Effect of Membrane Exposure on Guided Bone Regeneration: A Systematic Review and Meta‐Analysis

Aims: This review aimed at investigating the effect of membrane exposure on guided bone regeneration (GBR) outcomes at peri-implant sites and edentulous ridges. Material and Methods: Electronic and manual literature searches were conducted by two independent reviewers using four databases, including MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials, for articles up to February 2017. Articles were included if they were human clinical trials or case series reporting outcomes of GBR procedures with and without membrane exposure. A random-effects meta-analysis was conducted, and the weighted mean difference (WMD) between the two groups and 95% confidence interval (CI) were reported. Results: Overall, eight articles were included in the quantitative analysis. The WMD of the horizontal bone gain at edentulous ridges was −76.24% (95% CI = −137.52% to −14.97%, p = .01) between sites with membrane exposure and without exposure. In addition, the WMD of the dehiscence reduction at peri- implant sites was −27.27% (95% CI of −45.87% to −8.68%, p = .004). Both analyses showed significantly favorable outcomes at the sites without membrane exposure. Conclusion: Based on the findings of this study, membrane exposure after GBR procedures has a significant detrimental influence on the outcome of bone augmentation. For the edentulous ridges, the sites without membrane exposure achieved 74% more horizontal bone gain than the sites with exposure. For peri-implant dehiscence defects, the sites without membrane exposure had 27% more defect reduction than the sites with exposure

Intraoperative Complications during Sinus Floor Elevation Using Two Different Ultrasonic Approaches: A Two-Center, Randomized, Controlled Clinical Trial

The aim of this study was to assess the prevalence of intraoperative complications during maxillary sinus elevation with lateral approach using a piezoelectric device with two different surgical techniques. MATERIALS AND METHODS: Antrostomies were randomly performed by outlining a window (group A, 36 patients) or by eroding the cortical wall with a grinding insert until the membrane was visible under a thin layer of bone, before outlining the window (group B, 36 patients). Occurrence of membrane perforation, laceration of vascular branches, and surgical time was recorded. RESULTS: Seventy-two patients underwent sinus floor elevation: four perforations (11.1%) were observed in group A (two occurred during elevation with hand instruments) and zero perforations in group B (p\u2009<\u2009.05). No evidence of vascular lacerations was registered in both groups. A clinically insignificant but statistically shorter surgical time was recorded in group A (9.2\u2009\ub1\u20093.7 minutes) than in group B (13.3\u2009\ub1\u20092.4 minutes; p\u2009<\u2009.05). CONCLUSIONS: Within the limits of the present study, it may be concluded that ultrasonic erosion of the lateral wall of the sinus is a more predictable technique than piezoelectric outlining of a bone window in preventing from accidental perforations of Schneiderian membrane during sinus augmentation procedure

How to Select Replacement Grafts for Various Periodontal and Implant Indications

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141520/1/cap0167.pd

A histomorphometric meta-analysis of sinus elevation with various grafting materials

Several grafting materials have been used in sinus augmentation procedures including autogenous bone, demineralized freeze-dried bone (DFDBA), hydroxyapatite, β-tricalcium phosphate (β-TCP), anorganic deproteinized bovine bone and combination of these and others. Up to now a subject of controversy in maxillofacial surgery and dentistry is, what is the most appropriate graft material for sinus floor augmentation