Barrier Type Used During Guided-Bone Regeneration Impacts Exposure Rates


In total, 271 GBR procedures were investigated with 193 being RS, 45 TM, and 33 NRS.

Journal of Oral Implantology – When faced with the challenge of tooth loss, dental implants are an effective option to preserve the shape of your mouth while also promoting overall oral and full-body health. In some cases of dental implant surgery, the alveolar ridge may need to be reconstructed to ensure success. This reconstruction is achieved by using guided-bone regeneration (GBR) in which donor bone is grafted to strengthen and enhance the shape and volume of the alveolar ridge. GBR is typically performed with the use of a barrier to hold the shape of the graft material and prevent the ingrowth of soft tissue. However, the use of a barrier is not without risk.

“Barriers used for GBR can be categorized as resorbable (RS), nonresorbable (NRS), and titanium mesh (TM). Although grafted bone tends to heal better with a barrier, studies have reported high rates of barrier exposure, which increases the risk of infection that compromises the graft,” pens Kiddee Poomprakobsri, DDS, MSD, MBA, Loma Linda University School of Dentistry in Loma Linda, California, and co-authors. Poomprakobsri and colleagues recently published a retrospective study in the Journal of Oral Implantology that compared the post-GBR exposure rates of RS, NRS, and TM barriers.

In this analysis, records of 232 patients were evaluated. The patient cohort consisted of 89 males and 148 females, with a mean age of 56.8 years. In total, 271 GBR procedures were investigated with 193 being RS, 45 TM, and 33 NRS. The researchers examined the barrier type as well as “graft material, location of the graft, purpose of grafting, surgeon experience, the patient’s smoking habit, and the use of interim [prosthesis].”

The results of this study showed 100 (36.9%) exposed barriers with rates as follows: RS, 23.3%; NRS, 72.7%; and TM, 68.9%. While autogenous bone was the most frequently used graft material, it also had the highest exposure rate at 66.7% compared with xenografts that showed 0% exposure. Regarding graft location, the highest rate was found in the posterior mandible (42.7%) and the lowest in the anterior mandible (29.4%). Regarding grafting purposes, horizontal augmentation showed the least exposure (30.1%) while vertical augmentation was highest (65.0%). Smoking had nearly a two times greater risk of exposure, with 57.1% for smokers versus 35.8% for nonsmokers. There was no statistical significance related to the surgeon’s experience and the use of interim prosthesis; however, patients using an Essix retainer had the highest exposure rate (51.5%) of those examined.

The results of this study found that barrier type impacts the exposure rate after GBR, but overall, the researchers either did not find statistical significance or determined the sample size was inadequate as to the other variables tested. Poomprakobsri et al. concluded, “Based on the results of this study, the exposure rate of TM or NRS and its effect is more severe when compared with RS. Flap management is critical to reduce the risk of exposure.”

Full text of the article, “Exposure of Barriers Used in Guided Bone Regeneration: Rate, Timing, Management, and Effect on Grafted Bone—A Retrospective Analysis” Journal of Oral Implantology, Vol. 48, No. 1, 2022, is available at https://doi.org/10.1563/aaid-joi-D-19-00252

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About the Journal of Oral Implantology

The Journal of Oral Implantology is the official publication of the American Academy of Implant Dentistry and of the American Academy of Implant Prosthodontics. It is dedicated to providing valuable information to general dentists, oral surgeons, prosthodontists, periodontists, scientists, clinicians, laboratory owners and technicians, manufacturers, and educators. The JOI distinguishes itself as the first and oldest journal in the world devoted exclusively to implant dentistry. For more information about the journal or society, please visit http://www.joionline.org.

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