Received: 25 January 2019 Revised: 8 April 2019 Accepted: 22 May 2019

DOI: 10.1111/cid.12808

ORIGINAL ARTICLE

Horizontal ridge augmentation using GBR with a native

collagen membrane and 1:1 ratio of particulate xenograft
and autologous bone: A 3-year after final loading prospective
clinical study

Silvio Mario Meloni DDS, PhD, MS1 | Sascha Alexander Jovanovic2 | Istvan Urban2,3 |
Edoardo Baldoni DDS, MD1 | Milena Pisano DDS4 | Marco Tallarico DDS, MS5

1
School of Dentistry, University of Sassari,
Sassari, Italy Abstract
2
Loma Linda University, Loma Linda, California Background: Cawood-Howell class IV atrophies, also known as “knife-edge” ridges,
3
University of Szeged, Hungary represent a serious horizontal defect, making the placement of regular implants
4
Private Practice, Arzachena, Italy
challenging.
5
Implantology and Prosthetic Aspects, Master
of Science in Dentistry Program, Aldent
Aim: To clinically and radiographically evaluate bone regeneration of severe horizon-
University, Tirana, Albania tal bone defects with 3 years of follow-up.

Correspondence
Materials and Methods: This study was designed as a single cohort, prospective clini-
Silvio Mario Meloni, Viale San Pietro 43/C cal trial. Patients having horizontal bone width of 4 mm or less in the posterior man-
07100 Sassari Italy.
Email: [email protected]
dible or maxilla were treated with resorbable collagen membranes and a 1:1 mixture
of anorganic bovine bone (ABB) and autogenous bone. Implants were inserted and
loaded 7 months later. Outcomes were implant and prosthetic survival rates, any bio-
logical and prosthetic complications, horizontal and volumetric bone dimensional
changes measured on cone beam computer tomography (CBCT), peri-implant mar-
ginal bone level (MBL) changes measured on periapical radiographs, plaque index (PI),
and bleeding on probing (BOP).
Results: Eighteen patients received 55 implants. No patient dropped-out. No implant
and prosthetic failures and no complications were recorded. Super imposition of pre
and 7-month postoperative CBCT scans revealed an average horizontal bone gain of
5.03 ± 2.15 mm (95% CI: 4.13-5.92 mm). After 3 years, mean MBL was 1.15
± 0.28 mm (95% CI 0.84-1.22 mm). The PI was 11.6%, and BOP was 5.2%.
Conclusion: Within the limitations of the present study, high implant survival rate
and high average bone augmentation seem to validate the use of collagen resorbable
membranes with a 1:1 mixture of particulate ABB and autogenous bone for the
reconstruction of Cawood-Howell class IV alveolar ridge atrophies.

KEYWORDS
bone reconstruction, collagen membranes, GBR, horizontal GBR

Clin Implant Dent Relat Res. 2019;21:669–677. wileyonlinelibrary.com/journal/cid © 2019 Wiley Periodicals, Inc. 669
 17088208, 2019, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/cid.12808 by Chulalongkorn University Office Of Academic Resources, Wiley Online Library on [28/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
670 MELONI ET AL.

1 | I N T RO D UC T I O N center in Sardinia (Italy) from June 2013 to April 2014. One experi-
enced clinician performed all surgical procedures (S.M.M.). Another cli-
Dental implants have become a treatment option supported by sub- nician (M.P.) delivered all the prosthetic restorations. The investigation
1
stantial evidence, with excellent long-term results. The success of was conducted according to the principles embodied in the Helsinki
implant therapy also depends on biological parameters, including but Declaration of 1964 for biomedical research involving human subjects,
not limited to, sufficient amounts of bone volume at the insertion site.2 as amended in 2008. All patients were duly informed about the nature
Insufficient healthy bone volume around implants could negatively of the study and gave their written informed consent.
affects the prognosis of the implants. 3,4
In 1988, Cawood-Howell clas- All the patients required an implant supported restoration in the
5
sified the alveolar crest atrophy in six degrees. Among these, atrophy posterior mandible or maxilla, able to understand and sign an informed
within class IV, also known as “knife-edge” ridges, present a serious consent were considered eligible for inclusion in this study. Patients
horizontal defect, making the placement of regular implants challeng- were to be 18 years or older with posterior partial or total edentulism
6
ing. Many techniques were proposed to reconstruct atrophic alveolar of the mandible or maxilla, and a residual horizontal ridge thickness of

