Guided bone regeneration with titanium membrane : A preliminary study

1
Guided bone regeneration with titanium membrane
A preliminary study

• ??? ?? ??

2
Introduction

• Sufficient volume quality of alveolar bone
• Esthetics function in implant dentistry

3
Guided tissue regeneration

• The use of membranes to guide bony tissue
  formation by separating the underlying bone from
  the overlying connective tissue
• by creating a space into which the desirable
  bone cells can migrate
• 
  - by Dahlin C. 1994

4
Indication of GBR

• Extraction site
• - Prevention of crestal bone loss
• especially when 1 or more wall missing
  
• Correction of inadequate ridge width or shape
• - Atrophic alveolar bone reconstruction for
  implant
• placement

5
Indication of GBR

• Dehicence defects
• Apical fenestration
• Residual intraosseous defects
• - Fresh or incompletely repaired extraction
  site

6
Historical review of GBR

• Regeneration of alveolar bone beneath cellulose
  acetate filler implant
• 
  - by Boyne PJ. 1964
• Healing of bone defects by GTR
• - by
  Dahlin C et al. 1988

7
Historical review of GBR

• Bone formation utilizing titanium-reinforced
  barrier membrane
• 
  - by Jovanovic. 1995
• Augmentation of intramembraneous bone beyond the
  skeletal envelope using an occlusive titanium
  barrier
• 
  - by Lundgren D. 1995

8
Basic mechanism of GBR

• Prevention of fibroblasts filling the defect
• Prevention of contact inhibition by heterotophic
  cell interaction
• Exclusion of cell-derived soluble inhibitory
  factors

9
Requirement of GBR barrier membrane

• Biocompatibility safety
• Cell occlusiveness
• Space-making ability
• Tissue integration
• Clinical manageability cost effectiveness
• 
  - by Teparat T et al. 1998

10
Consideration of selecting membrane

• The creation maintenance of sufficient space
  underneath the barrier is an important factor for
  a successful results

11
Classification of barrier membrane

• Nonresorbable membrane
• Resorbable membrane

12
Nonresorbable membrane

• Expanded polytetrafluoroethlene ( e-PTFE )
• - Goretex
• Nonexpanded polytetrafluoroethlene
• - Tef Gen-FD

13
Nonresorbable membrane

• Titanium-reinforced expanded
• polytetrafluoroethlene
• Titanium membrane with microperforation
• - FRIOS Bone shield

14
Resorbable membrane

• Collagen barriers
• - Bio-Guide, Bio-Mend, Colla Tape
• Synthetic polymers
• - Vicryl Mesh, Resolut, Resolut XT

15
Resorbable membrane

• Biologically active membrane
• Platelet-rich plasma
• Other barrier materials
• - Capset, Lambone

16
Characteristics of titanium membrane

• Mechanical property of rigidity
• Smooth titanium surface with laserbeam-derived
  microperforation
• Lateral marginal slit for fixation shaping

17
(No Transcript)
18
Advantage of titanium membrane

• Effective fixation of grafting materials
• Optimal mechanical stability
• Easy durable shaping
• Maximum biocompatibility
• Easier fixation by membrane tacks

19
Disadvantage of titanium membrane

• Increase in the number of exposure with mucosal
  perforation
• Refrain from the placement of intermediate
  dentures
• Technical sensitivity

20
Purpose

• The purpose of this preliminary study is to
  present clinical results of titanium membrane
  used for GBR in implant dentistry

21
Patients

• Patients 6 patients ( Since 2000.11 )
• Sex Male ( 4 ), Female ( 2 )
• Age 16-42years

22
Results
No Sex Age Procedures Location Time of exposure Membrane maintenance Complication management
1 M 39 12 Ridge splitting - 7 mths -
2 M 33 22 Lab. dehiscence 3 wks 3 wks Local infection Osseointegration failure
3 F 42 32-41 Lab. dehiscence 2 mths 2 mths -
23
Results
No Sex Age Procedures Location Time of exposure Membrane maintenance Complication management
4 M 33 11-21 Ridge splitting 4 mths 4 mths Lab. fistula bone destruction Curettage with TC powder Mx tuberosity bone graft
5 F 16 36 Lab Lig dehiscence 4 wks 8 wks Osseointegration failure Remarks) Graft material good embedded state
6 M 42 14 Lab. dehiscence - 5 mths -

24
Results

• 2 Patients Uneventful healing of GBR site
  retrieval of membrane after adequate healing
  period
• 4 Patients Membrane exposures after primary
  healing of mucosal incision

25
Consideration of selecting membrane

• Most flexible membranes do not have enough
  rigidity tend to collapse
• More rigid nonresorbable membrane is needed

26
(No Transcript)
27
(No Transcript)
28
(No Transcript)
29
(No Transcript)
30
Discussion

• The time between operation exposure of the
  membrane is critical point
• The rigidity of the titanium membrane leads to an
  increase in the number of exposure

31
Conclusion

• The rigidity of titanium membrane makes the
  barrier able to maintain space
• Careful soft tissue management avoid directing
  loading by intermediate denture is essential to
  prevent wound dehiscence