Freeze-dried dura mater for guided tissue regeneration in post-extraction dental implants: a clinical and histologic study

Histological and Histomorphometric Effectiveness of the Barrier Membranes for Jawbone Regeneration: An Overview of More Than 30 Years’ Experience of Research Results of the Italian Implant Retrieval Center (1988–2020)

With the advent of implant dentistry, height and width of the bone site are fundamental to perform implant placements. There are several techniques to restore the amount of bone loss and one of them is guided bone regeneration, which is based on the employment of a membrane in order to bypass non-osteogenic cell invasion in the bone healing area, dispersing every interference with bone regeneration. Two expert reviewers performed a retrospective evaluation of all scientific papers published by the Implant Retrieval Center Laboratory of University “G. D’Annunzio” of Chieti-Pescara in the last three decades, and they implemented it by also similar conducting research on the main scientific databases, i.e., PubMed, Scopus, and EMBASE. The search was conducted up to December 2020, and a total of 843 articles published by the Implant Retrieval Center Laboratory of University “G.D’Annunzio” of Chieti-Pescara were identified and evaluated. After the application of inclusion and exclusion criteria, a total of 27 manuscripts were included for the qualitative synthesis: 8 animal studies, 17 human studies, and 2 in vitro articles. The present overview shows the importance of translational research for barrier membranes for bone regeneration, and additionally, the need for experts in different fields and research centers to produce high quality data in future research.

Long-term results of the application of solvent-dehydrated bone xenograft and duramater xenograft for the healing of oroantral osseous defects: a pilot experimental study

The aim of this study was to investigate the long-term effects of the use of human cadaveric solvent-dehydrated bone graft and duramater as a barrier membrane for the treatment of oroantral communication. Standard oroantral osseous defects were created in five minipigs. Subjects received cancellous bone graft in the form of block or microchips, duramater or a combination of bone and membrane. Uneventful healing was achieved in all of the subjects, clinically including the control site which did not receive any material. The operated bone segments were evaluated both by radiological and histological examinations after 6 months. Radiological evaluation was carried out using bone density analysis software and histological evaluation made by light microscopy. Radiological and histological results revealed that bone grafting of oroantral osseous defects improved the bone quality. However, application of duramater did not change this activity, both alone or combined with bone grafts. Within the limits of this experimental study, although solvent-dehydrated bone grafts were found superior and could be applied for the healing of osseous oroantral defects, resorbable membranes did not contribute to this process.

Self-setting barrier membrane for guided tissue regeneration method: initial evaluation of alginate membrane made with sodium alginate and calcium chloride aqueous solutions

Alginate membrane was proposed as a self-setting barrier membrane that can be used for guided tissue regeneration (GTR). The alginate membrane can be prepared and placed at the bone defect during the surgical procedure. The procedure consists of two simple steps. First, the bone defect is filled with sodium alginate (Na-Alg) aqueous solution. Then calcium chloride aqueous solution is dropped on the surface of the Na-Alg aqueous solution. An alginate membrane is formed on the bone defect, keeping the inside of the bone defect filled with unreacted Na-Alg aqueous solution. In this investigation, a preliminary animal study was conducted for an initial evaluation as to whether or not the alginate membrane can be used as a barrier membrane for the GTR method. Bone defects were made in the tibiae of 15-week-old rats. The alginate membrane was made on the surface of existing bone by filling the defect with Na-Alg aqueous solution and then dropping calcium chloride aqueous solution onto the surface of the Na-Alg solution. Four weeks after surgery, the bone defect was found to be reconstructed with new bone when the defect had been covered with alginate membrane whereas the bone defect was filled only with connective tissue when it had been kept open. We concluded, therefore, that this alginate membrane may be a useful barrier membrane when the GTR method is employed.

Resorption of composite polymer-hydroxyapatite membranes: a time-course study in rabbit

The histological findings in rabbit, concerning the resorption of a new composite hydroxyapatite-polymer membrane used in guided tissue regeneration are reported. The polymer appeared to be completely resorbed in about 4-6 months, while the inorganic component, hydroxyapatite, appeared to begin to resorb after the tenth month. The integrity of the membrane appeared to be unchanged after a 10-month period. No inflammatory cell infiltrate was present. This new type of membrane appeared to be relatively well tolerated by the host, had no significant adverse soft and hard tissue reaction, appeared to be easy to handle and had good space-maintaining capabilities. More research is certainly needed before clinical use in man.