jaws for implant purpose, using a one or two stage approaches. For 7 4 mm or less (Cawood-Howell Class IV).3

many years, bone blocks were the first choice to regenerate the alveo- Patients were not admitted in the study if any of the following

lar ridge bone defects. This technique requires harvesting of a large exclusion criteria were present:

amount of bone and for this reason, bone blocks were often harvested
from extra-oral sites causing higher patient's morbidity.4,8 Guided bone 1. American Society of Anesthesiologist (ASA) class III or IV;

regeneration (GBR) was used as an alternative for Cawood-Howell class 2. Pregnancy or nursing;

IV atrophies, to overcome the drawback of bone blocks techniques. 7,9 3. Alcohol or drug abuse;

Barrier membranes were used to protect the clot preventing the inva- 4. Heavy smoking (>10 cigarettes/day);

sion of nonosteogenic cells, and also maintaining an adequate biological 5. Radiation therapy to head or neck region within 5 years;

space for the regeneration of new bone tissue. 10

The use of either non- 6. Absence of teeth/denture in the opposite jaw;

resorbable or resorbable membranes, in combination with autologous 7. Untreated periodontitis;

or heterologous particulate bone, were investigated. 6,10-12

Expanded 8. Immediate postextractive implants;

polytetrafluoroethylene (e-PTFE) membranes were the most used non- 9. Full mouth bleeding and full mouth plaque index higher than or
13 equal to 25%;
resorbable membranes with the longest published follow-up. How-
10. Unavailability for regular follow-ups.
ever, a second surgery is needed, and in case of exposure in the oral
cavity, they may get soon contaminated with possible infection and
graft loss.13 Conversely, resorbable membranes demonstrated high bio-
compatibility due to the ability to merge with the host tissues, as well 2.1 | Surgical and prosthetic protocol
as a rapid resorption in case of exposure, reducing the risk of bacterial
Patients' medical history, photographs, and study models were col-
contamination.14 Resorbable membranes in combination with particu-
lected at the first visit (Figure 1). Preoperative cone beam computer
late anorganic bovine bone (ABB) were used for the augmentation of
6,15 tomography (CBCT) were obtained for initial screening and evaluation
horizontally deficient ridges. According to recent evidences, particu-
(Figure 2). Smokers were advised to refrain from smoking 4 weeks
late autogenous bone should be mixed with bone substitutes to add
before and 4 weeks after surgery. Patients received amoxicillin 2 g
more osteogenic factors.6,16,17
(Zimox, Pfizer, Rome, Italy) 1 hour before surgery and 1 g twice daily
The aim of the present prospective study is to report the 3-year clin-
for 1 week. In the event of a penicillin allergy, clindamycin was adminis-
ical and tridimensional radiographic data of patients treated with
tered for premedication (600 mg 1 hour before surgery) and after
resorbable collagen membranes to protect a mixture of ABB and autog-
enous particulate bone in 1:1 ratio for the reconstruction of severe hori-
zontal bone defects (<4 mm), in the posterior area and waiting 7 months
before implant placement. A 1-year interim report from this study
showed high implant survival rate and high average bone augmenta-
tion.6 This report was written in accordance with the Strengthening the
Reporting of Observational studies in Epidemiology guidelines.18

2 | MATERIALS AND METHODS

This study was designed as a single cohort prospective observational

study aimed to evaluate patients with severe horizontal bone defects in
their posterior mandible or maxilla, treated with GBR 7-month before
implants placement. Patients were selected and treated in one private FIGURE 1 Pre-op picture occlusal view
 17088208, 2019, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/cid.12808 by Chulalongkorn University Office Of Academic Resources, Wiley Online Library on [28/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
MELONI ET AL. 671

