The Bone Lamina Technique: A Novel Approach for Lateral Ridge Augmentation—A Case Series
Abstract and Figures
The goal of this case series is to present a novel treatment approach for lateral ridge augmentation. Four systemically healthy patients (aged 48 to 59 years) with inadequate dental alveolar ridge widths were selected for inclusion. All ridge defects were augmented using a xenogeneic cortical bone shield in combination with particulated bone substitutes and a thin collagen barrier. At baseline and after 6 months, digital cone beam computed tomography scans were performed. Biopsy specimens were harvested at reentry surgery and processed for histologic analysis. The results revealed a sufficient amount of bone structure for implant placement without additional augmentation procedures. The histologic analysis demonstrated that new bone formation had taken place and the bone shield had resorbed entirely. This case series indicates that the bone lamina technique has the biologic and mechanical properties to succesfully achieve hard tissue augmentation of deficient ridges.
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... Its use has provided promising histological and clinical results when used with particulate porcine xenograft (OsteoBiol ® Gen-Os ® , Tecnoss ® , Giaveno, Italy) [8] and appeared to fulfil the criteria for a successful horizontal and vertical GBR [9,10]. ...
... In a study by Wachtel et al. in 2013, a collagen membrane was used as an outer layer along with the cortical lamina in order to improve the tissue integration of the membrane. Since the collagen membrane has a cell-occlusive surface, the collagen fibers of the soft tissue can interlock with the membrane and improve primary wound closure [9]. ...
Introduction: Bone regenerations are common procedures used to restore the required bone width or height for adequate implant placement. Among the wide variety of materials developed for this purpose, the soft collagenated porcine membrane known as cortical lamina (OsteoBiol® Lamina, Tecnoss®, Giaveno, Italy) has provided promising clinical and histological results. It was used along with equine-derived bone particles (OsteoBiol® Gen-Os®, Tecnoss®, Giaveno, Italy) in a series of horizontal bone augmentations to clinically, radiologically and histologically evaluate the lateral bone augmentation, and to measure the vertical gain, if present, at the site of implant placement. Methods: Fifteen healthy patients with ridges < 4mm needing implant placement were included. The area was augmented using equine bone and the cortical lamina was immobilised using fixation screws. Six months later, at implant placement, a biopsy was taken for non-demineralised histology. Radiological superimposition of the pre and post-operative CBCT scans was made to calculate the radiological bone gain at the site of implant placement. Bone gain was also studied using histomorphometrical analysis. Results: At 6 months, implant placement was possible in all cases except one, where a total of 26 implants were placed in 14 patients. CBCT superimposition showed that the mean horizontal width had increased significantly at the level 0 mm, 2 mm, 4 mm and 6 mm of the implant sites. Histology showed signs of bone remodelling and vital bone formation. Histomorphometric results showed a higher bone percentage in the deep part of the biopsy compared to the superficial one. Conclusions: The porcine cortical lamina membrane used with the equine xenograft particles seems to be a promising technique for the horizontal bone augmentation. Randomized controlled clinical trials are still needed to evaluate the superiority of this membrane compared to the conventional regeneration techniques along with long term follow up of the regenerated bone.
... 8 Possiedono inoltre una rigidità simile alle membrane in PTFE rinforzate in titanio. 9 Al fine di migliorare i risultati clinici nelle tecniche di GBR, alcuni Autori hanno proposto l'utilizzo dei sigil-lanti di fibrina, chiamati anche colla di fibrina. 10 La matrice di fibrina, infatti, svolge una funzione meccanica, creando uno scaffold temporaneo che favorisce le fasi iniziali del processo di guarigione. ...
... Wachtel e Coll. 9 hanno utilizzato una lamina corticale (OsteoBiol ® Lamina, Tecnoss, Giaveno), stabilizzata con pin di fissazione, in combinazione con un sostituto osseo collagenato (OsteoBiol ® Mp3 ® , Tecnoss, Giaveno) e una membrana in collagene (OsteoBiol ® Evolution,, Tecnoss, Giaveno). A distanza di 6 mesi, il volume osseo rigenerato era ampiamente soddisfacente per l'inserimento implantare. ...
Rigenerazione ossea guidata con tecnica FIRST (Fibrin-Induced Regeneration Sealing Technique). Case report con evidenze istologiche
Scopo dello studio: la rigenerazione ossea guidata tramite l'utilizzo di lamine corticali e colla di fibrina permette il ripristino di volumi ossei adeguati ad un corretto inserimento implantare.
