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Title Zirconia Guided Bone Regeneration (GBR) Barriers Can Be Successful at Augmenting Alveolar Ridge Dimensions to Allow Restoratively Driven Implant Placement.
Clinical Question In patients with a deficient alveolar ridge, will a ridge augmentation with a custom milled zirconia guided bone regeneration (GBR) barrier and grafting be effective at increasing alveolar ridge width and height sufficient enough to place a restoratively driven implant?
Clinical Bottom Line For patients with insufficient alveolar ridge dimensions, custom-milled zirconia membranes can be used in guided bone regeneration cases to aid restoratively driven implant placement. This conclusion is based on a single case series with nine sites treated. Additional prospective studies are needed to assess validity and reliability.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 34400253Mandelli/20217 patients/ 9 sitesCase series
Key resultsThis case series showed that zirconia guided bone regeneration barriers successfully augment the alveolar ridge. Sites were grafted with autogenous bone and xenograft mixture. Eight of the nine guided bone regeneration procedures had no significant complications. The zirconia barrier became prematurely exposed at four weeks in one patient, but no adverse complications arose from the early exposure. New bone formation was confirmed through histological examination. All grafted sites healed successfully to allow restoratively driven implant placement. Seventeen implants were placed in the grafted sites after five to eight months of healing. All seventeen implants successfully osseointegrated and were successfully restored with definitive restorations.
#2) 33364058Petre/202030 adult Wistar ratsAnimal study
Key resultsThis animal study found that custom-designed zirconia space maintenance barrier membranes in thirty Wistar rat femurs were successful at osteogenesis in surgically created defects. No bone graft material was used in this experiment. All sites successfully healed and regained normal function. Samples collected at 2, 4, 6, and 8 weeks showed no evidence of tissue inflammation providing evidence of excellent biocompatibility of the membrane. GBR sites were analyzed histologically and histomorphometrically with samples demonstrating progressive maturation of the bone quality from week two to week eight.
Evidence Search ("zirconia s"[All Fields] OR "zirconias"[All Fields] OR "zirconium oxide"[Supplementary Concept] OR "zirconium oxide"[All Fields] OR "zirconia"[All Fields]) AND ("guide"[All Fields] OR "guided"[All Fields] OR "guides"[All Fields] OR "guiding"[All Fields]) AND ("bone regeneration"[MeSH Terms] OR ("bone"[All Fields] AND "regeneration"[All Fields]) OR "bone regeneration"[All Fields]) AND ("barrier"[All Fields] OR "barrier s"[All Fields] OR "barriers"[All Fields])
Comments on
The Evidence
Only one case series and one proof of concept animal study were found during the literature search. The case series showed 100% success using the zirconia barrier membranes and good short-term success of the implants placed into the region. A single master clinician in bone regeneration performed the procedures in the case series. GBR procedures are technique-sensitive, and surgical experience can impact outcomes. Eight of the nine procedures were performed in the maxilla. The case series did not comment on the size of the defects that were being grafted or give quantifiable data on the results. While the preliminary data shows promising results for using zirconia guided bone regeneration, additional randomized control trials with more participants, increased variability in grafting location, and long-term follow-up are needed to assess the reliability and validity of Zirconia GBR barriers.
Applicability There are multiple barrier techniques to choose from for guided bone regeneration. Milled zirconia membranes allow for detailed planning of the procedure before the appointment. Planning in the pre-operative phase reduces the surgical and chairside time for extensive guided bone regeneration procedures. Zirconia's biocompatibility provides an ideal environment for bony healing. Decreased surgical time and the material's biocompatibility may reduce the risk of post-operative infections and other complications, leading to better post-operative outcomes. Additional human research with more participants and long-term follow-up is needed.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics)
Keywords Zirconia barrier membrane, Guided bone regeneration, GBR
ID# 3493
Date of submission: 04/27/2023spacer
E-mail oconnort@uthscsa.livemail.edu
Author Thomas O’Connor, D.M.D.
Co-author(s) Alexis Dudash, D.D.S.
Co-author(s) e-mail dudash@uthscsa.edu
Faculty mentor/Co-author Dr. David Lasho, D.D.S., M.S.D.
Faculty mentor/Co-author e-mail lasho@uthscsa.edu
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