Unfortunately, some patients are forced to be told by dentists that they cannot undergo implant surgery because there is not enough bone available.
In fact, if there is not enough bone tissue, implants cannot have a solid and stable base to which they can be attached and to which they can integrate seamlessly.
But all is not lost: as you know, enormous strides have been made in the field of dentistry and oral surgery: today, thanks to guided bone regeneration, it is possible to restore a quantitatively adequate and perfectly placed amount of bone in order to proceed with implant placement.
What is guided bone regeneration
Guided bone regeneration is that technique that specialists in Dr. Savasta's practice resort to when there is a need to increase the volume of bone structure.
The introduction of this particular technique has opened up new possibilities regarding implantology, but also for all those oral surgeries for which a certain amount of bone is required.
This is based on the use of so-called membranes, which are barriers whose job is to protect the blood clots and isolate the area from the connective tissue around it, so as to create the space necessary for the generation of brand-new bone tissue.
Membranes are thus the stars of this regenerative method; they can be of two types, viz:
- Nonresorbable membranes;
- resorbable membranes.
The two types have important structural differences.
Membranes and bone substitute
Nonresorbable membranes are usually made of expanded polytetrafluoroethylene and depending on the case may or may not have a titanium weave to provide greater stability.
These membranes allow for complete regeneration in a period usually between nine months and one year.
The membranes are secured with small nails or microscrews to prevent cells from entering the space that has been created.
The regenerative effect is greater if membranes are used i combination with bone substitutes. Nonresorbable barriers allow horizontal or vertical bone augmentations of about 3 to 5 millimeters.
The main difference between resorbable and nonresorbable membranes should be found in the fact that the former do not have to be removed later with another surgery.
They can be used to treat smaller bone defects and can be made from collagen, pericardium, polylactic acid copolymers, and polyigliocholic acid.
They never have titanium reinforcement and should be used in combination with a bone substitute that can provide the proper support.
The job of resorbable membranes is to contain and protect the graft material. Given their composition they degrade and are absorbed by the body of within a few months (two to six).
You are probably wondering what is being referred to when the term bone substitute is used. That term refers to the bone material that is used in guided regeneration techniques in combination with membranes.
The use of autologous bone (i.e., from the patient himself) or heterologous material provides the best results in terms of regeneration and volume preservation.
The steps and timing of regeneration with GBR technique
GBR guided bone regeneration is not the only bone tissue reconstruction technique aimed at placing dental implants, however, since it was introduced in the late 1980s it is the one on which the most studies and experiments have been conducted.
Also for this reason, the survival rate of implants grafted onto GBR-treated areas is very high and close to 100%.
The latest technology is used at Dr. Savasta's office, so that the medical staff can examine the situation and choose the most suitable solution, and the surgeon can design and perform the surgery in the most precise and least invasive way
Three basic elements are needed to put this technique into practice:
- the membrane, which serves to give stability to the blood clot,
- The biomaterial, used to support the membrane;
- vital bone around the treated area, most important for its vascular support.
The whole process follows the typical steps of osteogenesis processes:
- The first stage is the formation of medullary bone (four to six weeks);
- The second stage consists of the maturation of the medullary bone and the formation of cortical bone (two to three months);
- The third stage is when the cortical bone matures (after four months).
Implants are placed when regeneration has been completed, which is after a period of usually four to eight months.