Materiali e metodi: è stato eseguito un posizionamento implantare in chirurgia guidata in sede 14-16. Il difetto osseo orizzontale vestibolare è stato trattato con tecnica FIRST.
Risultati: dopo cinque mesi è stato prelevato un campione dell'area rigenerata che ha rivelato la presenza di osso di nuova formazione e la maturazione dello stesso. Confrontando le CBCT pre e post-operatorie è emersa la stabilità del volume osseo rigenerato.
Conclusioni: la rigenerazione ossea ottenuta con la tecnica proposta ha permesso di ottenere un ottimale risultato estetico-funzionale. Quintessenza Int. 2023;37(3):24-35.
... CLBM has proven effective in treating both vertical and horizontal periodontal bone defects. Recent studies have shown its potential to augment the ridge laterally [6,11]. When combined with bone grafts, the membrane enhances clinical attachment levels and reduces probing depths, making it a valuable tool in managing periodontitis [2,9]. ...
... In their study, they utilized a xenogeneic cortical bone shield in combination with particulate bone substitute and a thin collagen barrier to maintain space and promote bone healing. This surgical approach resulted in bone healing through the mechanical and biological properties of the lamina [6]. ...
Giant cell tumors are rare, locally aggressive non-odontogenic osteolytic tumors associated with high rates of local recurrence. Treatment modalities are subject to considerable controversy, with successful outcomes hinging on achieving complete tumor elimination through thorough curettage. A 78-year-old male referred in December 2023 for a persistent mucosal lesion in the right maxilla under a removable denture. Clinical examination revealed a well-defined erythematous nodular lesion measuring approximately 3 cm along its long axis, localized on ridge quadrant 1. Biopsy confirmed the diagnosis of giant cell tumor.
Although complete resection with healthy margins may be justified for aggressive lesions, it often results in significant morbidity and requires immediate defect reconstruction. Some studies suggest favorable long-term outcomes with guided bone regeneration (GBR). The bone lamina technique uses a xenogeneic cortical bone membrane to maintain space and promote bone healing. This surgical approach promotes bone healing through the mechanical support and biological properties of the lamina.
The purpose of this case report is to evaluate the efficacy of the bone lamina technique and its role in managing complications following giant cell tumor resection.
... Previous studies demonstrate its effectiveness in horizontal GBR (8)(9)(10). In some works, the device is passively applied to the recipient site (15,16) in others it is immobilized using fixation screws (17). According to manufacturer instructions, CSL should be directly grafted without hydration. ...
Vertical and horizontal bone defect is a challenge in oral surgery. Alveolar bone reconstruction is needed beforeimplant insertion. Several surgical techniques are available. Here a case of posterior alveolar ridge reconstruction isreported together with a histological evaluation of bone sampled after 6 months of healing. Histological results suggestthe validity of surgical procedures for bone volume regeneration in the distal mandibular region. Furthermore, accordingto our clinical experience, both the pre-hydration and stabilization of the device, with fixation screws, are stronglyrecommended if vertical bone regeneration is needed.
... Traditional techniques fail to compare changes in anatomy in one data set. Clinical techniques for the measurement of bone height and width usually involve clinical measurements with calipers or probes [10,[34][35][36] at two different time points and encounter the problem of defining reference points. ...
Vertical ridge augmentation is a demanding and technique-sensitive surgical procedure. In the present case series, cone beam CT (CBCT) scans from the clinical routine of patients treated using a novel approach for vertical bone augmentation were assessed. All patients showed a single-tooth class 5 defect and were treated using a modification of the original shell technique. Cortical bone plates were replaced with a lamina composed of a partially demineralized porcine xenograft. CBCT scans of six consecutive patients were treated with the lamina and particulate bone from the mandibular ramus prior to a single tooth implant in the anterior maxilla were included. Pre- and postsurgical CBCT data sets were superimposed and analyzed digitally using surface matching and Boolean subtraction. The volume of the grafted area was calculated with and without the xenograft. The vertical gain of the ridge height measured in this case series varied from 7 to 11.3 mm. The mean vertical gain was 8.97 mm. The mean volume including the xenograft was 382.59 mm3 (SD 73.39) and 250.84 mm3 (SD 53.67) without the lamina. The modified shell technique used in this case series for the vertical augmentation of single-tooth class 5 defects provided sufficient bone for single implant restorations.
