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Guided bone regeneration with titanium membrane : A preliminary study

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Title: Guided bone regeneration with titanium membrane : A preliminary study Author: Last modified by: Created Date: 4/21/2002 8:46:09 AM – PowerPoint PPT presentation

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Title: 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
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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
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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
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