Guided Bone Regeneration

  • Guided Bone Regeneration
    3. Guided Bone Regeneration
  • Guided Bone Regeneration
    1. Guided Bone Regeneration
  • Guided Bone Regeneration
    2. Guided Bone Regeneration
GBR is a technique used for the regeneration of lost alveolar bone by the help of a grafting material and a barrier membrane. The defect is filled with a bone graft material (allogeneic-, xenogeneic- or alloplastic bone substitute materials) that serves as a scaffold for ingrowth of bone forming cells (osteoconduction) and blood vessels, and prevents collapse of the overlying membrane and soft tissue. The membrane acts as a barrier agains ingrowth of fast proliferating connective tissue cells, hence, giving the bone forming cells time and space for the osseous regeneration of the defect. Moreover, the membrane stabilizes the bone graft material and prevents the migration of particles.

Membrane application

Especially for lateral augmentations, it is beneficial to place a dry membrane before application of the graft material. After rehydration the membrane can be folded over the defect, and is easily repositioned if required.

Particle application

Avoid compressing the particles excessively during application; less packed particles leave space for blood vessel ingrowth and formation of new bone matrix.

Bone graft particle size

Small granules give better surface contouring, which is especially beneficial in the aesthetic region. Large particles enables a better revascularization and bone formation between the particle, therfore, should be preferred for the regeneration of larger defects.

Mixing with autologous bone

Mixing of a bone substitue material with autologous bone is always beneficial, as it confers a biological activity (osteo-inductive and osteo-genetic properties of autologous bone) that supports faster regeneration and improved formation of new bone.

GBR with maxresorb and collprotect - Dr. G. Bayer
GBR mit maxresorb® und collprotect® membrane - Dr. G. Bayer

Small horizontal defects, in particular defects inside the ridge contour, can predictably be treated with many kind of bone substitute materials. maxresorb® is a biphasic material composed of 60% hydroxyapatite and 40% beta-tricalcium phosphate. While the fast resorption of beta-TCP quickly offers space for new bone formation, the HA component provides volume stability for an extended time period, ensuring treatment success also in case of a two-stage procedure (delayed implantation). Of course, the bovine material cerabone® may also be applied. Due to its natural bone structure cerabone® provides optimal support for bone forming cells and blood vessels. A further alternative are the the allogenic maxgraft® granules.

Collagen membranes are very widely used, due to inherent advantagous properties of collagen. Collagen exhibits an excellent biocompatibility and controlled, complete degradation together with a natural hemostatic activity and chemotactic attraction of fibroblasts and osteoblasts. The desirable barrier function largely depends on the indication; for smaller augmentative procedures the collprotect® membrane, which has an intermediate barrier function is the optimal choice. Of course the pericardium membrane, Jason® membrane, which offers a significantly longer barrier function, may also be applied.

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