Classification of Bone Defects

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GBR small class 丨 (1) Overview of GBR Technology

Classification of Bone Defects

In order to successfully complete the implant surgery, to achieve a good long-term prognosis for osseointegrated implants and esthetic results, a sufficient volume of bone should exist at the sites of implantation. Before solving the problem of bone defects, we first need to understand the classification of bone defects at the sites of implantation:

Class 0, Site with a ridge contour defificit and suffificient bone volume for standard implant placement;

Class 1, Intra-alveolar defect between the implant surface and intact bone walls;

Class 2, Peri-implant dehiscence, in which the volume stability of the area to be augmented is provided by the adjacent bone walls;

Class 3, Peri-implant dehiscence, in which the volume stability of the area to be augmented is not provided by the adjacent bone walls;

Class 4, Horizontal ridge defect requiring bone augmentation before implant placement;

Class 5, Vertical ridge defect requiring bone augmentation before implant placement;

【1】

Fig. Schema displaying bone defect Classes 0–5 and the corresponding bone augmentation procedures. 【1】

Concept of GBR

Guided bone regeneration (GBR), in the bone defect, use the biological barrier membrane to maintain the space established by surgery, thereby prevent the growth of fast-proliferating epithelial cells and fibroblasts, and ensure the growth of slow-proliferating osteoblasts and blood vessels.

During surgery, biological barrier membranes often need to be combined with bone graft materials to prevent collapse. In addition, the bone graft material will provide a scaffold for new bone growth.【2】

Fig. Schematic illustration of the principle of guided bone regeneration (GBR).【2】

PASS Principles

• Tension-free wound closure

• Angiogenesis; Adequate blood supply

• Space creation/ maintenance; Exclusion of unwanted cells

• Stability of wound and implants【3】

Fig. Schematic illustration of the application of biofilm in GBR surgery

Effect of Biofilm

• Effect of Biofilm

• Mechanical barrier

• Stability and protection: secure a blood clot

• Bone regeneration-inducing effects: blood penetration, supply of endogenous growth factors or compound exogenous bone growth factors with biofilms. Physical close bone sites in need of regeneration, creates and maintains a covert space that provides an environment for osteoprogenitor cells. Allows recruitment and proliferation, differentiation along the osteoblast lineage, and expression of osteogenic activity of osteoprogenitor cells.【4】

Fig. Application of biofilm in GBR surgery

Conditions for an ideal biofilm

Conditions for an ideal biofilm

• Biocompatibility: The degradation process and final product are harmless and do not affect new bone formation and new bone quality;

• Cell Barrier: Prevents connective tissue cells from entering the area where bone regeneration will occur, protecting the blood supply from surrounding bone tissue as well as angiogenic and osteogenic cells.

• Maintain the space for bone regeneration: create and maintain sufficient space for bone regeneration during the healing period. The key factors for the anti-collapse of the barrier membrane are the stiffness of the membrane, absorbable or not and the rate of absorption; bone graft materials are an effective way to prevent the collapse of the barrier membrane;

• Tissue affinity: able to integrate with the surface soft tissue, reduce the possibility of soft tissue dehiscence, and enhance mechanical stability.

• Clinical operability: The bioabsorbable membrane is hydrophilic, and can immediately adhere to the bone tissue around the defect area and the surface of the bone graft material after infiltrating blood. However, due to the stiffness and hydrophobic nature of the non-absorbable membrane, it must be fixed with screws or nails.

PS: The above texts are all compiled from Professor Zhou Yanmin's course on "Clinical Application of GBR" from the Stomatological Hospital of Jilin University.

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Compared with inert tissue-derived materials such as dermis on the market, 博瑞金® Oral Biological Graft has good softness, fit and hydrophilicity, which can better fit the defect area and facilitate surgical operations; is rich in bioactive substances which can promote cell attachment and tissue regeneration; has excellent tolerance to infection, can reduce the chance of wound infection. This is an ideal biofilm product in clinical practice.

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Fig. 博瑞金® Oral Biological Graft

References

1、Benic Goran I, et al. "Horizontal bone augmentation by means of guided bone regeneration." Periodontology 2000 66. 1 (2014): 13-40.

2、Elgali I , Omar O , Dahlin C , et al. Guided bone regeneration: materials and biological mechanisms revisited[J]. Wiley-Blackwell Online Open, 2017, 125(5).

3、Wang H L , Boyapati L . "PASS" Principles for Predictable Bone Regeneration[J]. Implant Dentistry, 2006, 15.

4、Linde A , C Thorén, Dahlin C , et al. Creation of new bone by an osteopromotive membrane technique: An experimental study in rats[J]. Journal of Oral and Maxillofacial Surgery, 1993, 51(8):892-897.