FIGURE 2 Pre-op computed tomography scan

F I G U R E 4 Two stages horizonatal guided bone regeneration with

50% autologous bone, 50% bovine bone and collagen membrane

membrane (Bio-gide, Geistlich Biomaterials Italia S.r.l., Italy) was fixed

using two lingual/palatal titanium pins (Supertack, MCbio s.r.l., Lom-
azzo, Italy). The harvested autogenous bone graft material was mixed
with ABB material (Bio-OSS, Geistlich Biomaterials Italia S.r.l.) in a 1:1
ratio, and placed at the buccal and lingual/palatal side of the defect.
At this stage, the collagen membrane was trimmed to cover the entire
volume of the graft. Two additional titanium pins were placed on the
buccal side to fix the membrane. Then, a third tack in mid buccal side
was placed to prevent apical movement of the bone graft. Where indi-
cated, maxillary cases were combined with a conventional sinus aug-
mentation procedure to achieve additional apical bone height for
FIGURE 3 Alveolar crest before reconstruction occlusal view subsequent implant placement. Finally, a periosteal incision was per-
formed between the two vertical incisions to allow for completely
surgery (300 mg four times a day for 1 week). Patients were instructed tension-free flap closure. In the mandible, both the lingual and the
to rinse with 0.2% chlorhexidine solution (Curasept, Curaden Healthcare buccal flaps were released. The flaps were sutured in two layers to
S.p.A., Saronno, Varese, Italy) for 1 minute to disinfect the surgical site prevent exposure of the membrane. Horizontal mattress sutures (4-0
and a sterile surgical drape was applied to minimize the potential con- Vycril, Ethicon, Johnson & Johnson, Italy) were first placed 4 mm from
tamination from extra-oral sources. Oral sedation with triazolam the incision line, then, single interrupted sutures were placed to close
0.50 mg (Triazolam ratiopharm Italia) was given prior to surgery. Local the edges of the flap. Vertical incisions were sutured with single inter-
anesthesia (Septanest with adrenaline, 1/100000, Septodont) was used. rupted sutures (4-0 Vycril, Ethicon, Johnson & Johnson, Italy).
A midcrestal incision into the keratinized tissue was made using a Postoperatively, 5 mg of oxycodone hydrochloride (Mundipharma
surgical blade No. 11, and a full-thickness flaps were elevated beyond Pharmaceuticals, Milan, Italy) two times daily was prescribed for the
the mucogingival junction, at least 5 mm beyond the bone defect. first day and then as needed. Dexamethasone (Desoren, Rekah Phar-
Two vertical incisions were placed at least one tooth mesial and distal maceutical Products, Ltd, Holon, Israel) 4 mg was administered imme-
from the area to be augmented, while, in edentulous areas, vertical diately after surgery. Patients were instructed to continue antibiotic
incisions were placed at least 5 mm away from the planned surgical therapy as prescribed and to rinse with 0.2% chlorhexidine (Curasept,
site. In the posterior mandible, a lingual flap was elevated beyond the Curaden Healthcare S.p.A.) for 2 weeks and to follow a soft food diet
mylohyoid line, protecting sensitive anatomical structures. Before for 10 days. The single interrupted sutures were removed between
bone collection, the recipient site was debrided by removing soft tis- 10 and 14 days postsurgery, and mattress sutures were removed two
sue remnants (Figure 3). In both mandible and maxilla cases, autoge- to 3 weeks after surgery.
nous bone was harvested from the retromolar regions using a Seven months after GBR, a CBCT scan was performed to evaluate
minimally invasive cortical bone collector (Micross, Meta, Italy). In the graft material integration and to measure the horizontal bone rem-
cases of maxillary sites, an additional flap was elevated for the bone odeling (Figures 5 and 6A,B). Implants were placed submerged
harvesting procedure. After that, multiple decortication was made at according to the manufacturer's instruction, using an insertion torque
the recipient site with a 2 mm round bur (Figure 4). Then, a collagen ranging between 30 and 45 Ncm, as measured with the manual
 17088208, 2019, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/cid.12808 by Chulalongkorn University Office Of Academic Resources, Wiley Online Library on [28/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
672 MELONI ET AL.

