The role of bone decortication in enhancing the results of guided bone regeneration: a literature review.

BACKGROUND

Bone decortication is often performed as part of a guided bone regeneration (GBR) procedure. The biologic rationale for decortication of bone is to allow progenitor cells easy access to a GBR-treated site and to facilitate prompt angiogenesis. It also may enhance the physical connection between a bone graft and a recipient site. However, the concept of decortication prior to a GBR procedure is controversial because there are no human clinical trials to support its effectiveness, and there are opposing points of view derived from animal studies regarding its usefulness.

METHODS

The literature was assessed to determine whether there are enough data to validate the rationale for using decortication of bone as an integral part of GBR procedures. Eight searches were performed seeking controlled clinical trials that addressed the ability of decortication to enhance GBR.

RESULTS

Three controlled animal clinical trials were found that supported the use of decortication prior to performing GBR. Two controlled animal clinical trials were located that indicated decortication did not improve GBR procedures. No human controlled clinical trial was identified that addressed the ability of decortication to alter GBR procedures. The literature addressing the capacity of decortication to affect onlay grafting or wound healing also provided mixed results.

CONCLUSION

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.