Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy.
Operative Unit of Dentistry, Azienda Unità Sanitaria Locale (AUSL), Ferrara, Italy.
Periodontol 2000. 2023 Feb;91(1):113-125. doi: 10.1111/prd.12481. Epub 2023 Feb 8.
The presence of a peri-implant bone dehiscence (BD) or fenestration (BF) is a common finding after implant placement in a crest with a reduced bucco-lingual bone dimension. The presence of a residual BD is associated with a relevant incidence of peri-implant biological complications over time. Guided bone regeneration (GBR), performed at implant placement, is the most validated treatment to correct a BD. In the present systematic review, the evidence evaluating factors which could reduce the invasiveness of a GBR procedure with respect to patient-reported outcomes, intra- and post- surgical complications, was summarized. Factors included were: technical aspects, regenerative materials for GBR, and peri- and post-operative pharmacological regimens. The available evidence seems to indicate that the use of membrane fixation and flap passivation by means of a double flap incision technique may reduce the incidence of post-surgical complications. When feasible, the coronal advancement of the lingual flap is suggested. The use of a non-cross linked resorbable membrane positively impacts on patient discomfort. The adjunctive use of autogenous bone to a xenograft seems not to improve BD correction, but could increase patient discomfort. Systemic antibiotic administration after a GBR procedure does not seem to be justified in systemically healthy patients.
种植体周围骨缺损（BD）或骨开窗（BF）的存在是在颊舌骨宽度减小的牙槽嵴上放置种植体后常见的发现。残留的 BD 与种植体周围生物并发症的相关发生率随时间的推移而增加。在种植体放置时进行引导骨再生（GBR）是纠正 BD 的最有效的治疗方法。在本系统评价中，总结了评估与患者报告的结果、手术内和手术后并发症相关的减少 GBR 手术侵袭性的因素的证据。包括的因素有：技术方面、GBR 的再生材料以及围手术期和术后的药理学方案。现有证据似乎表明，使用膜固定和通过双瓣切口技术使瓣钝化可能会降低手术后并发症的发生率。在可行的情况下，建议将舌瓣向冠方推进。使用非交联可吸收膜可减轻患者的不适。异种移植物中添加自体骨似乎不能改善 BD 的纠正，但可能会增加患者的不适。在系统健康的患者中，GBR 手术后全身性应用抗生素似乎没有道理。
