BUILDING BETTER BONE - A Comprehensive Guide to GBR Techniques

ABSTRACT:
L’idea di questo libro è nata in un momento critico per l’umanità, durante il lockdown conseguente alla pandemia per il COVID-19. Un gruppo internazionale di colleghi e amici si è messo al lavoro per creare un opera che analizzasse tutti gli aspetti di un proble- ma comune in odontoiatria, la perdita di uno o più denti, e il sus- seguente riassorbimento fisiologico dei tessuti duri e molli. I difetti conseguenti alla perdita dei denti possono essere trattati in molte maniere differenti, con tecniche chirurgiche, materiali e metodi si- mili ma diversi tra loro. La GBR è una tecnica che esiste da più di trent’anni, ed abbiamo imparato strada facendo tutti i suoi pro e contro. Saper selezionare la tecnica giusta significa ridurre i rischi per clinico e pazienti. Questo vuole essere un manuale di “ricette” comprendente tutto quello che alla data attuale rappresenta lo stato dell’arte e senza bias commerciali. Il libro è corredato da 14 video che spiegano nel dettaglio una buona parte delle tecniche adottate e in ogni capitolo illustra le raccomandazioni degli esper- ti per ottimizzare ogni singola tecnica presentata.

The idea for this book was conceived at a critical time for humanity, during the lockdown following the Covid 19 pandemic. An international group of fellow clinicians set out to create a book to analyze all aspects of a common problem in implant dentistry: the loss of one or more teeth, and the subsequent physiological resorption of both hard and soft tissues. Defects resulting from tooth loss can be treated in several different ways, with similar but different surgical techniques, materials, and methods. GBR is an approach that has been around for over 30 years, during which time we have learnt its pros and cons. Understanding how to select the optimal GBR technique ensures reduced risks for patients and clinicians alike. This book is intended to be a ‘recipe manual’ for how to help build better bone, and includes varied protocols representing the state of the art in modern dentistry, without commercial bias. The book is also enriched by 14 videos that provide detailed explanations of the techniques adopted, and each chapter illustrates expert recommendations for optimizing the techniques presented.

Authors
ANTONIO BARONE
JOSEPH CHOUKROUN
SALVATORE D’AMATO
PETER JM FAIRBAIRN
EDOARDO FOCE
FILIPPO FONTANA
VINCENZO FOTI
HOWARD GLUCKMAN
ANDREA GRASSI
ARNDT HAPPE
SALAH HUWAIS
GIOVANNA IEZZI
EUGENIO LONGO
MICHELE ANTONIO LOPEZ
HASSAN MAGHAIREH
FABIO PERRET
ADRIANO PIATTELLI
ANDREA PILLONI
ALESSANDRO POZZI
LORENA RISPOLI
ROBERTO ROSSI
PAUL LEONHARD SCHUH
GIORGIO TABANELLA
HANNES WACHTEL

Chapter 1
Guidelines and Scientific Background of GBR
Biologic basis of GBR
Barrier membranes
Clinical applications
Surgical technique
Conclusions

Chapter 2
Wound healing: from basic mechanisms to soft tissue healing in oral surgery
Bone healing
Wound healing
Soft Tissue Healing in Bone Reconstructive Surgery
Exploring rapid and scarless wound healing in oral soft tissues: the “time” and “quality” factors in oral mucosal healing
Postsurgical monitoring of soft tissue healing
Clinical implications of poor soft tissue healing
Personalized medicine: is there a translational gap applying in molecular understanding?

