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Guided Bone Regeneration

The future of GBR-membranes

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A better understanding of the processes underlying Guided Bone Regeneration might lead to a new generation of products – such as bioactive membranes. A look into the crystal ball.

Prof. Christer Dahlin | Sweden

Guided Bone Regeneration (GBR) was developed and introduced as a biological concept and treatment modality to repair bone deficiency of the alveolar bone in order to allow placement of oral implants.1,2 The concept has been in clinical use since the early 90’s and is still an established technique that has spread and is now used globally.

Re-examining the role of the membrane

GBR membranes are used in combination with various bone substitute materials. The original hypothesis implies that the membranes would isolate the bone defect site from non-osteogenic soft tissue, and the bone substitute would act as a “ladder” or scaffold for the newly formed bone, thereby promoting osteogenic cells and de novo bone formation.

In order to design future regenerative products, for example for more complex situations such as medically compromised patients and more advanced cases, it is imperative to gain a more in-depth knowledge regarding the mechanisms of regeneration. This would open up possibilities for tailoring materials with specific properties for various clinical indications.

Bioactive membranes

Native (not chemically manipulated) membranes, based on collagen, have received considerable attention over recent years. This is not only due to their configuration and user-friendly status in the clinical setting, but also because of positive biological factors such as low immunogenicity, stimulatory actions by means of the collagen itself3 and potential presence of growth factors and other signals within the native extracellular matrix, such as fibroblast growth factor 2 (FGF-2), which, for example, stimulates angiogenesis.4-6

There is a belief that the classic role of the membrane acting as a passive barrier and graft container might shift into a situation where the membrane takes a more active role by guiding and directing the healing events during regeneration. With this new view of the GBR principle, tailor making ­bioactive barrier membranes seems to be a logical development for the future, where structural and functional mimicry of the native extracellular matrix using novel tissue engineering techniques is the ultimate goal.

By moving away from the classical barrier function only, and also demonstrating an active involvement in the wound healing, issues such as degradation rate and membrane dimensions might be of more importance in the future.

Future perspectives

Based on current trends and knowledge, I foresee future scientific developments that will focus on the effect of specific membrane properties, for example, porosity, thickness and cell affinity. Furthermore, research will ­focus on how the differences in the structure of the membrane will alter the regulation of cellular and molecular events inside the membrane as well as within the protected defect areas. A continuous development and a renewed interest in non-resorbable membranes, in particular for more advanced reconstructions, can be anticipated, combined with novel material knowledge in this field.

Prof. Christer Dahlin

Prof. Christer Dahlin | Sweden

University of Gothenburg
Sahlgrenska Academy,
Inst. of Clinical Sciences

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