Recommended by PD Dr. med. Dr. med. dent. David Schneider
Insights from this study for clinical practice
In this study with a small number of patients, associating a non-resorbable membrane with an onlay bone graft led to significantly less bone resorption compared with an onlay bone graft alone.
Using dental implants is an established treatment option for the replacement of missing teeth. However, some patients have insufficient alveolar bone to support an implant, for example due to trauma or disease. In these cases, some form of bone reconstruction is required prior to implantation. The gold standard is an autogenous bone graft, although there may be substantial bone resorption. With this in mind, a group of researchers from Paris performed a prospective, randomized trial comparing onlay bone grafts with and without a non-resorbable membrane.
«We conducted a prospective, randomized study comparing two techniques of bone augmentation, the first evaluating onlay bone graft alone and the second bone graft associated with a non-resorbable membrane.»
Dr. Antoun et al. in the cited publication
Seven patients (with eight surgical sites) received a bone graft alone, and five patients received a bone graft with a membrane. The onlay bone graft was harvested from the mandible symphysis area, contoured to fit the defect, and secured with titanium screws. When used, the expanded PTFE non-resorbable membrane was fixed with mini-titanium screws.
The authors describe healing as uneventful, with one graft site showing membrane exposure after 4 weeks. The membrane was removed two weeks later, with no clinical sign of infection. The bone quality at two grafted sites in the membrane group were classified as 3/5 (dense, allows slight penetration of the probe), and all other sites were classified as 5/5 (normal bone). Implants were successfully placed at all grafted sites.
Comparing the two groups, there was a significant difference in width resorption 6 months after the surgery (mean 0.3 mm with membrane versus 2.3 mm without; P<0.01). There was a non-significant difference in width gain between the groups (3.7 mm with membrane versus 2.9 mm without), and the graft width was comparable (4.0 mm with membrane versus 5.1 mm without). The authors speculate that the greater width gain and less width resorption in the membrane group could be due to the membrane protecting the graft during the healing period.
PD Dr. med. Dr. med. dent. David Schneider
This study shows the importance of non-resorbable membranes in the context of autologous bone augmentation. This has a significant influence on the clinical procedure.
The findings of this study highlight the importance of membranes in autologous bone augmentation, demonstrating their role in reducing graft resorption during healing. Despite the additional cost and procedural steps, the use of a membrane appears to enhance graft stability, potentially improving the long-term success of implant placement. In clinical practice, this suggests that when performing onlay grafting, the decision to include a membrane should be carefully considered, weighing its benefits in preserving graft volume against the added complexity of the procedure.
