The selection of appropriate biomaterials is most important for optimizing outcomes with the guided bone regeneration (GBR) technique. In 1988, the GBR technique was originally developed with bioinert expanded polytetrafluoroethylene (e-PTFE) membranes to create a secluded space filled with a blood clot. Since then, major efforts have been made to improve treatment outcomes with the GBR technique. The objectives of these efforts were to improve the predictability for successful outcomes, reduce the risk of complications, and make these procedures more user-friendly for clinicians. This progress was feasible with improved surgical techniques, but also with better biomaterials. This lecture will review the progress in the past 18 years and present the current knowledge and clinical applications with the GBR technique. For the selection of an appropriate barrier membrane, aspects of biocompatibility, longevity of barrier function, susceptibility for complications, and clinical handling during surgery will be discussed. It seems that clinicians today prefer bioresorbable collagen membranes since they offer several advantages when compared with bioinert e-PTFE membranes. Bioresorbable collagen membranes must be combined with appropriate bone fillers to avoid membrane collapse and to enhance new bone formation in the membrane-protected space. Bone fillers are characterized by their osteogenic potential, their osteoconductivity, their physical stability and size, and their substitution rate during bone remodeling. Since local bone augmentation is predominantly used for contour augmentation around endosseous implants, bone fillers with a low substitution rate are often preferred today. They are often combined with autogenous bone chips with a high osteogenic potential.
Daniel Buser, PD, Dr Med Dent, is professor and chairman of the Department of Oral Surgery and Stomatology at the University of Berne in Switzerland. His main research areas are bone regeneration around endosseous implants, surface technology, and guided bone regeneration. He has authored or co-authored approximately 180 publications. He is president of the Swiss Society of Oral Surgery and Stomatology and a past president of the European Association for Osseointegration and the Swiss Society of Oral Implantology. Dr Buser has received awards from several professional organizations.