Vertical and horizontal guided bone regeneration (gbr) with resorbable membrane and titanium plate

Background

Many authors demonstrated the predictability of non-resorbable membranes or titanium meshes for bone augmentation for alveolar deficiencies. However, the use of a non-resorbable barrier device is a technique-sensitive procedure which does not lack complications. To reduce complication rates, some authors suggest using and a resorbable membrane for unwanted-cell exclusion effect and just a titanium osteosynthesis plate for space-making effect.

Aim/Hypothesis

The aim of this prospective study is to evaluate complications and success rates of this approach for GBR in the treatment of vertical and horizontal bone defects after 1 to 3 years follow-up.

Material and Methods

The study was conducted in accordance with ethical guidelines in 3 different centres. All patients requiring bone augmentation for implant-prosthetic rehabilitation were consecutively treated between 2015 and 2017 by means of titanium plates, native collagen membranes, and a mixture of autogenous bone and deproteinized bovine bone matrix (T0). After 6 months of submerged healing, re-entry surgery was accomplished for plate removal and implant placement in the augmented sites (T1). After 3 months (T2), soft tissue management was accomplished with implant exposure and a connective tissue graft, before prosthetic restoration (T3) if necessary. The titanium plate was used as reference tool to measure horizontal and vertical bone gain+ moreover, complication rate, class, and type were recorded. Statistical analysis was used to investigate significant correlations between patients, sites and implant parameters. STATA software was used for statistical analysis (significance = 0.05).

Results

In total, 38 patients were treated for bone augmentation, 50 ridges were vertically and or horizontally augmented, and 108 implants were placed. The median follow-up is 18 months. Uneventful healing always permitted to place implants as planned (prosthetically-guided digital planning). Primary stability was 30 Ncm for all implants. In 16.0%(8 50), the plates were fully integrated in newly-formed bone+ in 20.0%(10 50) integrated more than 50%+ in 44.0% (22 50), integrated less than 50%+ and only in 6.0%(3 50) integrated in soft tissue. Four plates (8.0%) showed a partial late exposure without suppuration, that did not compromise the regeneration. During healing period, complications included 3 localized infections (6.0%) and 2 generalized infections (4.0%). As consequence, overall complication rates were 18.7%. Considering bone augmentation and implant placement, the overall success rate was 95.8%. No Statistical correlations were found for all variables (P > 0.05).

Conclusion and Clinical Implications

The results of this study showed that resorbable membranes and osteosynthesis plates represent a reliable and predictable technique for horizontal and vertical ridge augmentation. This procedure is not lack of complications, even if the most of them did not significantly compromised the regeneration rates. Finally, newly-formed bone using resorbable membranes was able to stabilize and osseointegrated implants with delayed approach.