J Periodontal Implant Sci.  2019 Feb;49(1):14-24. 10.5051/jpis.2019.49.1.14.

Influence of wound closure on volume stability with the application of different GBR materials: an in vitro cone-beam computed tomographic study

• Naenni N
• Berner T
• Waller T
• Huesler J
• Hämmerle
• Thoma DS

• KMID: 2440174
• DOI: http://doi.org/10.5051/jpis.2019.49.1.14

Abstract

PURPOSE
To assess the influence of using different combinations of guided bone regeneration (GBR) materials on volume changes after wound closure at peri-implant dehiscence defects.
METHODS
In 5 pig mandibles, standardized bone defects were created and implants were centrally placed. The defects were augmented using different combinations of GBR materials: xenogeneic granulate and collagen membrane (group 1, n=10), xenogeneic granulate and alloplastic membrane (group 2, n=10), alloplastic granulates and alloplastic membrane (group 3, n=10). The horizontal thickness was assessed using cone-beam computed tomography before and after suturing. Measurements were performed at the implant shoulder (HT0) and at 1 mm (HT1) and 2 mm (HT2) below. The data were statistically analysed using the Wilcoxon signed-rank test to evaluate within-group differences. Bonferroni correction was applied when calculating statistical significance between the groups.
RESULTS
The mean horizontal thickness before suturing was 2.55±0.53 mm (group 1), 1.94±0.56 mm (group 2), and 2.49±0.73 mm (group 3). Post-suturing, the values were 1.47±0.31 mm (group 1), 1.77±0.27 mm (group 2), and 2.00±0.48 mm (group 3). All groups demonstrated a loss of horizontal dimension. Intragroup changes exhibited significant differences in group 1 (P < 0.001) and group 3 (P < 0.01). Intergroup comparisons revealed statistically significant differences of the relative changes between groups 1 and 2 (P=0.033) and groups 1 and 3 (P=0.015).
CONCLUSIONS
Volume change after wound closure was minimized by using an alloplastic membrane. The stability of the augmented horizontal thickness was most ensured by using this type of membrane irrespective of the bone substitute material used for membrane support.

Keyword

Alveolar ridge augmentation; Bone regeneration; Bone substitute; Cone-beam computed tomography; In vitro; Membranes

MeSH Terms

Alveolar Ridge Augmentation
Bone Regeneration
Bone Substitutes
Collagen
Cone-Beam Computed Tomography
In Vitro Techniques*
Mandible
Membranes
Shoulder
Wounds and Injuries*
Bone Substitutes
Collagen

Figure

• 

  Figure 1 Extraction of the mesial root of the second premolar and preparation of the bone defect. (A) Incision and hemisection of the second premolar. (B) Metallic template measuring 8 mm×6 mm×3 mm. (C) Buccal and (D) occlusal view of the standardised peri-implant bone defect showing the respective measurements.

• 

  Figure 2 Silicone mould and application of material for guided bone regeneration. (A) The silicon mould used to standardize the amount of bone substitute material. (B) Particulated demineralized bovine bone mineral used in groups 1 and 2. (C) Alloplastic bone mineral used in group 3. (D) Group 1: xenogeneic granulate+collagen membrane. (E) Group 2: xenogeneic granulate+alloplastic membrane. (F) Group 3: alloplastic granulate+alloplastic membrane.

• 

  Figure 3 Wound closure. Wound closure was obtained by 1 horizontal mattress suture and 2 single interrupted sutures, each at the crestal and at the vertical releasing incision.

• 

  Figure 4 CBCT scan perpendicular to the implant axis before and after suturing. (A) Pre-suturing CBCT of groups 1, 2, and 3. (B) Post-suturing CBCT of groups 1, 2, and 3. CBCT: cone-beam computed tomography, HT0: at the implant shoulder, HT1, 1 mm below the implant shoulder, HT2: 2 mm below the implant shoulder.

• 

  Figure 5 Diagram showing all values for horizontal thickness of the augmented region buccal of the implant before and after suturing at the 3 levels measured. Skyblue: group 1; green: group 2; blue: group 3. HT0: at the implant shoulder, HT1: 1 mm below the implant shoulder, HT2: 2 mm below the implant shoulder.

• 

  Figure 6 Diagram showing the values for the absolute changes (mm) and the relative changes (%) in horizontal thickness at the different levels measured (HT0, HT1, HT2) for the 3 investigated groups. (A) Change in horizontal thickness in (mm). (B) Relative change in horizontal thickness in (%). Skyblue: group 1; green: group 2; blue: group 3. HT0: at the implant shoulder, HT1: 1 mm below the implant shoulder, HT2: 2 mm below the implant shoulder.

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