... On the other hand, our study showed correspondence between the increase in the tensile strength of mESM and the mineralization percentage of mESM samples. This mechanical behavior would increase the likeliness of mESM being used in applications where membranes with higher tensile strength and elastic modulus are required to maintain their shape without losing the ability to adapt to the defect in bone tissue regeneration procedures [63,64]. Unlike those reported by Torres et al. [14], the stress-strain curves demonstrated a linear regime, where the strain variation is directly proportional to the variation of stress, without registering a toe region that represents an un-crimping of the membrane. ...
Hybrid biomimetic materials aim to replicate the organic-inorganic constructs of mineralized tissues. During eggshell formation, the outer surface of the eggshell membrane (ESM) promotes calcium carbonate nucleation, while the inner one prevents mineralization toward the egg white and yolk. In the current study, the outer surface of the ESM acted as a heteronucleant in calcium phosphate precipitation by the vapor diffusion sitting drop method, while the inner one remained unmineralized. The aim was to fabricate a 2D biomaterial with dual functions, osteoinductive on one side and protective against cell invasion on the other side. The microstructural, physicochemical, morphological, and mechanical properties of the mineralized ESM were characterized by XRD, TGA, XPS, FTIR/Raman, HR-SEM, and mechanical testing techniques. The cytocompatibility and osteoinductive ability were assessed by biological assays of cell viability, proliferation, and osteogenic differentiation on human mesenchymal stromal cells (hMSCs). Results indicate that the outer surface of the ESM induces the heterogeneous precipitation of carbonate-apatite phase depicting biomimetic features. In addition, the apatite/ESM shows a much higher cytocompatibility than the pristine ESM and promotes the osteogenic differentiation of hMSCs more efficiently. Overall, the apatite/ESM composite exhibits compositional, crystalline, mechanical, and biological properties that resemble those of mineralized tissues, rendering it an approachable and novel material especially useful in guided tissue/bone regeneration.
... This curved flexible lamina is easily adapted by the clinician to the defect morphology, creating, once fixated, a semi-rigid covering to the underlying graft. This property is particularly useful when it is necessary to maintain the graft volume in horizontal augmentation of two wall defects and in lateral sinus lift procedures [29]. Among other characteristics, this type of membrane should meet two fundamental criteria: biocompatibility and promotion of growth of bone-forming cells. ...
Guided bone regeneration (GBR) comprehends the application of membranes to drive bone healing and to exclude non-osteogenic tissues from interfering with bone regeneration. However, the membranes may be exposed to bacterial attack, with the risk of failure of the GBR. Recently, an antibacterial photodynamic protocol (ALAD-PDT) based on a gel with 5% 5-aminolevulinic acid incubated for 45 min and irradiated for 7 min by a LED light at 630 nm, also showed a pro-proliferative effect on human fibroblasts and osteoblasts. The present study hypothesized that the functionalization of a porcine cortical membrane (soft-curved lamina, OsteoBiol) with ALAD-PDT might promote its osteoconductive properties. TEST 1 aimed to verify the response of osteoblasts seeded on lamina with respect to the plate surface (CTRL). TEST 2 aimed to investigate the effects of ALAD-PDT on the osteoblasts cultured on the lamina. SEM analyses were performed to study the topographical characteristics of the membrane surface, the adhesion, and the morphology of cells at 3 days. The viability was assessed at 3 days, the ALP activity at 7 days, and calcium deposition at 14 days. Results showed the porous surface of the lamina and the increase in cell attachment of osteoblasts with respect to controls. The proliferation, the ALP, and bone mineralization activity of osteoblasts seeded on lamina resulted in being significantly higher (p < 0.0001) than controls. Results also showed an additional significative enhancement (p < 0.0001) in the proliferative rate in ALP and calcium deposition after applying ALAD-PDT. In conclusion, the functionalization of the cortical membranes cultured with osteoblasts with the ALAD-PDT improved their osteoconductive properties.
Purpose
To evaluate the performance and clinical outcome of vertical and horizontal bone augmentation (VHBA) in posterior maxillary regions combining lateral window sinus floor elevation (LWSFE) with a horizontal bone shell technique applying the maxillary facial sinus wall as a bone plate.
