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Guided bone regeneration with titanium membrane : A preliminary study

Guided bone regeneration with titanium membrane : A preliminary study. 길병원 치과 센터. Introduction. Sufficient volume & quality of alveolar bone Esthetics & function in implant dentistry . Guided tissue regeneration.

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Guided bone regeneration with titanium membrane : A preliminary study

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  1. Guided bone regeneration with titanium membrane : A preliminary study 길병원 치과 센터

  2. Introduction • Sufficient volume & quality of alveolar bone • Esthetics & function in implant dentistry

  3. Guided tissue regeneration • The use of membranes to guide bony tissue formation by separating the underlying bone from the overlying connective tissue & by creating a space into which the desirable bone cells can migrate - by Dahlin C. 1994

  4. Indication of GBR • Extraction site - Prevention of crestal bone loss especially when 1 or more wall missing • Correction of inadequate ridge width or shape - Atrophic alveolar bone reconstruction for implant placement

  5. Indication of GBR • Dehicence defects • Apical fenestration • Residual intraosseous defects - Fresh or incompletely repaired extraction site

  6. Historical review of GBR • Regeneration of alveolar bone beneath cellulose acetate filler implant - by Boyne PJ. 1964 • Healing of bone defects by GTR - by Dahlin C et al. 1988

  7. Historical review of GBR • Bone formation utilizing titanium-reinforced barrier membrane - by Jovanovic. 1995 • Augmentation of intramembraneous bone beyond the skeletal envelope using an occlusive titanium barrier - by Lundgren D. 1995

  8. Basic mechanism of GBR • Prevention of fibroblasts filling the defect • Prevention of contact inhibition by heterotophic cell interaction • Exclusion of cell-derived soluble inhibitory factors

  9. Requirement of GBR barrier membrane • Biocompatibility & safety • Cell occlusiveness • Space-making ability • Tissue integration • Clinical manageability & cost effectiveness - by Teparat T et al. 1998

  10. Consideration of selecting membrane • The creation & maintenance of sufficient space underneath the barrier is an important factor for a successful results

  11. Classification of barrier membrane • Nonresorbable membrane • Resorbable membrane

  12. Nonresorbable membrane • Expanded polytetrafluoroethlene ( e-PTFE ) - Goretex • Nonexpanded polytetrafluoroethlene - Tef Gen-FD

  13. Nonresorbable membrane • Titanium-reinforced expanded polytetrafluoroethlene • Titanium membrane with microperforation - FRIOS®Bone shield

  14. Resorbable membrane • Collagen barriers - Bio-Guide, Bio-Mend, Colla Tape • Synthetic polymers - Vicryl Mesh, Resolut, Resolut XT

  15. Resorbable membrane • Biologically active membrane: Platelet-rich plasma • Other barrier materials - Capset, Lambone

  16. Characteristics of titanium membrane • Mechanical property of rigidity • Smooth titanium surface with laserbeam-derived microperforation • Lateral marginal slit for fixation & shaping

  17. Advantage of titanium membrane • Effective fixation of grafting materials • Optimal mechanical stability • Easy & durable shaping • Maximum biocompatibility • Easier fixation by membrane tacks

  18. Disadvantage of titanium membrane • Increase in the number of exposure with mucosal perforation • Refrain from the placement of intermediate dentures • Technical sensitivity

  19. Purpose • The purpose of this preliminary study is to present clinical results of titanium membrane used for GBR in implant dentistry

  20. Patients • Patients: 6 patients ( Since 2000.11 ) • Sex: Male ( 4 ), Female ( 2 ) • Age: 16-42years

  21. Results

  22. Results

  23. Results • 2 Patients: Uneventful healing of GBR site & retrieval of membrane after adequate healing period • 4 Patients: Membrane exposures after primary healing of mucosal incision

  24. Consideration of selecting membrane • Most flexible membranes do not have enough rigidity & tend to collapse • More rigid nonresorbable membrane is needed

  25. Discussion • The time between operation & exposure of the membrane is critical point • The rigidity of the titanium membrane leads to an increase in the number of exposure

  26. Conclusion • The rigidity of titanium membrane makes the barrier able to maintain space • Careful soft tissue management & avoid directing loading by intermediate denture is essential to prevent wound dehiscence

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