torque wrench by the surgeon (S.M.M.; Figures 7–9). Three to six provisional or definitive ceramic crown, abutment mobility, and
months after implant placement, zirconia ceramic final crowns were any biological complications, such as wound or implant infection,
delivered (Figures 10 and 11). All patients were followed for at least mucositis, abscesses, or peri-implantitis, were recorded.
36 months after final loading. Data were collected at baseline (implant
placement), final loading, 12 months, and 36 months after loading Secondary outcome measures were:
(Figures 12 and 13). Hygiene maintenance, occlusal control, and peri-
apical radiographs were planned every 6 months after loading. • Horizontal and volumetric dimensional changes
The CBCT scans were performed before ridge reconstruction and
Primary outcome measures were:

• Implant and crowns survival rates

Removal of implants dictated by implant mobility, progressive mar-
ginal bone loss, infection, or implant fracture. The stability of indi-
vidual implants was measured by the prosthodontist at the time of
definitive crown delivery and at 12 months by applying 35 Ncm of
removal torque. Thirty-six months final loading, implant stability
was tested manually by the same prosthodontist with two dental
mirror handles.
• Complications
Any complications such as membrane exposure, subsequent
infection, and/or morbidity associated with the harvest site, any
prosthetic complications, such as fractures or chipping of the
FIGURE 7 Reconstructed bone occlusal view

F I G U R E 5 Computed tomography scan 7 months after alveolar

ridge reconstruction axial view FIGURE 8 Implant installation occlusal view

F I G U R E 6 A, Computed tomography
(CT) scan 7 months after reconstruction
cross sectional view. B, CT
superimposition cross sectional view
 17088208, 2019, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/cid.12808 by Chulalongkorn University Office Of Academic Resources, Wiley Online Library on [28/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
MELONI ET AL. 673

FIGURE 12 Final crowns at 3 years after final crowns delivery

FIGURE 9 Soft Tissue after healing occlusal view

FIGURE 13 Peri-apical x-ray 3 years after final crowns delivery

all measurements. Superimposition of the DICOM data were auto-

matically performed according to an already published voxel-based
FIGURE 10 Final crown delivery lateral view
registration method.18-20 The DICOM data was manually aligned
on unchanged anatomical areas (eg, teeth, basal skull, and previous
implants) and then automatically matched using the Fusion adjunc-
tive module (Cybermed, Inc). Horizontal bone measure was
recorded for all reconstructed ridge 2 mm below the bone crest
(Figure 14), before and after treatment. Bone loss was calculated
for each value, expressed as a linear difference between pre-
regeneration and postregeneration measurements. Then, the post-
operative volumetric data were subtracted from the original
scenario and the volumes of the grafted material were calculated
using automatic tools.

2.2 | Peri-implant marginal bone loss

FIGURE 11 Peri-apical x-ray at final crowns delivery
The distance from the most coronal margin of the implant collar and
the most coronal point of bone-to-implant contact, evaluated on
7 months after. The Digital Imaging and Communication in Medi- intraoral digital radiographs taken with the paralleling technique using
cine (DICOM) data were imported into the OnDemand 3D soft- a film-holder (Rinn XCP, Dentsply, Elgin, Illinois) at implant placement
ware (version 1.0.9.3223, Cybermed, Inc, Seoul, Korea) to perform (baseline) and at 12 and 36 months after final loading. The radiographs
 17088208, 2019, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/cid.12808 by Chulalongkorn University Office Of Academic Resources, Wiley Online Library on [28/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
674 MELONI ET AL.

between each time point and the baseline measurements were made
by paired tests, to detect any changes in volumetric dimensional of
the ridge. Differences in the proportion of patients with early collagen
membrane exposure and smoking were compared using the Fisher's
exact probability test. Post hoc compute achieved power was calcu-
lated using G*Power 3.1 for MacOs (http://www.gpower.hhu.de/en.
html) given /, sample size, and effect size. The patient was the statis-
tical unit of the analyses. All statistical comparisons were conducted
at the .05 level of significance.