Materials and Methods
In 18 patients, LWSFE was combined with a horizontal bone shield augmentation procedure utilizing the maxillary facial sinus bone wall as a lateral bone plate. Both the sinus cavity and the lateral bone box created were grafted with a mixture of autogenous bone/venous blood and bovine bone mineral. The primary aim was to assess the performance of combined techniques enabling subsequent implant placement. Using radiographic measurements (preoperative, after VHBA, at implant placement, and at follow‐up), bone gain/reduction of augmented horizontal ridge width (HRW) and vertical bone height (VBH) were evaluated. Additionally, clinical outcome assessing implant survival/success rate, marginal bone loss (MBL), and implant health (mucositis/peri‐implantitis) was evaluated.
Results
For the combined VHBA techniques, HRW and VBH increased significantly ( p < 0.001) from preoperative 3.5 ± 1.4 mm/3.6 ± 2.1 mm to 9.7 ± 1.9 mm/18.0 ± 1.6 mm post‐augmentation. However, HRW and VBH dimensions decreased up to 8.9 ± 1.8 mm/17.1 ± 1.4 mm at implant placement and 8.6 ± 1.7 mm/16.7 ± 1.3 mm at follow‐up evaluation (3.8 ± 1.8 years; p < 0.001, respectively). Augmented bone reduction was significantly higher (−7.7%) between the augmentation procedure and implant placement than in the post‐implant‐placement period (−2.5%). All implants survived (100%) representing peri‐implant MBL of −0.9 ± 0.7 mm, pocket depth of 3.4 + 1.8 mm, and prevalences of 5%/0% for peri‐implant mucositis/peri‐implantitis.
Conclusion
The combination of horizontal bone augmentation using local bone shield transfer from the maxillary facial sinus wall with LWSFE enables sufficient reconstruction of maxillary posterior ridge.
Background/Objectives: The primary aim of this retrospective clinical study was to assess the success and bone gain achieved by using the Fibrinogen-Induced Regeneration Sealing Technique (F.I.R.S.T.) in different indications. Methods: In this single-center retrospective clinical study, F.I.R.S.T. was performed in the following indications: alveolar ridge preservation (ARP), immediate implant placement, and horizontal and vertical guided bone regeneration (GBR) with simultaneous dental implant placement. F.I.R.S.T. is a modified approach to GBR characterized by the application of a porcine cortical lamina, as a long-term resorbable bone barrier to cover the bone defect, and a fibrin sealant for easy adaptation of the xenogenic bone graft material and the fixation of the collagenic bone barrier. Patients with uncontrolled systemic diseases, medications, or diseases that may alter bone metabolism; local inflammation; poor oral hygiene; and heavy smoking were excluded from this study. Horizontal and vertical bone gain (HBG and VBG) were measured by comparing postoperative and preoperative cone beam computed tomography (CBCT) reconstructions. Patients were recalled for controls and oral hygiene treatment every 6 months. Results: Altogether, 62 patients (27 male, 35 female, age 63.73 ± 12.95 years) were included in this study, and 105 implants were placed. Six implants failed during the 50.67 ± 22.18-month-long follow-up. Cumulative implant survival throughout the groups was 94.29 %. In the immediate implant group, HBG was 0.86 mm (range: −0.75–8.19 mm) at the 2 mm subcrestal level, while VBG was 0.87 ± 1.21 mm. In the ARP group, HBG was 0.51 mm (range: −0.29–3.90 mm) at the 2 mm subcrestal level, while VBG was −0.16 mm (range: −0.52–0.92 mm). In the horizontal GBR group, HBG was 2.91 mm (range: 1.24–8.10 mm) at the 2 mm subcrestal level. In the vertical GBR group, VBG was 4.15 mm (range: 3.00–10.41 mm). Conclusions: F.I.R.S.T. can be utilized successfully for bone augmentation. The vertical and horizontal bone gains achieved through F.I.R.S.T. allow for implant placement with adequate bone width on both the vestibular and oral aspects of the implant.
The objective of this review was to evaluate the efficacy of different grafting protocols for the augmentation of localized alveolar ridge defects.
A MEDLINE search and an additional hand search of selected journals were performed to identify all levels of clinical evidence except expert opinions. Any publication written in English and including 10 or more patients with at least 12 months of follow-up after loading of the implants was eligible for this review. The results were categorized according to the presenting defect type: (1) dehiscence and fenestration-type defects, (2) horizontal ridge augmentations, (3) vertical ridge augmentations, and (4) maxillary sinus floor elevations using the lateral window technique or transalveolar approach. The review focused on: (1) the outcome of the individual grafting protocols and (2) survival rates of implants placed in the augmented bone.
