Modified guided bone regeneration technique of the mandible using a biocomposition and an allogeneic dura mater membrane: clinical cases

Abstract

Insufficient bone volume requires augmentation of the alveolar ridge to create conditions for implant placement in an optimal position and to select its size considering the anticipated functional load. Of clinical interest is a comprehensive modification of the guided bone regeneration protocol aimed at obtaining sufficient alveolar ridge volume for subsequent implant and prosthetic rehabilitation. The article presents clinical observations of patients with secondary edentulism and alveolar ridge volume deficiency in the lateral parts of the mandible. The series included 3 female patients aged 32, 39, and 44 years with buccal, horizontal, and combined horizontal-vertical alveolar ridge defects, respectively. In all cases, bone reconstruction was performed before dental implantation using a single modified guided bone regeneration protocol. Results were assessed by CBCT before bone reconstruction, control CBCT 6 months after guided bone regeneration before implantation, and panoramic radiography after implant placement. In the case series, the initial alveolar ridge width ranged from 2.7 to 5.1 mm. Six months after guided bone regeneration, bone tissue width ranged from 6.1 to 9.5 mm, with linear ridge width gain from 2.2 to 4.4 mm. In the observation with a combined horizontal-vertical defect, the vertical parameter increased from 7.1–7.7 to 10.0 mm. In the presented clinical cases, the obtained bone volume allowed placement of dental implants with a diameter of 4.0 mm in the planned positions. According to morphometry, the proportion of bone tissue was 46.7%, bone marrow — 11.9%, residual bone grafting material — 1.1%. The presented clinical observations demonstrate the possibility of using a modified guided bone regeneration protocol for alveolar ridge deficiency in the lateral parts of the mandible before dental implantation. The obtained clinical, radiological, and morphological data allow considering the technique as a promising variant of guided bone regeneration, requiring further study on a larger patient sample.