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ePaper created 2014-11-07, 14:16:52 | version 1.30.01
I research 08 I implants3_2014 erationwereofgreatinteresttome.Atthistime,great hopes were placed on the so-called GTR (Guided Tis- sue Regeneration) technique for treating extensive periodontalbonedefects.Afewyearslater,themem- brane technique was tested as part of experimental studiesonboneregenerationforlargeralveolarridge defects.Basedonthestudies’promisingfindings,the clinicaluseofmembranesonimplantpatientsstarted in the late 1980s (Nyman et al. 1990). Despitethis,itwasnotbeforethebeginningofthe 1990s until the discussion of this application found itswaytocongresses.Fromthistime,worksbyWach- tel and Bernimoulin are to be named (Wachtel 1990, WachtelandBernimoulin1991).In1994,Ipurchased the first book dealing with this issue by Buser, Dahlin andSchenkformyprivate,scientificlibrary.Underthe title“GuidedBoneRegenerationinImplantIndustry”, theauthorspublishedafterfiveyearsofintensiveex- perimental and clinical preparation the first English- speakingissueofthisbookin1994,whichcouldrouse a large interest for this topic on my side as well as among implantological experts. Since then, the GBR technique has constantly developed. Always about to find better and for the patient more gentle treatment methods, in the last 20 years I applieddifferentmembranetypesintheclinicaldaily routine (Tab. 3), compared their suitability and appli- cation parameters and based on the outcomes, dis- carded or kept them (Tab. 2). Thereby, an important criterion for the selection of the operation method andtheusedtypeofmembranewasalsothepatient’s subjective feeling (Tab. 1). _Aims of membrane application – Undisturbedregenerationofbonethroughabarrier function against the adjacent soft tissue. – Avoidance of graft resorption particularly in autol- ogous bone transplants. – Protection against loss or dislocation of bone or bone graft substitute particles. – Protection of the regenerate in case of wound de- hiscence. Depending on the used membrane type, the de- siredboneregenerationisgiventherequiredtimeand rest in a defined area. Especially the reservation of space volume defined by a surgeon can be perfectly ensured by the use of titanium-reinforced mem- branes (Figs. 1 & 2). Before the insertion into the op- eration area, these membranes can be tailored and also bended, as shown in Fig. 3 only exemplarily. From 1994 to 1996, I thus used non-resorbable, titanium-mesh-reinforced membranes from the company W. L. Gore and Associates, Inc. USA, at first. Although, I as an operator was very satisfied with the clinical outcomes of the bone regeneration in Tab. 1_Subjective patient satisfaction during and after augmentative procedures in our practice from 1994 to 1999, five years, total number of cases n = 280, average satisfaction based on a subjective satisfaction scale 0 = very unsatisfied … 10 = very satisfied. Tab. 2_Assessment of the handling for the operator and subjective evaluation of the plastic coverage and healing process, total amount of cases n = 280. Membrane types Amount of patients questioned First surgery Second surgery for membrane removal Overall assessment three month after membrane augmentation Non-resorbable, titanium-mesh- reinforced ePTFE membrane 32 7 5 7 Resorbable ePTFE membrane 52 8 0 8 Collagen membrane 196 9 0 10 Membrane type First surgery Second surgery Wound dehiscence simple difficult simple difficult after 8 days after 30 days Non-resorbable, titanium-mesh-reinforced ePTFE membrane 6,25 % (2) 93,8 % (30) 28,2 % (9) 71,9 % (23) 9,4 % (3) 21,9 % (7) Resorbable ePTFE membrane 11,5 % (6) 88,5 % (46) 0 0 3,8 % (2) 11,5 % (6) Collagen membrane 59,5 % (117) 40,5 % (79) 0 0 1,5 % (3) 5,1 % (10)