The Role of Blood Clot in Guided Bone Regeneration: Biological Considerations and Clinical Applications with Titanium Foil

Abstract

In Guided Bone Regeneration (GBR) materials and techniques are essential to achieve the expected results. Thanks to their properties, blood clots induce bone healing, maturation, differentiation and organization. The preferred material to protect the clot in Guided Bone Regeneration is the titanium foil, as it can be shaped according to the bone defect. Furthermore, its exposition in the oral cavity does not impair the procedure. We report on five clinical cases in order to explain the management of blood clots in combination with titanium foil barriers in different clinical settings. Besides being the best choice to protect the clot, the titanium foil represents an excellent barrier that is useful in GBR due to its biocompatibility, handling, and mechanical strength properties. The clot alone is the best natural scaffold to obtain the ideal bone quality and avoid the persistence of not-resorbed granules of filler materials in the newly regenerated bone. Even though clot contraction still needs to be improved, as it impacts the volume of the regenerated bone, future studies in GBR should be inspired by the clot and its fundamental properties.

Blood Clotting Dissolution in the Presence of a Magnetic Field and Preliminary Study with MG63 Osteoblast-like Cells—Further Developments for Guided Bone Regeneration?

“…In an in vivo study, Lambert and colleagues [ 16 ] investigated double sinus lift procedures using blood clot, autogenous bone chips or bovine hydroxyapatite (BHA), finding that the bone formation occurred with all three of the space fillers. Many studies have recently reported several clinical cases, which were supportive of the usefulness of titanium foil barriers along with blood clots and were in agreement with our results, demonstrating the role of titanium in clot protection during GBR procedures [ 12 , 14 , 15 , 17 , 18 , 19 ].…”

Guided Bone Regeneration with Occlusive Titanium Barrier: A Case Report and Clinical Considerations

“…The clot plays a key role in GBR, and its protection during its maturation process is essential to obtain good bone quality for successive implant insertion [ 16 ].…”

“…Among the existing fillers used under the occlusive barriers [ 14 , 15 ], blood clots mixed with beta-tricalcium phosphate seems to be the most suitable [ 16 ].…”

Fabrication and application of salicin-polycaprolactone 3D-printed scaffold in the healing of femur bone defects

“…The critical role of blood clots in wound healing and fracture repair has been well-studied (Shiu et al 2018). In bone repair, blood clots form a temporary matrix that initiates bone formation through the influence of soluble factors (growth factors, cytokines, inflammatory factors, coagulation factors, and antimicrobial agents), cell recruitment, and their migration through the fibrin network (Milillo et al 2021). Using Sal instead of aspirin is likely beneficial because the formation of blood clots is necessary to start the repair mechanisms in the tissue.…”