Based on 2,006 abstracts, 424 full-text articles were evaluated, of which 108 were included. Eleven studies were randomized controlled clinical trials. The majority were prospective or retrospective studies including a limited number of patients and short observation periods. The heterogeneity of the available data did not allow identifying one superior grafting protocol for any of the osseous defect types under investigation. However, a series of grafting materials can be considered well-documented for different indications based on this review. There is a high level of evidence (level A to B) to support that survival rates of implants placed in augmented bone are comparable to rates of implants placed in pristine bone.
Criteria for the evaluation of dental implant success are proposed. These criteria are applied in an assessment of the long-term efficacy of currently used dental implants including the subperiosteal implant, the vitreous carbon implant, the blade-vent implant, the single-crystal sapphire implant, the Tübingen implant, the TCP-implant, the TPS-screw, the ITI hollow-cylinder implant, the IMZ dental implant, the Core-Vent titanium alloy implant, the transosteal mandibular staple bone plate, and the Brånemark osseointegrated titanium implant. An attempt has been made to standardize the basis for comments on each type of implant.
This study evaluates a prototype bioabsorbable physical barrier material for guided bone regeneration. Nonspacemaking dehiscence-type defects were surgically created in the right and left mandibles of six adult dogs. Each animal received six roof-form threaded titanium implants. The osseous defects were randomized to receive treatment by either the prototype bioabsorbable barrier composed of a copolymer of lactide and glycolide, an expanded polytetrafluoroethylene nonresorbable barrier; or no barrier (control). Clinical and histologic results after 3.5 months of wound healing indicated that exposed threads were covered when treated with the expanded polytetrafluoroethylene barrier Minimal thread coverage was evident with the bioabsorbable barrier and the control.
The present study was designed to examine whether new attachment forms on root surfaces previously exposed to plaque by preventing the oral epithelium and the gingival connective tissue from participating in the process of healing following treatment.
4 roots in each of 3 monkeys were used as test units while the roots of contralateral teeth served as controls. A surgical procedure was first used to expose the coronal half of the buccal root surfaces. Plaque was allowed to accumulate on the exposed surfaces for a period of 6 months. Subsequently, soft tissue flaps were raised and the root surfaces were carefully scaled and planed. The crowns of the test and control teeth were resected and the mucosal Haps were repositioned and sutured in such a way that the roots were properly covered. Immediately prior to suturing, membranes (Millipore® filter or Gore‐tex® membrane) were placed over the denuded root surfaces of the test teeth in order to prevent granulation tissue from the soft tissue flaps from reaching the roots during healing. The monkeys were sacrificed 3 months later. The jaws were removed and histological sections of test and control roots including their periodontal tissues were produced.
New cementum with inserting collagen fibers was observed on the previously exposed surfaces of both test and control roots. However, the test surfaces exhibited considerably more new attachment than the control surfaces, indicating that the placement of the membrane favoured repopulation of the wound area adjacent to the roots by cells originating from the periodontal ligament.
the aim of this study was to histologically assess whether elevation of partial-thickness flaps results in reduced bone alterations, as compared with full-thickness flap preparations.
in five beagle dogs, both mandibular second premolars (split-mouth design) were subjected to one of the following treatments: Tx1: elevation of a partial-thickness flap over the mesial root of P(2) and performing a notch at the height of the bone. Tx2: elevation of a full-thickness flap over the mesial root of P(2) and performing a notch at the height of the bone. After 4 months, sections were evaluated for: (i) vertical bone loss and (ii) osteoclastic activity using histometry.
elevation of both full- and partial-thickness flaps results in bone loss and elevated osteoclastic activity. Partial-thickness flaps can result in less bone loss than full-thickness flaps, but are subject to some variability.
use of partial-thickness flaps does not prevent from all bone loss. The procedure may result most of the times in less bone loss than the elevation of full-thickness flaps. Further research has to evaluate the determinants of effective outcomes of partial-thickness flap procedures.
