Clinical and histological evaluations of alveolar ridge augmentation using a novel bi-layered porous polyethylene barrier membrane

Effectiveness of a polycaprolactone scaffold combined with platelet-rich fibrin as guided tissue regeneration materials for preserving an implant-supported overdenture

Objectives

This study aimed to assess the effectiveness of ridge preservation using a polycaprolactone (PCL) scaffold combined with platelet-rich fibrin (PRF) to promote bone regeneration before implantation.

Materials and Methods

This prospective study was conducted at Al-Azhar University in Egypt. It included 30 participants requiring the extraction of their last mandibular premolar before constructing an implant-supported overdenture. The participants were divided into three groups: Group A was treated with a PCL scaffold and PRF as ridge preservative materials, Group B was treated with PRF alone, and Group C (control) was treated with no preservative material. Bone samples were collected for histomorphometric analysis at implant placement.

Results

The participants' mean age was 65.3 ± 4.27 years, and 18 (60%) were male. Postoperative alveolar bone lengths differed significantly between Groups A and B (P = 0.001). However, alveolar bone width changes did not differ significantly among groups. In contrast, the postoperative bone density and loss differed significantly among groups (P = 0.001).

Conclusion

Combining two ridge preservation techniques (PCL and PRF) enhanced participants' alveolar bone remodelling by decreasing its resorption and maintaining its width.

Barrier membranes for periodontal guided bone regeneration: a potential therapeutic strategy

Periodontal disease is one of the most common oral diseases with the highest incidence world-wide. In particular, the treatment of periodontal bone defects caused by periodontitis has attracted extensive attention. Guided bone regeneration (GBR) has been recognized as advanced treatment techniques for periodontal bone defects. GBR technique relies on the application of barrier membranes to protect the bone defects. The commonly used GBR membranes are resorbable and non-resorbable. Resorbable GBR membranes are divided into natural polymer resorbable membranes and synthetic polymer resorbable membranes. Each has its advantages and disadvantages. The current research focuses on exploring and improving its preparation and application. This review summarizes the recent literature on the application of GBR membranes to promote the regeneration of periodontal bone defects, elaborates on GBR development strategies, specific applications, and the progress of inducing periodontal bone regeneration to provide a theoretical basis and ideas for the future application of GBR membranes to promote the repair of periodontal bone defects.

Preparation and Characterization of a Novel Tragacanth Gum/Chitosan/Sr-Nano-Hydroxyapatite Composite Membrane

It is a great challenge to obtain an ideal guided bone regeneration (GBR) membrane. In this study, tragacanth gum (GT) was introduced into a chitosan/nano-hydroxyapatite (CS/n-HA) system. The effects of different component ratios and strontium-doped nano-hydroxyapatite (Sr-HA) on the physical-chemical properties and degradation behavior of the CS/Sr-n-HA/GT ternary composite membrane were investigated using Fourier transform infrared spectroscopy (FT-IR), X-ray diffraction (XRD), scanning electron microscopy (SEM), contact angle, electromechanical universal tester and in vitro soaking in simulated body fluid (SBF). The results showed that CS could be ionically crosslinked with GT through electrostatic interaction, and Sr-n-HA was loaded via hydrogen bond, which endowed the GT/CS/n-HA composite membrane with good tensile strength and hydrophilicity. In addition, the results of immersion in SBF in vitro showed that CS/n-HA/GT composite membranes had different degradation rates and good apatite deposition by investigating the changes in pH value, weight loss, water absorption ratio, SEM morphology observation and tensile strength reduction. All results revealed that the CS/Sr-n-HA/GT (6:2:2) ternary composite membrane possessed the strongest ionic crosslinking of GT and CS, which was expected to obtain more satisfactory GBR membranes, and this study will provide new applications of GT in the field of biomedical membranes.

Healing complications and their detrimental effects on bone gain in vertical-guided bone regeneration: A systematic review and meta-analysis

PURPOSE

Guided bone regeneration (GBR) utilizes a barrier membrane to allow osteogenic cells to populate a space by excluding epithelial and connective tissue cells. The purpose of this systematic review was to investigate the ratio of means (RoM) of vertical bone gained (Outcome) in vertical GBR procedures with healing complications (Intervention) and in vertical GBR procedures without healing complications (Comparison) in patients with vertically resorbed edentulous ridges that require dental implant placement (Population). A further aim was to investigate the incidence of complications after vertical GBR, and the influence of the timing of implant placement and regenerative devices on complications.

MATERIALS AND METHODS

MEDLINE (through PubMed), EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched in duplicate up to, and including, November 2020 for randomized and controlled clinical trials and prospective and retrospective case series. Outcomes included patient-level and site-level RoM of vertical bone gain between healing complications and uneventful healing, and incidences of complications that occurred after vertical GBR. Random-effects and fixed-effects meta-analyses were performed where appropriate. This study was registered on PROSPERO (CRD42021226432).

RESULTS

A total of 31 publications were selected for the qualitative and quantitative analyses. The RoM of vertical bone gained was 0.65 [95% CI = 0.47, 0.91] and 0.62 [95% CI = 0.45, 0.85] when membrane exposure without suppuration and abscess formation without membrane exposure occurred respectively, in comparison to uneventful healing. The overall incidence proportion of healing complications occurring at the augmented site at a site- and patient-level was 11.0% [95% CI = 7.0, 15.6] and 10.8% [95% CI = 6.6, 15.7]. At a patient-level, there were no significant differences between a simultaneous or staged approach, or with the regenerative device used. The site-level incidence proportion of membrane exposure without suppuration, membrane exposure with suppuration, and with abscess formation without membrane exposure was 8.7% [95% CI = 4.2, 14.2], 0.7% [95% CI = 0.0, 2.9], and 0.5% [95% CI = 0.0, 1.7], respectively. The site-level weighted mean incidence proportion of neurologic complications occurring at the donor site was 0.8% [95% CI = 0.0, 5.3].

CONCLUSIONS

There is a significant reduction in bone gain when healing complications occur. However, healing complications are relatively uncommon surgical complications after vertical GBR.