3 | RESULTS

Twenty patients were screened for eligibility, but two patients were
not enrolled in the trial, because of the refusal to undergo a CBCT scan.
Eighteen consecutive patients (seven males and 11 females) with a
mean age of 56.8 years (range 24-78) with 22 surgical sites classified as
Cawood-Howell Class IV17 received at least one GBR procedure each,
followed by placement of 55 regular platform implants of 4.3 mm of
diameter (NobelReplace Conical Connection, PMC, Nobel Biocare).
F I G U R E 1 4 Pre- and post-op cone beam computer tomography Eight patients were treated in the mandible and 10 in the maxilla
scan measurements
(Figures 15 and 16). Of these, six procedures (60%) were associated
with sinus lift elevation. Eight out of 18 patients (44.4%) were light
were accepted or rejected for evaluation based on the clarity of the smokers. However, four patients stopped smoking at least 4 weeks
implant threads. All readable radiographs were displayed in an image before surgery, and they have not restarted. The main patients and
analysis program (DFW2.8 for windows, Soredex) on a 24-in. LCD interventions characteristics are summarized in Table 1.
screen (iMac, Apple, Cupertino, California) and evaluated under stan- At the 3-year follow-up examination after final loading, there were
dardized conditions (SO 12646:2004). The software has been cali-
no patient dropped-out and no deviation from the original protocol
brated for all single images using the known distance of two adjacent
occurred. All the collected data were included in the statistical analysis.
threads. Measurements of the mesial and distal bone crest level adja-
There were no implant failures, resulting in a cumulative implant and
cent to each implant were made to the nearest 0.01 mm and averaged
prosthetic survival rate of 100%. In three patients (13.6%), the collagen
at patient level.
membrane was exposed 2 weeks after bone reconstruction. Two of
these patients are light smokers, however, the Fisher's exact test failed
2.3 | Periodontal parameters
Plaque index (PI), defined as plaque absent or present (0/1), and
bleeding on probing (BoP), defined as absent or present bleeding on
probing (0/1), were recorded 1 year after final prosthesis delivery and
3 years after final loading.
Complications were evaluated and treated by the same clinician
that performed the augmentation and implant placement procedure.
Volumetric dimensional changes, as well as the peri-implant marginal
bone level changes were evaluated by an expert radiologist not previ-
ously involved in the study. Another clinician (G.F.) not previously
involved in the study, made all the others outcomes.

2.4 | Statistical analysis

All the analysis was carried out according to a pre-established analysis
plan using SPSS software for Mac OS X (version 22.0; SPSS, Inc, Chi-
cago, Illinois). A bio-statistician with expertise in dentistry analyzed
the data. Descriptive analysis was performed for numeric parameters F I G U R E 1 5 Upper jaw cone beam computer tomography scan
using means ± SD and 95% confidence interval (CI). Comparisons before bone reconstruction
 17088208, 2019, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/cid.12808 by Chulalongkorn University Office Of Academic Resources, Wiley Online Library on [28/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
MELONI ET AL. 675