Sixteen intrabony defects in 12 patients were treated by gingival flap surgery including root surface debridement and placement of an expanded polytetrafluoroethylene (ePTFE) membrane. The membranes were removed after 4 to 6 weeks and examined by scanning electron microscopy (SEM) for bacterial contamination and adherent connective tissue elements. Twelve months postsurgery, the defect sites were reexamined for changes in probing attachment level and probing bone level. Comparison of ultrastructural findings and clinical observations revealed that extent of bacterial contamination of the membrane correlated inversely with clinical assessment of attachment gain. The results indicate that the extent of oral exposure and bacterial contamination of the ePTFE membrane at the time of removal may be an indicator of the long-term success or failure of the regenerative procedure.
Considerable research effort has been directed at preparing root surfaces in a fashion that would promote cell attachment leading to periodontal regeneration; however, no methods have proven to be clinically predictable. Identification of attachment protein(s) associated with the root surface matrix of cementum may prove valuable for developing effective clinical treatments. In this study cementum proteins were extracted from bovine and human teeth by sequential chaotropic extraction using guanidine followed by guanidine/EDTA. The guanidine/EDTA extract, but not guanidine extract, was found to promote attachment of fibroblasts. This attachment activity was inhibitable with synthetic peptide containing the attachment sequence arginine-glycine-aspartic acid (RGD). Fractionation of the guanidine/EDTA extract revealed several fractions with attachment activity. Immunoblot analysis demonstrated that two of these fractions contain the bone-associated RGD containing attachment protein, bone sialoprotein-II (BSP-II). In addition, attachment activity was also noted in other fractions that could not be attributed to BSP-II or fibronectin. These studies indicate that a component of the attachment activity of cementum is likely to be due to BSP-II and that cementum contains additional, as yet undetermined, attachment proteins.
This study reviews the long-term outcome of prostheses and fixtures (implants) in 759 totally edentulous jaws of 700 patients. A total of 4,636 standard fixtures were placed and followed according to the osseointegration method for a maximum of 24 years by the original team at the University of Göteborg. Standardized annual clinical and radiographic examinations were conducted as far as possible. A lifetable approach was applied for statistical analysis. Sufficient numbers of fixtures and prostheses for a detailed statistical analysis were present for observation times up to 15 years. More than 95% of maxillae had continuous prosthesis stability at 5 and 10 years, and at least 92% at 15 years. The figure for mandibles was 99% at all time intervals. Calculated from the time of fixture placement, the estimated survival rates for individual fixtures in the maxilla were 84%, 89%, and 92% at 5 years; 81% and 82% at 10 years; and 78% at 15 years. In the mandible they were 91%, 98%, and 99% at 5 years; 89% and 98% at 10 years; and 86% at 15 years. (The different percentages at 5 and 10 years refer to results for different routine groups of fixtures with 5 to 10, 10 to 15, and 1 to 5 years of observation time, respectively.) The results of this study concur with multicenter and earlier results for the osseointegration method.
Membranes, clinically used to improve bone regeneration according to the osteopromotion principle, have primarily been made of expanded polytetrafluoroethylene (Gore-Tex Membrane). Recently, different types of biodegradable membranes have become available. This investigation explored the osteopromotive potential of 10 different biodegradable and non-biodegradable membrane materials. Scanning electron microscopy revealed quite different surface configurations of these membranes, even though some of them were chemically closely related. Standardized, transosseous, critical size mandibular defects were made bilaterally in adult rats and were randomly covered with the different types of membrane. After 6 wk of healing, evaluation was performed by light microscopy according to a histological scoring system. Varying degrees of bone healing were seen beneath the different membranes. Some of the membranes (such as Gore-Tex Augmentation Material, Millipore and Resolut 'long term') revealed a good osteopromotive effect, whereas others had little or no beneficial effects on bone healing. Certain membrane materials caused a pronounced inflammatory response in the surrounding soft tissue, while others displayed a low inflammatory reaction. The study shows that different membranes differ strongly in osteopromotive efficacy, even if seemingly chemically closely related. Furthermore, the study demonstrates that membranes developed primarily for periodontal regeneration purposes may not be adequate to promote bone healing.
The principle of guided bone regeneration can be applied for localized ridge augmentation in a staged approach. The surgical procedure for the mandible is presented through three case reports. Incision technique and flap design, utilization of autogenous bone grafts as a membrane-supporting device and osteoconductive scaffold, proper placement of barrier membranes and their stabilization with miniscrews, and wound closure are all emphasized. Furthermore, factors essential for achieving predictable results with barrier membranes for localized ridge augmentation and the benefits of combining barrier membranes with autogenous bone grafts are discussed.