The development of guided tissue regeneration (GTR) therapy for teeth and its adjunct guided bone regeneration (GBR) for dental implants has required testing of a variety of surgical techniques and biomaterials over the years.
Today, GBR is performed as a combined procedure involving supporting bone grafts of diverse origin and various types of membranes, which provide varying levels of mechanical support and integration characteristics. Two contrasting GBR approaches include:
► artificially cross-linked collagen membrane combined with allograft; and
► native collagen membrane, not artificially cross-linked, combined with xenogeneic bone graft.
How to make the right choice?
To better understand which approach might be more effective for ridge preservation, a randomized, multicenter ridge preservation <link https: owncloud.geistlich.ch index.php s bhbvyfmqf0qusnd external-link-new-window external link in new>study of extraction sockets exhibiting substantial buccal dehiscences compared these two techniques.
40 subjects were enrolled and randomized across ten standardized centers. The ridge preservation control therapy used demineralized allograft plus reconstituted and artificially cross-linked bovine collagen membrane (DFDBA + RECXC). The ridge preservation test therapy was Geistlich Bio-Oss® Collagen plus Geistlich Bio-Gide® (DBBMC + NBCM). Patients were assigned randomly to either the control or test therapy at a ratio of 1:1, resulting in 21 DFDBA + RECXC and 19 DBBMC + NBCM cases.
As primary outcome, horizontal changes from baseline to 6 months were significantly different between the two modalities, with the Geistlich solution, on average, providing 35% more horizontal bone width (1.76 mm greater). As secondary and exploratory outcomes, DBBMC + NBCM cases resulted in 1) better soft-tissue healing at one week, which significantly correlates with better ridge preservation outcome; and 2) significantly smaller incision line gaps and fewer open incision lines at one month. Overall, 100% of the implants in this group could be placed without regrafting, in contrast to the alternative GBR approach using an allograft combined with a reconstituted and artificially cross-linked collagen membrane (86%).
<link https: www.ncbi.nlm.nih.gov pubmed>Scheyer ET et al.: J Clin Periodontol 2016; 43(12): 1188-1199.
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