tr?id=735770906937422&ev=PageView&noscript=1 GBR Tools and Screws Highlights
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DSI Guided Bone Regeneration Procedure Overview

Modern-day implants have become the best solution for missing teeth as of today.
To successfully place a dental implant, the patient must present with a healthy alveolar ridge,
that can house the titanium dental fixture, serving as the base foundation for the crown to come.

In many cases, patients show inadequate dental ridge dimensions or defects,
preventing the placement of a dental implant.
A horizontal or vertical bone deficiency can lead to major clinical complications and are necessary to mend before implant placement.
Therefore, the patient is required to undergo a GBR (Guided Bone Regeneration) procedure.
 

Guided Bone Regeneration technique, is a surgical procedure that aims to expand a narrow dental ridge or to repair bone tissue defects, using barrier membrane with bone graft material or without.

GBR Principles:

There are four basic principles for a successful Guided Bone Regeneration:
* Exclusion of epithelial and connective tissue
* Space maintenance
* Stability of fibrin cloth
* Primary wound closure

GBR Biological Success overview: The osseous regenerative process following a GBR procedure depends on the migration of pluripotential and osteogenic (Osteoblasts) cells to the bone defect site, and ingrowth prevention of neighbouring epithelial cells, derived from the surrounding tissue. Another aspect is the regeneration rate of the bony tissue inside the defect area.
It is crucial for the osteogenesis extending from the bony margins to exceed the rate of fibro-genesis emerging from the soft tissue at the vicinity of the bone.

Biological Properties & Types of Bone Graft in GBR:


There are three different possible mechanisms for achieving bone regeneration:
1. Osteogenesis – Formation of bone tissue even in the absence of undifferentiated mesenchymal stem cells.
2. Osteo-induction – Differentiation of undifferentiated mesenchymal stem cells into osteoblasts and chondroblasts with the help of growth factors.
3. Osteo-conduction – Is a process of a biological framework introduction, such as bone graft, to encourage differentiated mesenchymal cells, to grow along the graft surface. The primary bone grafts used in GBR procedures are: Autograft: Patients own bone harvested from a different area in the body, supports bone regeneration by all three mechanisms: Osteogenesis, Osteoinduction and osteoconduction. Allograft: Bone graft harvested from cadavers presents osteoconductive properties. XenoGraft: Harvested mainly from, a bovine source, presents osteoconductive properties. Alloplasts: Synthetic material, usually made from tri-calcium phosphate, obtains osteoinductive properties.


Mechanical and Biological Properties of Barrier Membranes in GBR: As of today, there are two major types of membranes: Resorbable (Collagen type 1, 2, 3) and Non-Resorbable (PTFE with Titanium reinforcement & without, and Titanium mesh).

Preventing the competing in-growth of soft tissue cells from the overlying mucosa. The barrier membrane succeeds in mechanical protection of the augmented tissue, making it possible for the newly formed bone to proliferate and reach its needed volume, for a successful implantation procedure in the future. Barrier membrane expected characteristics:
* Anti-Bacterial Protection
* Block Soft Tissue In-Growth
* Biocompatibility
* Space-Maintenance
* Rigid enough to prevent collapse into the bone defect.
* Plasticity for re-shaping
 Titanium Mesh Membrane in GBR Procedures: While barrier membranes provide a solution for moderate to severe osseous defects treated by guided bone regeneration procedures, they tend to collapse towards the defect area due to the overlying soft tissue pressure.
For cases where space maintenance is vital, titanium mesh can provide a strong yet flexible structure,
that can be manipulated and shaped, with pores supporting vascularization.
Titanium mesh is a completely bio-compatible material.

GBR Approaches: There are 2 Guided bone regeneration approaches: 1. GBR Staged approach: When the alveolar ridge anatomy does not comply with an optimal three-dimensional implant placement, a two-staged procedure is recommended, where the implant placement will take place in the second stage after the tissue has been regenerated following the GBR procedure. 2. GBR Simultaneous approach: This approach is suggested, only if the implant can be placed
in a three dimensional position with adequate primary bone stability.
The main indication of using the simultaneous approach is to treat dehiscence and fenestration type of defects.
In Conclusion:

Guided Bone Regeneration can be achieved by applying a variety of different bone graft materials and barrier membranes, to achieve maximum
hard tissue regeneration for future implant placement.

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The regulatory status of different devices in the DSI Dental Implant System is not the same in all regions.
Please check with us to find out which devices are available in your country