Histological evaluation of freeze-dried dura mater (FDDMA) used in guided bone regeneration (GBR): a time course study in man

In 26 patients freeze-dried dura mater (FDDMA) membranes were used in fenestrations and dehiscences around dental implants, in implants inserted into postextraction sockets, in vertical ridge augmentation and in sinus lifting procedures. A re-entry procedure was carried out after 6, 9 and 12 months. In all patients a small portion of the membrane was removed and examined. No inflammatory infiltrate was present in the tissues around the membranes. No cells were present inside the membranes and only in the most peripheral portions was it possible to observe a few cells positive to acid phosphatase. The FDDMA membranes appeared to resorb slowly, did not seem to elicit an inflammatory reaction, and at 12 months they still appeared to play a role in cell occlusion.

Evaluation of guided bone regeneration in rabbit tibia using bioresorbable and non-resorbable membranes

The aim of this study was an evaluation of the possibility of bone regeneration in connection with implant placement, using a new bioresorbable membrane (Guidor Matrix Barrier) used previously in periodontal tissues regeneration. The study compared the bone regeneration obtained around Bonefit-ITI implants inserted in rabbit tibia using Guidor membranes, Gore-Tex membranes and in control sites. Microscopic analysis was performed after 6, 9 and 12 weeks. It was possible to see that the amount of bone around implants covered by Guidor and Gore-Tex membranes was roughly equivalent in all experimental sites at the 6-, 9- and 12-week time intervals. Also, all control sites healed completely. It could be concluded from this study that: (1) rabbit tibia cannot be recommended in research connected with guided bone regeneration, as all control sites healed in the same way as the test sites; (2) in no case did the presence or the degradation of the resorbable membrane prevent the formation of new bone; (3) no inflammatory reaction was present around the bioresorbable and the non-resorbable membranes; (4) bone formed in all cases on the outer surface of the non-resorbable membranes; (5) large Guidor membrane fragments were present in the 6-week specimens, while in the 12-week specimens only small fragments were recognizable; (6) Guidor membranes can be used in guided bone regeneration.

Bone tissue reactions to demineralized freeze-dried bone in conjunction with e-PTFE barrier membranes in man

Demineralized freeze-dried bone (DFDB) has been demonstrated to be osteoinductive in rodents, while no new bone formation has been reported at ectopic sites in goats, dogs and monkeys. In the present study, DFDB was used in connection with dental implant placement and expanded polytetrafluorethylene (e-PTFE) membranes. Histological examination showed that DFDB particles near the host bone underwent a partial remineralization, while DFDB distant from pre-existing bone was slowly resorbed and showed no remineralization, no osteoinduction, and no osteoconduction. This could be due either to the fact that the response to osteoinductive stimuli is lower in higher species, or to the fact that large quantities of DFDB are required to provide sufficient quantities of bone morphogenetic protein.

Vertical ridge augmentation using a resorbable membrane: a case report

The vertical dimension may be very important clinically where anatomic structures may limit the bone height available for implant insertion. Moreover, lack of bone tissue may result in exposure of implant threads, soft tissue recession, less-than-optimal implant stability, and esthetic problems in the prosthetic reconstruction. Attempts have been made to increase the bone height with the placement of autografts and allografts on top of the ridge, but long-term results have been unsatisfactory. Recently an increase of bone in a vertical direction has been obtained in rats, rabbits, and man using expanded polytetrafluoroethylene (ePTFE) membranes. The authors present a case in which an increase of the vertical dimension of the alveolar ridge was obtained using a resorbable freeze-dried dura mater membrane in association with demineralized freeze-dried bone. After a 6-month uneventful healing period the space under the membrane was filled by a tissue with the macroscopic features of bone, and the two implants were almost covered by the newly-formed tissue. An histological examination of a retrieved sample of the newly formed tissue demonstrated the presence of mature bone. It can be concluded that a localized vertical increase of the alveolar ridge may be obtained with the use of a resorbable freeze-dried dura mater membrane.

Abscess formation around the apex of a maxillary root form implant: clinical and microscopical aspects. A case report

This case report describes the occurrence of an abscess in the periapical area of a root form maxillary titanium implant, with a radiolucent appearance and purulent discharge. The removal of the infected periapical tissues was carried out but the clinical symptoms of infection persisted, an attempt at guided tissue regeneration with a freeze-dried dura mater membrane notwithstanding, and it was necessary to remove the implant. The microscopical examination showed that it was possible to observe nonviable bone tissue, with absence of bone cells and areas of bone resorption in the apical portion of the implant. These microscopical features were compatible with an acute localized suppurative osteomyelitis.