Clinical and histological sequelae of surgical complications in horizontal guided bone regeneration: a systematic review and proposal for management

Abstract

It is not uncommon to encounter post-surgical complications after horizontal guided bone regeneration (GBR). The primary aim of this review was to evaluate the incidence and types of complications that occur after horizontal GBR and propose management strategies to deal with these clinical situations. A secondary aim was to conduct a histomorphometric review of the wound healing process at sites that experienced post-surgical complications after GBR. A keyword search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for studies published in English from January 2015 to January 2020 was conducted for the primary aim and 23 studies were selected. A second search addressing the secondary aim was conducted, and five studies were included. Site-level analysis showed that the weighted mean incidence proportion of minor wound dehiscence and minor infections occurring at the augmented site was 9.9% [95% CI 6.4, 13.9, P < 0.01] and 1.5% [95% CI 0.4, 3.1, P = 0.21) respectively. Patient-level analysis showed minor and major complications occurring at a weighted mean incidence proportion of 16.1% [95% CI 11.9, 20.8, P = 0.01] and 1.6% [95% CI 0.0, 4.7, P < 0.01] respectively, while neurosensory alterations at the donor site was 7.0% [95% CI 1.3, 15.5, P < 0.01]. Subgroup analysis also revealed that the use of block grafts increased the incidence proportion of minor post-surgical complications, whereas a staged GBR procedure increased the incidence proportion of both minor and major post-surgical complications. Although exposure of the barrier membrane is often associated with less bone regeneration and graft resorption, the type of membrane used (resorbable or non-resorbable) had no statistically significant influence on any post-surgical complication. Histologically, a layer of fibrous connective tissue instead of bone is commonly observed at the interface between the native bone at the recipient site and the regenerated bone in cases with membrane exposure after GBR procedure. Minor wound dehiscence was the highest incidence proportion of post-surgical complications. Methods ranging from daily application of antiseptics, use of systemic antimicrobials, regular reviews, and total removal of the non-integrated biomaterials are commonly prescribed to manage these post-surgical complications in attempt to minimise the loss of tissue at the surgical site.

Lateral Alveolar Ridge Augmentation with an Autogenous Bone Block Graft Alone with or without Barrier Membrane Coverage: a Systematic Review and Meta-Analysis

“…Mucosal dehiscence appears to be the most common complication with the two treatment modalities, which is in accordance with previous published systematic reviews [7,17,28,29]. Mucosal dehiscence and barrier membrane exposure is often associated with less bone regeneration and resorption of the augmented area, which may compromise implant placement in an optimal prosthetically position [57]. However, mucosal dehiscence with exposed barrier membrane is usually treated sufficiently with either daily application of antiseptics, use of systemic antimicrobials or removal the sequestered bone [57].…”

“…Mucosal dehiscence and barrier membrane exposure is often associated with less bone regeneration and resorption of the augmented area, which may compromise implant placement in an optimal prosthetically position [57]. However, mucosal dehiscence with exposed barrier membrane is usually treated sufficiently with either daily application of antiseptics, use of systemic antimicrobials or removal the sequestered bone [57]. The need for total removal of a non-integrated autogenous bone block graft in conjunction with a mucosal dehiscence rarely occurs, but additional alveolar ridge augmentation at the time of implant placement is often necessitated in the case of a mucosal dehiscence [3,28].…”

Guided Bone Regeneration with Concentrated Growth Factor Enriched Bone Graft Matrix (Sticky Bone) vs. Bone-Shell Technique in Horizontal Ridge Augmentation: A Retrospective Study

“…Incidence of postoperative complications recorded in the present study (12.5% both for test and control groups) is comparable to the weighted complication rate reported in recent systematic reviews on GBR procedures (16.1-16.8%) [49,50]. Moreover, the present findings suggest that implant failure rate in sites showing flap dehiscence and/or graft infection is extremely high (60%).…”

Honeycomb scaffolds capable of achieving barrier membrane-free guided bone regeneration

“…Among various bone loss configurations, the augmentation of bone loss vertically is extremely challenging owing to the low supply of osteogenic cells often causes soft tissue dehiscence, resulting in wound infection and extended healing period. [18][19][20][21][22] Resorbable barrier membranes (e.g., polylactide, polyglycolide, polycaprolactone, and collagen) provide less volume stability during bone repair, because of the faster resorption, than the complete bone regeneration (3-6 months), resulting in the premature loss of mechanical properties. 23] The biodegradation of these membranes causes an inflammatory reaction in the soft tissue.…”