to find significant association (P = .559) between a smoking habit and At initial examination, the mean horizontal alveolar ridge width was
early membrane exposure. In these situations, the area was treated 3.07 ± 0.64 mm (95% CI 2.80-3.34 mm). At the 7-month follow-up
with local application of chlorhexidine gel 0.5% (Curasept ADS 0.5% gel examination, the mean bone width was 8.09 ± 2.16 mm (95% CI
parodontale, Curaden Healthcare S.p.A.) twice per day, for 3 weeks. 7.19-8.99 mm). The mean bone gain was 5.03 ± 2.15 mm (95% CI
Complete soft tissue healing was observed in all the three cases. No 4.13-5.92 mm). The difference was statistically significant (P = .000;
other biological and/or technical complications were recorded. Table 2). The mean volume of the grafted bone calculated using the sup-
raimposition technique19-21 was 1.12 ± 0.18 CC (95% CI 1.01-1.23 CC).
One year after final loading, the mean marginal bone loss was
1.03 ± 0.21 mm (95% CI 0.83-1.17 mm), 3 year final loading, the
mean marginal bone loss was 1.15 ± 0.28 mm (95% CI 0.84-1.22 mm;
Table 3). One year after final loading, the mean PI was 11.1% ± 7.1%
(95% CI 7.3%-14.8%); while 5.6% ± 4.4% (95% CI 3.1%-8.1%) of the
implants showed positive BoP. Three year after final loading PI was
11.6% ± 3.5% (95% CI 8.6%-14.6%) and BoP was 5.2% ± 2.9% (95%
CI 3.3%-7.1%). Differences were not statistically significant (P > .05).

4 | DISCUSSION

The aim of this prospective study was to investigate the 3-year after
final loading clinical and radiographic data of GBR procedure using
particulate autologous bone and ABB with ratio 1:1 in combination
with a resorbable membrane for horizontal augmentation of knife-
edged ridges.
The main limitations of the present study were the low number of
treated patients and the medium term follow-up. Second limitation is
that the study was limited at the posterior jaws although contour aug-
mentation are often required in aesthetic area. Nevertheless, even
though the number of patients enrolled in this study cannot ensure
F I G U R E 1 6 Upper jaw cone beam computer tomography scan definitive conclusions, a total of 55 implants were placed in 22 aug-
7 months after bone reconstruction mented sites. Post hoc analysis given a compute achieved power of
100%, allowing the results of the present study to be generalized to a
TABLE 1 Baseline characteristics of selected patients larger population with similar characteristics.
Data obtained at 3-year follow-up confirm the 1-year results all-
Mean age (range) 56.8 years (24-78)
owing for the use of collagen resorbable membrane in GBR proce-
Female/male (n = 18) 11/7
dures for horizontal ridge augmentation. Although the two-stage
Smokers (≤10 cigarettes/day) 8
approach needs a longer time before prosthesis delivery, this tech-
Single cases 3
nique seems to be safe and predictable for large reconstruction and
Partial cases 14
can be applied in daily practice.16
Fully edentulous cases 1
In the present study, the mean horizontal bone gain was 5.03 mm
Maxillary/mandibular cases 10/8
(±2.15 mm), with seven sites gaining ≥7 mm. This data is in accordance

T A B L E 2 Horizontal bone width

Horizontal bone width (Mean ± SD, 95% CI)

Baseline (mm) 7 months follow-up Difference P-value

3.07 ± 0.64 (2.8-3.34) 8.09 ± 2.16 (7.19-8.99) 5.03 ± 2.15 (4.13-5.92) .000*

TABLE 3 Marginal bone level

Marginal bone level (Mean ± SD, 95% CI)

Baseline (mm) 12 months after loading Difference 36 months after loading Difference
−0.12 ± 0.06 (−0.2 to −0.04) 1.16 ± 0.16 (1.02-1.3) 1.03 ± 0.21 (0.83-1.17) 1.27 ± 0.18 (1.14-1.46) 1.15 ± 0.28 (0.84-1.22)
 17088208, 2019, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/cid.12808 by Chulalongkorn University Office Of Academic Resources, Wiley Online Library on [28/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
676 MELONI ET AL.