Chapter 3
Classification and Guidelines for Treatment of Bony and Soft Tissue Defects
Case study and evaluation
Classification of bony defects
Subclassification of bony defects

Chapter 4
Fresh extraction socket management: thinking in and out of the box
THINKING IN THE BOX 
Immediate implants
Early implant placement
Alveolar ridge preservation
Summary
Case report 1
Case report 2
Tips & tricks
THINKING OUT OF THE BOX 
Periosteal Inhibition in Edentulous Sockets: A New Paradigm
Surgical protocol
Case report 3
Case report 4
Tips & tricks

Chapter 5
Osseodensification for ridge expansion: clinical protocols and case reports
Case report 1
Case report 2
Case report 3
Tips & tricks

Chapter 6
Resorbable and nonresorbable membranes
Decision criteria in GBR
Case report 1
Case report 2
Tips & tricks

Chapter 7
Rationale for the use of autogenous grafts, alloplasts, and xenografts
Anorganic Bovine Bone (ABB)
Porcine Bone (PB)
Equine Bone (EQ)
Biphasic Calcium Phosphate (BCP)
Porous Hydroxyapatite (HA)
Engineered Hydroxyapatite (ENGIpore)
Dense Hydroxyapatite (HA)
Biocoral
Calcium Sulfate (CaS)
Polylactic/polyglycolic acid
Conclusions and useful tips

Chapter 8
Autogenous Bone Grafting in the Posterior Edentulous Mandible with the Khoury Technique: Indications, Contraindications, and Limitations
Case report 1
Case report 2
Tips & tricks

Chapter 9
Innovative Autogenous Bone Grafting Techniques
Palatal Bone Block Graft
Case report 1
Tips & tricks
Case report 2
Tips & tricks

Chapter 10
Use of heterologous lamina in the esthetic zone: site specific treatment options depending on site morphology
Case report 1
Case report 2
Case report 3
Tips & tricks

Chapter 11
Occlusive titanium barriers for GBR
Surgical technique
Case report 1
Case report 2
Tips & tricks

Chapter 12
Cortical lamina xenogeneic bone membrane: indications, contraindications, and limitations
Case report 1
Case report 2
Tips & tricks

Chapter 13
Cortical lamina in horizontal and anterior defects: the multilayer technique
Indications
Contraindications
Surgical technique
Case report 1
Case report 2
Tips & tricks

Chapter 14
Fibrinogen-Induced Regeneration Sealing Technique (F.I.R.S.T.)
Fibrin sealant
Fibrinogen-Induced Regeneration Sealing Technique (F.I.R.S.T.) Case report 1
Case report 2
Tips & tricks

Chapter 15
Use of cortical laminas for bone layering and bone-into-bone techniques
Case report 1
Case report 2
Tips & tricks

Chapter 16
Osteodistraction for ridge augmentation: principles, indications, and contraindications
Objectives of crestal distraction
Surgical technique
Benefits
Disadvantages
Discussion
Conclusions
Indications
Tips & tricks

Chapter 17
GBR for maxillofacial and congenital defects
Esthetic approach to the management of residual alveolar cleft
Case report 1
Tips & tricks
Discussion
Conclusions

Chapter 18
Digital vertical and horizontal bone block grafting
Workflow
Case report 1
Case report 2
Tips & tricks

Chapter 19
Immune modulation with calcium phosphate alloplast. up-regulated, membrane free host bone regeneration
Case report 1
Case report 2
Tips & tricks

Chapter 20
Using digital dentistry to build soft and hard tissues for function and esthetics
Case report 1
Case report 2
Tips & tricks

Chapter 21
Evolution of xenogeneic bone membranes: flex cortical sheet
Case report 1
Case report 2
Tips & tricks

Chapter 22
Digitally assisted soft tissue and bone sculpting for PK1 (pink-free) full arch prosthesis
Principles
Interplay between the prosthesis and the hard and soft tissues
Biologic pontic design
Digitally Assisted Soft tissue Sculpturing (DASS) technique
Smiling Scan technique
Prosthetic- and soft tissue-driven implant planning
Surgical phases
Role of biomaterials
Differences from other protocols
Conclusions
Tips & tricks

Chapter 23
Magnesium: the next generation of biomaterials in regenerative dentistry
Magnesium
Magnesium barrier membranes
Case report 1
Magnesium fixation screws
Case report 2
Tips & tricks

Chapter 24
Oxidative stress and osteoimmunology: the two missing pieces of the oral osseointegration puzzle
Oxidative stress
Osteoimmunology
Immunity and the immune system
Prevention of oxidative stress during osseointegration/oral surgery
Growth factors and oxidative stress
Conclusion