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International Journal of Periodontics & Restorative Dentistry



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Int J Periodontics Restorative Dent 39 (2019), No. 4     12. July 2019
Int J Periodontics Restorative Dent 39 (2019), No. 4  (12.07.2019)

Online Article, Page e157-e165, doi:10.11607/prd.e3598, PubMed:31226196

Online Article: A Proposal of Pseudo-periosteum Classification After GBR by Means of Titanium-Reinforced d-PTFE Membranes or Titanium Meshes Plus Cross-Linked Collagen Membranes
Cucchi, Alessandro / Sartori, Maria / Aldini, Nicolò Nicoli / Vignudelli, Elisabetta / Corinaldesi, Giuseppe
After guided bone regeneration (GBR) with different devices, a layer of connective tissue called pseudo-periosteum can be observed above the newly formed bone. The aim of this study is to evaluate the clinical and histologic features and to suggest a classification of this connective tissue after GBR with nonresorbable membranes or titanium (Ti)-mesh plus resorbable membranes. Forty patients with partial edentulism in the posterior mandible were randomized into two groups: 20 patients were treated by means of Ti-reinforced dense polytetrafluoroethylene (d-PTFE) membrane (group A), while the other 20 patients were treated with Timesh and a cross-linked collagen membrane (group B). After 9 months and during re-opening surgery, bone density and pseudo-periosteum type were recorded. Pseudo-periosteum was classified into Type 1 (no tissue or tissue < 1 mm); Type 2 (regular tissue between 1 and 2 mm); and Type 3 (irregular tissue or tissue > 2 mm). Histologic analyses were performed to identify the features of pseudo-periosteum. Out of 40 patients, 36 (n = 19 in Group A; n = 17 in Group B) with 99 implants were analyzed after GBR and according to the study protocol. The vertical bone gain was 4.2 ± 1.0 mm in Group A and 4.1 ± 1.0 mm in Group B. Group A had a higher bone density and greater amounts of type 1 periosteum than Group B (P = .01 for both). The preliminary results of this study show that both d-PTFE membranes and Ti-mesh plus collagen membranes are two valid options for bone augmentation in the mandible. However, nonresorbable membranes achieve higher bone density and a thinner pseudo-periosteum layer above the newly formed bone.