Bradley Lander
| Bradley Lander |
Bradley Lander, Yu-Cheng Chang, Rodrigo Neiva
Periodontics, University of Pennsylvania School of Dental Medicine
Introduction
Sufficient bone volume is a prerequisite for predictable and long-term dental implant success. Following tooth loss, bone remodeling is characterized by constant alveolar resorption, which may lead to horizontal, vertical, or combined ridge deficiencies. Alveolar ridge atrophy can also be attributed to periodontal disease and traumatic injury. Various procedures were developed to increase bone volume, including alveolar distraction osteogenesis, ridge expansion, inlay/onlay block grafting procedure, and guided bone regeneration (GBR). GBR has been shown to be a predictable and effective regenerative technique for ridge augmentation. Predictable bone formation requires the presence of essential biological components, including cells, signaling molecules, and scaffolds. With adequate blood supply, soft tissue isolation, and time, these components have been shown to regenerate alveolar bone predictably. Consequently, significant effort has been made to develop novel GBR techniques and materials to improve clinical outcomes for patients undergoing ridge augmentation. Bone grafts in modern implant dentistry may be autogenous, allogenic, xenogenic, and alloplastic in nature, all of which vary in their osteogenic, osteoinductive, and osteoconductive capabilities. Similarly, various barrier membranes have been considered to optimize bone regeneration by stabilizing bone graft material, maintaining space, and preventing epithelial cellular ingrowth. Resorbable and non-resorbable barrier membranes are both effective in achieving treatment objectives while offering unique properties Due to such a diverse library of materials, clinicians must have an evidence-based approach to material selection to optimize alveolar ridge augmentation, and clinical outcomes and minimize complications. The aim of this study is to retrospectively analyze factors related to the difficulties of alveolar ridge augmentation using guided bone regeneration in a university setting.
Methods
This study is a retrospective case-control study and has received Institutional Review Board (IRB) approval. Medical records of 50 patients of Penn Dental Medicine who received guided bone regeneration were retrospectively reviewed and evaluated. Subjects would be included in the study if they received GBR from 01/01/2019 to 07/01/2021. The eligible candidates for the study will be determined by automated search using the procedure code in Axium. The Axium software will be used as the data source for this study. Descriptive statistics will be used to evaluate primary and secondary outcomes. Also, an analysis of covariance (ANCOVA) test will be performed to compare study outcomes. The primary endpoint of this study is the use of a barrier membrane and successful GBR to facilitate implant placement. Complications will be assessed by identifying barrier membrane exposure, infection, osteonecrosis, the need for additional grafting or repeat procedure, and prospective implant loss. To supplement this, the influence of factors on complications rates will be analyzed, including health status, pre-and post- operative medication, bone graft material, the membrane used, and method of stabilization.
Results
In 27% of cases, there were barrier membrane exposures. There was a dramatic increase in failure rates in patients with higher ASA scores, with 84% of the membrane exposures occurring in patients classified as ASA II compared to 16% in ASA I patients. Exposures and infections occurred after 9% of GBR procedures. Assessing the influence of the bone graft material, when cortical bone allograft was used alone, there as a membrane exposure rate of 37.5%. While barrier membrane selection did not appear to have a significant impact, in cases where two different barrier membranes were used, there was a complication rate of 100%.
Conclusion
Within the limitations of this study, material selection and surgical techniques play a critical role in complication rates of guided bone regeneration at Penn Dental Medicine.