with others reports of the literature supporting the use of GBR pro- OR CID
cedure with collagen membranes as the standard treatment for
Silvio Mario Meloni https://orcid.org/0000-0002-3317-0124
knife-edged ridges.16 Similarly, results were intact obtained by Urban
Marco Tallarico https://orcid.org/0000-0001-9206-0454
et al. (5.68 ± 1.42 mm), in a prospective case series study.16 Never-
theless, measurements of the alveolar ridge width were taken at the
time of grafting and then at implant placement, using a caliper 2 mm RE FE RE NCE S
apically from the top of the crest. In a systematic review, Aghaloo
1. Pjetursson BE, Thoma D, Jung RE, Zwahlen M, Zembic A. A system-
and Moy reported statistically significant reduced implant survival
atic review of the survival and complication rates of implant-
rates at sites grafted with autogenous bone block, compared with supported fixed dental prostheses (FDPs) after a mean observation
other regenerative techniques.2 Their meta-analysis found an period of at least 5 years. Clin Oral Implants Res. 2012;12(23):22-38.
2. Aghaloo TL, Moy PK. Which hard tissue augmentation techniques are
implant survival rate of 74.4% for iliac crest grafts, as compared with
the most successful in furnishing bony support for implant placement.
95.5% for GBR.2 Int J Oral Maxillofac Implants. 2007;22:49-70.
Nonresorbable e-PTFE membranes are still considered the most 3. Esposito M, Grusovin MG, Coulthard P, Worthington HV. The effi-
investigated membranes for GBR procedures6,12,17; however, fre- cacy of various bone augmentation procedures for dental implants: a
Cochrane systematic review of randomized controlled clinical trials.
quently reported soft tissue problems, as well as the need to remove
Int J Oral Maxillofac Implants. 2006;21:696-710.
the membrane, have led clinicians to use resorbable membranes.16 4. Simion M, Jovanovic SA, Tinti C, Benfenati SP. Long-term evaluation
The lack of titanium reinforcement for the collagen membrane can be of osseointegrated implants inserted at the time or after vertical ridge
only partially overcome by an accurate fixation of the membrane with augmentation. A retrospective study on 123 implants with 1-5 year
follow-up. Clin Oral Implants Res. 2001;12:35-45.
titanium pins on both the lingual/palatal and the vestibular side.6 With
5. Cawood JI, Howell RA. A classification of the edentulous jaws. Int J
a secure fixation, the membrane better immobilizes the graft material, Oral Maxillofac Implants. 1988;17:232-236.
allowing for a protected healing process.6 6. Meloni SM, Jovanovic SA, Urban I, Canullo L, Pisano M, Tallarico M.
In the present study, three patients experienced early collagen Horizontal ridge augmentation using GBR with a native collagen
membrane and 1:1 ratio of particulated xenograft and autologous
membrane exposure, but the planned treatment was carried out and
bone: a 1-year prospective clinical study. Clin Implant Dent Relat Res.
no other complications were recorded at 3 year follow-up. In our
2017;19(1):38-45.
opinion, the use of bone grafting materials and resorbable mem- 7. Buser D, Ingimarsson S, Dula K, Lussi A, Hirt HP, Belser UC. Long-
branes to treat severe horizontal defects may lead to less morbidity term stability of osseointegrated implants in augment- ed bone: a
in the treatment of patients with these defects (6, 16). In addition, 5-year prospective study in partially edentulous patients. Int J Peri-
odontics Restorative Dent. 2002;22:109-117.
the use of 50% ABBM in these procedures reduces the need for
8. Chiapasco M, Casentini P, Zaniboni M, Corsi E. Evaluation of peri-
large amounts of harvested autogenous bone. The use of particulate implant bone resorption around Straumann Bone Level implants
bone harvested with a scraper generally could lead to decreased placed in areas reconstructed with autogenous vertical onlay bone
morbidity, allowing for wide regeneration procedures without hospi- grafts. Clin Oral Implants Res. 2012;23(9):1012-1021.
9. Urban IA, Jovanovic S, Lozada JL. Vertical ridge augmentation using
tal permanence.
guided bone regeneration (GBR) in three clinical scenarios prior to
implant placement: a retrospective study of 35 patients 12 to
72 months after loading. Int J Oral Maxilofac Implants. 2009;24:
5 | CO NC LUSIO N 502-510.
10. Urban IA, Caplanis N, Lozada JL. Simultaneous vertical guided bone
regeneration (GBR) and guided tissue regeneration (GTR) in the pos-
Within the limitation of the present study, small sample size, short terior maxilla using recombinant human platelet-derived growth fac-
follow-up, high implant survival rate, and high average bone augmen- tor (rhPDGF). A case report. J Oral Implantol. 2009;35:251-256.
tation seem to validate the use of collagen resorbable membranes 11. Esposito M, Grusovin M, Worthington H, Coulthard P. Inter- ventions
for replacing missing teeth: bone augmentation techniques for dental
with a 1:1 mixture of particulate ABB and autogenous bone, for the
implant treatment. Cochrane Database Syst Rev. 2006;CD003607.
reconstruction of severe horizontal ridge defects of posterior jaws up 12. Wessing B, Urban I, Montero E, et al. A multicenter randomized con-
to a 3 year follow-up. Anyway this results should be handled with cau- trolled clinical trial using a new resorbable non-cross-linked collagen
tions due to the above discussed limitations and considered at 3 year membrane for guided bone regeneration at dehisced single implant
sites: interim results of a bone augmentation procedure. Clin Oral
follow-up in term of marginal bone remodeling, while bone horizontal
Implants Res. 2017;28(11):e218-e226.
augmentation was not investigated at 3 year follow-up, further clinical 13. Chiapasco M, Abati S, Romeo E, Vogel G. Clinical outcome of autoge-
trials and a randomized one should be carried on to better validate nous bone blocks or guided bone regeneration with e-PTFE mem-
these results. branes for the reconstruction of narrow edentulous ridges. Clin Oral
Implants Res. 1999;10:278-288.
14. Schenk RK, Buser D, Hardwick WR, Dahlin C. Healing pattern of bone
regeneration in membrane-protected defects: a histologic study in
CONF LICT OF IN TE RE ST the canine mandible. Int J Oral Maxillofac Implants. 1994;9:13-29.
15. Buser D, Dula K, Hirt HP, Schenk RK. Lateral ridge augmen- tation
This study was not supported by any company and none of the using autografts and barrier membranes: a clinical study with 40 par-
authors has conflict of interest to declare. tially edentulous patients. J Oral Maxillofac Surg. 1996;54:420-432.
 17088208, 2019, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/cid.12808 by Chulalongkorn University Office Of Academic Resources, Wiley Online Library on [28/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
MELONI ET AL. 677

