Clinical Classification of Healing Complications and Management in Guided Bone Regeneration Procedures with a Nonresorbable d-PTFE Membrane.

Since the introduction of guided bone regeneration (GBR) using nonresorbable membranes, membrane exposure has been categorized as one of the major complications associated with the procedure. Expanded polytetrafluoroethylene (e-PTFE) has a long history of use in GBR, and now the use of high-density PTFE (d-PTFE) is commonly reported in the literature. The major structural difference between these two materials is their permeability to bacteria: e-PTFE has an open-pore microstructure and is permeable to bacteria, while d-PTFE is not. Thus, there are fundamental differences in the two materials if premature exposure occurs. Protocols for classification and management of exposure specific to e-PTFE have been published and were well-received by clinicians, but these protocols do not necessarily apply to d-PTFE exposures. Because of the fundamental structural differences between these two PTFE materials, a protocol specific to the classification and management of d-PTFE membrane healing complications is required and is thus presented in this paper.

Comparative analysis of two biomaterials mixed with autogenous bone graft for vertical ridge augmentation: A histomorphometric study in humans.

BACKGROUND: The vertical increase of the alveolar ridge dimension using allograft or xenograft mixed with autogenous bone graft and covered by a nonabsorbable high-density polytetrafluoroethylene (d-PTFE) membrane is well documented in the literature. PURPOSE: The aim of this study was to assess vital mineralized tissue formation in vertical ridge augmentation (VRA) procedures using autogenous bone chips mixed either with an allograft or a xenograft. METHODS: This prospective clinical trial recruited 16 partially edentulous patients to undergo vertical ridge augmentation in one or more sites, making up a total of 24 samples for histological evaluation. Patients were sequentially stratified into Group A (treated with a freeze-dried bone allograft [FDBA] mixed with autogenous bone) or to Group B (treated with a bovine xenograft mixed with autogenous bone). Histological samples were analyzed according to the biomaterial used for VRA. Histological samples were obtained on the same day of membrane removal and implant placement. RESULTS: Thirty-three implants were placed in 16 sites of regenerated bone via VRA, 13 patients with ridge augmentation in the posterior mandible, and 3 patients with VRA in the anterior maxilla. Group A (FDBA + autogenous) and Group B (xenograft + autogenous) showed a percent vital mineralized tissue (VMT) area of 67.64 ± 16.84 and 60.93 ± 18.25, respectively. A significant difference between the two biomaterials was not observed. CONCLUSION: When mixed with autogenous bone, either allografts or xenografts may provide a successful augmentation. Either mixture could serve as reliable alternative in VRA for obtaining a high percentage of VMT.

Management Of 80 Complications In Vertical And Horizontal Ridge Augmentation With Nonresorbable Membrane (d-PTFE): A Cross-Sectional Study.

PURPOSE: Vertical and horizontal guided bone regeneration with nonresorbable membranes is a regenerative alternative for treating bone defects in edentulous zones. Its indication and good outcomes have been confirmed by different authors; however, this procedure remains highly technique sensitive and might lead to complications. The purpose of this study was to describe the management of complications such as exposures and infections following vertical and horizontal guided bone regeneration with titanium-reinforced high-density polytetrafluoroethylene (PTFE) nonresorbable membranes carried out using a new management protocol for complications related to this type of membrane. MATERIALS AND METHODS: Complications in vertical and horizontal guided bone regeneration were evaluated by the same surgeon in a private practice between 2010 and 2017. They were classified and managed according to whether they were exposures and/or infections, and also according to their size, sagittal location, and coronal position of the alveolar ridge of the exposures. Descriptive analyses were conducted to evaluate the influence of age, sex, clinical characteristics of the complication, time of appearance, location, membrane size, anatomical and sagittal location, pink ceramic use, and definitive restoration, both before and after management protocol application. RESULTS: Eighty complications were evaluated. The sextant with the highest number of complications was the anterior maxilla (35/80, 43.75%), followed by the mandibular left side area (16/80, 20.00%). The majority (56/80, 70.00%) of all complications appeared before 2 months. In relation to the sagittal location of exposures, 43.64% (24/55) were located coronal to the alveolar ridge. Statistically significant differences were found between exposures with or without purulent exudate, related to the coronal location of the exposure (P ± .05). CONCLUSION: A new protocol for managing complications with titanium-reinforced high-density PTFE nonresorbable membranes is proposed based on the follow-up of 80 complications. These steps can help prevent total graft loss, allowing patients to reach final rehabilitation without multiple additional surgeries. Infections continue to be the most common cause of bone loss in guided bone regeneration. Long-term results and follow-up studies are necessary to assess the stability of soft and hard tissues in patients rehabilitated using this complication management protocol.

A Case Series of Vertical Ridge Augmentation Using a Nonresorbable Membrane: A Multicenter Study.

Vertical ridge augmentation (VRA) using titanium-reinforced dense polytetrafluorethylene (d-PTFE) membranes has been associated with promising clinical outcomes. This retrospective multicenter case series was prepared for the purpose of identifying the elements that contribute to the predictability of this surgical technique. VRA procedures were carried out in 35 patients (13 male and 22 female) with an age range of 43 to 76 years. The average bone gain was 5.44 mm. In the Kaplan-Meier estimates of cumulative survival calculated at 15 months, membrane exposure (P = .045) was a predictor for VRA.