Guided Bone RegenerationWoodland Hills, CA

Steps to a Successful Guided Bone Regeneration

According to an article in Chairside Magazine, up to 40% of dental implant sites require guided bone regeneration as a necessary part of the patient's rehabilitation process. There are certain factors and principles that a periodontist must adhere to for a successful implant placement. If the patient has a deficient bony ridge, for instance, then the implant's function, support, and aesthetics may all become compromised.

A successful bone graft requires the "passage of various cellular components from the surrounding recipient site's bony walls and vascular components into the developing graft site." It is more challenging for angiogenesis and cells to migrate to the outer limits of the particulate graft when the distance between these bony surfaces and the peripheral graft components is larger. As such, bony defects should be treated "according to the type of defect and the amount of bone growth required."

To begin the bone regeneration process, the periodontist must first identify both ideal and nonideal cases for the surgery. To do so, they may use cone-beam computed tomography (CBCT) imaging and interactive CBCT treatment planning. Bony defects may be classified as small depressions, concavity defects, convex/straight bone deficiencies, vertical (height) defects, or buccal-lingual defects. Once the periodontist has reviewed the patient's teeth, they will move onto flap design and incision.

It is ideal to gain complete access to the surgical site without compromising the surrounding tissue's integrity. As such, planning the flap design and incision is of the utmost importance. Irregular incisions may lead to maceration of the flap, compromising the primary blood supply source. Afterward, the periodontist will move onto reflection and release of the tissue. During tissue reflection, any underlying bone is scraped with a bone curette to remove any tissue. The flap must also have complete release of tension to prevent incision line opening.

Preparing the recipient site involves soft-tissue removal (upon which the periodontist removes all soft-tissue remnants from the bony recipient site) and decortication (upon which the periodontist creates pilot holes into the cortical bone, initiating the regional acceleratory phenomenon). Then comes space maintenance, which involves tenting screws, and placement of the bone graft, which may involve an autograft (bone graft using one's own bone) or allograft (bone graft using donor bone). Finally, the periodontist will select and place the barrier membrane and ensure proper closure.