16. Urban IA, Nagursky H, Lozada JL, Nagy K. Horizontal ridge augmenta- 21. Meloni SM, Tallarico M, Lolli FM, Deledda A, Pisano M, Jovanovic SA.
tion with a collagen membrane and a combination of particulated Postextraction socket preservation using epithelial connective tissue
autogenous bone and anorganic bovine bone-derived mineral: a pro- graft vs porcine collagen matrix. 1-year results of a randomized con-
spective case series in 25 patients. Int J Periodontics Restorative Dent. trolled trial. Eur J Oral Implantol. 2015;8(1):39-48.
2013;33(3):299-307.
17. Jovanovic SA, Spiekermann H, Richter EJ. Bone regeneration around
titanium dental implants in dehisced defect sites: a clinical study. Int J
Oral Maxillofac Implants. 1992;7(2):233-245. How to cite this article: Meloni SM, Jovanovic SA, Urban I,
18. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke
Baldoni E, Pisano M, Tallarico M. Horizontal ridge
JP. The strengthening the reporting of observational studies in epidemiol-
ogy (STROBE) statement: guidelines for reporting observational studies. augmentation using GBR with a native collagen membrane
STROBE initiative. Int J Surg. 2014;12(12):1495-1499. and 1:1 ratio of particulate xenograft and autologous bone: A
19. Maes F, Collignon A, Vandermeulen D, Marchal G, Suetens P. 3-year after final loading prospective clinical study. Clin
Multimodality image registration by maximization of mutual informa-
Implant Dent Relat Res. 2019;21:669–677. https://doi.org/
tion. IEEE Trans Med Imaging. 1997;16(2):187-198.
20. Kim ES, Moon SY, Kim SG, Park HC, Oh JS. Three-dimensional volu- 10.1111/cid.12808
metric analysis after sinus grafts. Implant Dent. 2013;22(2):170-174.