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Case Study
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Using an Allograft Material for Assistance in Guided Bone Regeneration

Review and Case Presentations

Learning Objectives:

This case study reviews the use of an allograft material for predictable bone regeneration prior to implant placement. Upon completing this study, the reader should:

  • Recognize the role of bone grafting materials on implant longevity and retention.
  • Understand the importance of developing sufficient bone structures with minimal patient discomfort or trauma.

 

Bone grafts have long been employed for the treatment and correction of periodontal defects and ridge deficiencies. The rationale behind bone graft use originates from the osteogenic, osteoinductive, or osseoconductive properties possessed by the grafting materials. Osteogenic material stimulates new bone formation, as bone-forming cells are contained within the graft itself. Osteoinductive materials stimulate bone formation in the surrounding tissue immediately adjacent to the graft. In contrast, osseoconductive materials serve as scaffolds for bone growth within existing bony walls.  

Sources of bone grafts include autografts, allografts, xenografts, and alloplasts. Autografts are obtained from extra- or intraoral sites and implanted in the same patient from whom they are obtained. Although the use of autografts often results in the redevelopment of periodontal attachment, significant morbidity is associated with their placement, including ankylosis and root resorption. Xenografts contain tissues transferred from one species to another and synthetic alloplasts have been used in grafting applications as well. Allografts were developed using materials harvested from cadavers of the same species to circumvent the morbidity associated with autogenous bone grafts. Application of allografts elicited minimal postoperative pain and clinical signs of immunologic rejection.

Cells derived from periodontal ligaments and bones have the potential to heal by true regeneration. The process of guided bone regeneration (GBR) regenerates lost alveolar bone and promotes hard tissue formation by employing a barrier. It is used to regenerate bone in preparation for implant site development. As techniques evolved, predictable intraoral GBR was developed for localized ridge augmentation and repair of dehiscences, or tissue ruptures, around implants. Guided bone regeneration is also used to correct bony defects (eg, fenestrations, dehiscence defects) around dental implants.  Researchers have concluded that GBR is a predictable treatment for dental implants placed in sites with insufficient bone structure. 

As the presented surgical cases demonstrate, guided bone regeneration enhanced the preservation of hard and soft tissue contour. There was no infection or surgical complication present and predictable bone regeneration was obtained and verified at time of surgical re-entry. This allowed for good implant positioning as well as improved aesthetic and functional results. Overall, GBR using an allograft paste demonstrated no adverse effects on clinical implant osseointegration and sufficient periodontal health was observed in all the cases.

 

*University of Detroit, School of Dentistry, Department of Periodontology and Dental Hygiene, Detroit, Michigan.

  

Related Reading:

  1. Lindhe J, Karring T, Lang NP. Clinical Periodontology and Implant Dentistry. 4th ed. Oxford, UK: Blackwell Munksgaard; 2003:667.
  2. Schallhorn RG. Present status of osseous grafting procedures. J Periodontol 1977;48(9):570-576.
  3. Schallhorn RG, Hiatt WH. Human allografts of iliac cancellous bone and marrow in periodontal osseous defects. II. Clinical observations. J Periodontol 1972;43(2):67-81.
  4. Mellonig JT, Bowers GM, Bright RW, Lawrence JJ. Clinical evaluation of freeze-dried bone allografts in periodontal osseous defects. J Periodontol 1976;47(3):125-131.
  5. Melcher AH. On the repair potential of periodontal tissues. J Periodontol 1976;47(5):256-260.
  6. Buser D, Dula K, Belser U, et al. Localized ridge augmentation using guided bone regeneration. I. Surgical procedure in the maxilla. Int J Periodont Rest Dent 1993;13(1):29-45.
  7. Buser D, Dula K, Belser U, et al. Localized ridge augmentation using guided bone regeneration. II. Surgical procedure in the maxilla. Int J Periodont Rest Dent 1995;15(1):10-29.
  8. Dahlin C, Lekholm U, Becker W, et al. Treatment of fenestration and dehiscence bone defects around oral implants using the guided tissue regeneration technique: A prospective multicenter study. Int J Oral Maxillofac Impl 1995;10(3):312-318.
  9. Coulthard P, Esposito M, Jokstad A, Worthington HV. Interventions for replacing missing teeth: Bone augmentation techniques for dental implant treatment. Cochrane Database Syst Rev 2003;(3):CD003607.
  10. Nevins M, Mellonig JT, Clem DS 3rd, et al. Implants in regenerated bone: Long-term survival. Int J Periodont Rest Dent 1998;18(1):34-45.
  11. Bunyaratavej P, Wang HL. Collagen membranes: A review. J Periodontol 2001;72(2):215-229.
  12. Jaffin RA, Berman CL. The excessive loss of Branemark fixtures in type IV bone: A 5-year analysis. J Periodontol 1991;62(1):2-4.
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