 1 (VEGFR-1) and VEGF Receptor 2 (VEGFR-2) (4.88 vs. 2.24 and 5.06 vs. 2.74), and endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) (5.29 vs. 3.28 and 5.22 vs. 3.09; p = 0.000, all others p < 0.05), whereas the control group showed a higher rate of resorption during the surveillance period until euthanasia of sheep after 16weeks. The use of GBR and DBBM in the transplantation process of autogenous bone grafts compared with the therapeutical use of certain growth factors may enhance vascularization and lower atrophy and resorption. The use of a combination of GBR and DBBM in augmentation procedures on the mandible shows less resorption than simple onlay bone grafts and seems to be superior in a clinical use.