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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (6): 1097-1104. doi: 10.19723/j.issn.1671-167X.2023.06.022

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Role of collagen membrane in modified guided bone regeneration surgery using buccal punch flap approach: A retrospective and radiographical cohort study

Deng-hui DUAN1,Hom-Lay WANG2,En-bo WANG1,*()   

  1. 1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, 48109, USA
  • Received:2023-06-30 Online:2023-12-18 Published:2023-12-11
  • Contact: En-bo WANG E-mail:ebwang-hlg@163.com

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Abstract:

Objective: To investigate whether the placement of absorbable collagen membrane increase the stability of alveolar ridge contour after guided bone regeneration (GBR) using buccal punch flap. Methods: From June 2019 to June 2023, patients who underwent GBR using buccal punch flap simultaneously with a single implant placement in posterior region (from first premolar to second molar) were divided into coverage group, in which particular bone graft was covered by collagen membrane and non-coverage group. Cone beam CT (CBCT) was taken before surgery (T0), immediately after surgery (T1), and 3-7 months after surgery (T2), and the thickness of the buccal bone plate at different levels (0, 2, 4, and 6 mm) below the smooth-rough interface of the implant (BBT-0, -2, -4, -6) was mea-sured after superimposition of CBCT models using Mimics software. Results: A total of 29 patients, including 15 patients in coverage group and 14 patients in non-coverage group, were investigated in this study. At T0, T1, and T2, there was no significant difference in BBT between the two groups (P>0.05). At T1, BBT-0 was (2.50±0.90) mm in the coverage group and (2.97±1.28) mm in the non-coverage group, with corresponding BBT-2 of (3.65±1.08) mm and (3.58±1.26) mm, respectively. At T2, BBT-0 was (1.22±0.55) mm in the coverage group and (1.70±0.97) mm in the non-coverage group, with corresponding BBT-2 of (2.32±0.94) mm and (2.57±1.26) mm, respectively. From T1 to T2, there were no statistically significant differences in the absolute values [(0.47±0.54)-(1.33±0.75) mm] and percentages [(10.04%±24.81%)-(48.43%±18.32%)] of BBT change between the two groups. The thickness of new bone formation in the buccal bone plate from T0 to T2 ranged from (1.27±1.09) mm to (2.75±2.15) mm with no statistical difference between the two groups at all levels. Conclusion: In the short term, the GBR using buccal punch flap with or without collagen membrane coverage can effectively repair the buccal implant bone defect. But collagen membrane coverage showed no additional benefit on alveolar ridge contour stability compared with non-membrane coverage.

Key words: Alveolar bone loss, Guided tissue regeneration, periodontal, Bone regeneration, Cone-beam computed tomography, Collagen membrane

CLC Number: 

  • R782.13

Figure 1

Patient enrollment procedure GBR, guided bone regeneration; CBCT, cone beam CT."

Figure 2

Guided bone regeneration with buccal punch flap and collagen membrane coverage A-C, implant placement in right mandible first molar site with buccal bone defect; D, collagen membrane inserted beneath the buccal flat; E, bone graft material grafted at implant buccal side; F, buccal flap closure with healing abutment exposure."

Figure 3

Guided bone regeneration with buccal punch flap and non-membrane coverage A-D, implant placement in left mandible first molar site with buccal bone defect; E, bone graft material grafted at implant buccal side; F, buccal flap closure with healing abutment exposure."

Figure 4

Measurement of the thickness of the buccal bone plate (green line) at different levels below the smooth-rough interface of the implant (red line) A, measurement of the thickness of the buccal bone plate before surgery (registration with the CBCT mandible and implant model immediately after surgery); B, measurement of buccal bone plate thickness immediately after surgery; C, measurement of buccal bone plate thickness 3-7 months after surgery. BBT-0, -2, -4, -6 means the thickness of buccal bone plates (BBT) at different levels of 0, 2, 4 and 6 mm."

Table 1

The thickness of buccal bone plates at different levels of 0, 2, 4 and 6 mm below the smooth-rough interface of implants"

Items Coverage group (n=15) Non-coverage group (n=14) Differences between groups P
Pre-operation (T0)
  BBT-0/mm -1.36±1.33 -1.04±1.64 -0.32 0.564
  BBT-2/mm -0.28±1.44 0.67±0.92 -0.95 0.045
  BBT-4/mm 0.96±1.52 1.16±1.03 -0.21 0.672
  BBT-6/mm 1.75±1.78 2.02±1.37 -0.26 0.661
Immediately after surgery (T1)
  BBT-0/mm 2.50±0.90 2.97±1.28 -0.47 0.262
  BBT-2/mm 3.65±1.08 3.58±1.26 0.07 0.877
  BBT-4/mm 4.40±1.39 3.82±1.22 0.58 0.247
  BBT-6/mm 4.48±1.58 3.75±1.65 0.73 0.237
3-7 months after surgery (T2)
  BBT-0/mm 1.22±0.55 1.70±0.97 -0.48 0.109
  BBT-2/mm 2.32±0.94 2.57±1.26 -0.25 0.549
  BBT-4/mm 3.45±1.29 3.25±1.52 0.20 0.706
  BBT-6/mm 3.87±1.44 3.28±1.57 0.59 0.302

Table 2

Changes in thickness of buccal bone plates at different levels of 0, 2, 4 and 6 mm under the smooth-rough interface of implants during the healing process"

Items Coverage group (n=15) Non-coverage group (n=14) Differences between groups P
Buccal bone augmentation from T0 to T1
  ABBT-0/mm 3.86±1.43 4.01±2.55 -0.15 0.848
  ABBT-2/mm 3.93±1.23 2.92±1.17 1.01 0.032
  ABBT-4/mm 3.44±1.41 2.66±0.68 0.78 0.071
  ABBT-6/mm 2.72±1.33 1.74±1.17 0.99 0.043
Buccal bone resorption from T1 to T2
  RBBT-0/mm 1.27±0.94 1.26±0.70 0.01 0.970
  RBBT-2/mm 1.33±0.75 1.02±0.62 0.32 0.227
  RBBT-4/mm 0.94±0.75 0.57±0.55 0.38 0.138
  RBBT-6/mm 0.61±0.53 0.47±0.54 0.14 0.495
  RBBT-0% 48.43%±18.32% 42.22%±16.46% 6.21 0.347
  RBBT-2% 37.01%±17.01% 29.43%±15.05% 7.58 0.216
  RBBT-4% 22.00%±15.64% 17.12%±15.55% 4.88 0.407
  RBBT-6% 13.07%±11.19% 10.04%±24.81% 3.03 0.671
New buccal bone formation from T0 to T2
  NBBT-0/mm 2.59±1.49 2.75±2.15 -0.16 0.817
  NBBT-2/mm 2.60±1.30 1.90±1.02 0.70 0.122
  NBBT-4/mm 2.50±1.25 2.09±0.84 0.41 0.315
  NBBT-6/mm 2.12±1.17 1.27±1.09 0.85 0.054
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