Posted: February 17th, 2021

Barrier Membrane Materials for Guided Bone Regeneration (GBR)

Barrier Membrane Materials for Guided Bone Regeneration (GBR)

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Introduction

Guided Bone Regeneration (GBR) is a technique that has been implemented in clinic for almost 30 years. The technique promotes growth of the hard tissue using a space-making barrier membrane which prevents the ingrowth of surrounding soft tissue. Sufficient augmentation of bone on oral sites, namely the alveolar ridge is crucial for implant attachment (figure 1) [2].  Successful GBR is defined by four criteria: epithelium exclusion, space maintenance, fibrin clot stability and the primary wound closure [1].

Current membrane materials available for commercial use are shown in Table 1 [5]. The barriers may be used with a bone grafting material and can be subdivided into two main categories based on their ability to resorb. Their application is evaluated based on five main design criteria: Biocompatibility, Cell Occlusion, Tissue Integration, space-maintaining ability and ease of handling in a clinical setting [4]. This essay will discuss the success of current materials used for GBR, and their limitations.

Figure 1: (a) sufficient bone width/height, (b) placement of a membrane for GBR (c) subsequent implant [2]

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Discussion

Expanded polytetrafluoroethylene (e-PTFE) was the first commercially available membrane, composed of a collar portion with pores allowing connective tissue augmentation and to prevent epithelial intrusions, and an occlusive part to prevent the flap tissues contacting the root surface [6].  The exposure of e-PTFE is problematic as its rough surface induces bacterial colonisation and infection, compromising bone augmentation [3]. High density PTFE (d-PTFE) has subsequently been adopted as a preferred alternative [14]. The smaller pores prevent bacteria invasion and primary soft tissue closure is not required. Additionally, the relatively smooth surface improves the ease of removal [10].

Titanium mesh was introduced as a more stable and better space-making barrier, with small pores to allow interstitial fluid transfer. The metal offers excellent biocompatibility and mechanical properties- combining rigidity, elasticity and plasticity [4]. Titanium-reinforced PTFE membranes show enhanced rigidity and malleability while maintaining sufficient protection for blood clot