30 Years of Guided Bone Regeneration

30 Years of Guided Bone Regeneration
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With each passing decade, more research is done on GBR, and more surgeons begin adopting this practice with incredible results. Prof Daniel Buser has assembled a team of the top names in implant surgery to put together a comprehensive guide on the materials, indications, techniques, timing, and results of GBR. The book begins with the science of bone regeneration, describing how bone and soft tissue will react and behave under different circumstances, before delving into the different methods and uses of GBR based on the presenting scenario. How to properly time and stage grafting, implant, and prosthetic therapy is a major focus. Case examples are presented documenting each patient's bone regeneration from start to finish, frequently with long-term follow-ups of 10 years or more. Emphasis is given to incision technique and flap design; the selection, handling, and placement of barrier membranes; the combination of membranes with autogenous bone grafts and low-substitution bone fillers; and aspects of wound closure. This book offers solutions for those who want to begin providing implants to a wider range of patients, for GBR veterans who want to refine their skills and practice more advanced techniques, and for implant surgeons who want to keep up to date with the most current research and technology in GBR.

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Daniel Buser. 30 Years of Guided Bone Regeneration

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30 Years of Guided Bone Regeneration

Third Edition

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The healing pattern of bone under a barrier membrane with the addition of various particulate bone fillers was analyzed in numerous experimental animal studies. One standardized animal model was introduced by Buser et al.106 In this model, which excludes the interference of the particular conditions in the oral cavity, standardized bone defects were created in the mandibles of minipigs with extraoral access. This study showed that particulate bone fillers have different biologic characteristics with regard to both bone formation potential and bone filler degradation dynamics. After 4 weeks, which was the earliest observation period in this study, significantly more new bone was formed when autogenous bone was used as a filler, as compared to DFDBA, a synthetic β-TCP biomaterial, and coral-derived HA (Fig 2-33).106 After 12 and 24 weeks, there was still more bone formation in the autogenous bone group than in the groups with DFDBA and coral-derived HA, but most new bone was found in the TCP group. On the other hand, TCP showed the greatest degradation rate, meaning that the volume of all three other fillers was more stable. Another important finding was that the autograft was the most osteoconductive filler material over the entire observation period (Fig 2-34).106 From this study, it was concluded that defects filled with autograft clearly demonstrated the best results in the early phase of healing and that the TCP biomaterial used showed a fast degradation and substitution rate.

Fig 2-33 Percentage of new bone in standardized bone defects in the mandibles of minipigs grafted with different materials. (Data from Buser et al.106)

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