The Role of Bone Decortication in Enhancing the Results of Guided Bone Regeneration: A Literature Review

Greenstein, Gary; Greenstein, Benjamin; Cavallaro, John; Tarnow, Dennis P.

doi:10.1902/jop.2009.080309

Cited by 74 publications

(56 citation statements)

References 61 publications

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“…A recent review paper found conflicting information on the role of bone decortication in enhancing outcomes for GBR. The authors suggested the need for clinical trials to elucidate the role of this variable in GBR procedures 30 . Cortical perforations at the recipient site may have enhanced the blood supply coming from the marrow spaces favoring the process of osteogenesis in the present study.…”

Section: Discussionmentioning

confidence: 70%

Clinical, Tomographic, and Histological Assessment of Periosteal Guided Bone Regeneration with Cortical Perforations in Advanced Human Critical Size Defects

Verdugo

D’Addona

Pontón

2012

Clin Implant Dent Rel Res

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Section: Discussionmentioning

confidence: 70%

Clinical, Tomographic, and Histological Assessment of Periosteal Guided Bone Regeneration with Cortical Perforations in Advanced Human Critical Size Defects

Verdugo

D’Addona

Pontón

2012

Clin Implant Dent Rel Res

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“…The evidence on the efficacy for cortical perforation (decortication) during GBR procedures in an effort to enhance bone formation remains controversial [142]. Studies have shown that cortical perforations increase the blood supply, facilitate angiogenesis, and allow access for progenitor cells from the bone marrow into the 'chamber' [142] whereas other studies showed that bone formation occurred from a non-injured cortical bone surface and that perforations were not required as they did not increase bone formation [59,81].…”

Section: Discussionmentioning

confidence: 99%

“…Studies have shown that cortical perforations increase the blood supply, facilitate angiogenesis, and allow access for progenitor cells from the bone marrow into the 'chamber' [142] whereas other studies showed that bone formation occurred from a non-injured cortical bone surface and that perforations were not required as they did not increase bone formation [59,81]. However, since there are no relevant human clinical studies and the relevant animal studies refer to mandibular defects, where local vascularity is superior to long bones, recommendations for additional bone decortication cannot be made for orthopedic GBR applications [142]. …”

Section: Discussionmentioning

confidence: 99%

The role of barrier membranes for guided bone regeneration and restoration of large bone defects: current experimental and clinical evidence

Dimitriou

Mataliotakis

Calori

et al. 2012

BMC Med

302

280

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Treatment of large bone defects represents a great challenge in orthopedic and craniomaxillofacial surgery. Although there are several methods for bone reconstruction, they all have specific indications and limitations. The concept of using barrier membranes for restoration of bone defects has been developed in an effort to simplify their treatment by offering a sinlge-staged procedure. Research on this field of bone regeneration is ongoing, with evidence being mainly attained from preclinical studies. The purpose of this review is to summarize the current experimental and clinical evidence on the use of barrier membranes for restoration of bone defects in maxillofacial and orthopedic surgery. Although there are a few promising preliminary human studies, before clinical applications can be recommended, future research should aim to establish the 'ideal' barrier membrane and delineate the need for additional bone grafting materials aiming to 'mimic' or even accelerate the normal process of bone formation. Reproducible results and long-term observations with barrier membranes in animal studies, and particularly in large animal models, are required as well as well-designed clinical studies to evaluate their safety, efficacy and cost-effectiveness.

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“…The benefits of decortication are increased bleeding, access for progenitor cells and blood vessels, interlocking of bone, and spatial relationships of decortications in traditional OS. Prior to lasers, decortication could have only been done mechanically by scalers or dental drills only [63].…”

Section: Decorticationmentioning

confidence: 99%

Minimally invasive erbium flap (MINIETM flap)—a retrospective surgical treatment for chronic periodontitis

Desai

Gutknecht

2018

Laser Dent Sci

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This clinical retrospective split-mouth study was designed to evaluate the efficacy of two (FDA approved) erbium laser wavelengths in a minimally invasive flapped approach for the treatment of generalized chronic periodontitis. Twenty-eight (28) patients diagnosed with generalized chronic periodontitis with pocket depths ranging from 4 to 9 mm had 551 posterior teeth surgically treated in a minimally invasive manner and were followed over 6 months. Minimally invasive erbium (MINIE) flaps were performed in all four posterior sextants (distal of cuspid to distal of second molar) in a traditional splitmouth design. Mean baseline probings were 5.4 mm. Patients were randomly assigned to Laser 1 (Er:YAG, Erbium doped yttrium, aluminium, garnet, 2940 nm or Laser 2 (Er, Cr:YSGG, Erbium, chromium doped yttrium, scandium, gallium, garnet, 2780 nm) in the first appointment. The alternate laser wavelength was used in the second appointment. Pre-surgical examination for pocket depth (PD), recession (RC), and clinical attachment levels (CAL) was performed and then repeated 6 months post-surgery. Patients with history of traditional flap surgery (> 5 years ago) completed a visual acuity test (VAT) describing their surgical experience compared to the conventional approach. The results showed statistically significant improvements in PD (1.43 mm) and reduction in CAL (1.41 mm), whereas the change in RC (0.01 mm) was not statistically significant. Clinical improvements of PD and CAL in this study are consistent with the range reported in previous landmark papers implementing a modified Widman flap (MWF) or osseous surgery (OS). The difference compared to traditional procedures was that there was no statistically significant change in RC over 6 months. The patients' experience was much improved compared to traditional flap surgery [1,2].

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The Role of Bone Decortication in Enhancing the Results of Guided Bone Regeneration: A Literature Review

Abstract: There is conflicting information and not enough clinical trials to make a definitive determination as to the merits of bone decortication prior to GBR procedures.

Cited by 74 publications

References 61 publications

Clinical, Tomographic, and Histological Assessment of Periosteal Guided Bone Regeneration with Cortical Perforations in Advanced Human Critical Size Defects

Clinical, Tomographic, and Histological Assessment of Periosteal Guided Bone Regeneration with Cortical Perforations in Advanced Human Critical Size Defects

The role of barrier membranes for guided bone regeneration and restoration of large bone defects: current experimental and clinical evidence

Minimally invasive erbium flap (MINIETM flap)—a retrospective surgical treatment for chronic periodontitis

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