Reconstruction of Mandibular Segmental Defects Using the Guided-Bone Regeneration Technique With Polylactide Membranes and/or Autogenous Bone Graft: A Preliminary Study on the Influence of Membrane Permeability

Sverzut, Cassio E.; Faria, Paulo E.P.; Magdalena, Carolina M.; Trivellato, Alexandre E.; Mello-Filho, Francisco V.; Paccola, Cleber A.J.; Gogolewski, Sylwester; Salata, Luiz A.

doi:10.1016/j.joms.2007.06.664

« Previous Next »Journal of Oral and Maxillofacial Surgery
Volume 66, Issue 4 , Pages 647-656, April 2008

Reconstruction of Mandibular Segmental Defects Using the Guided-Bone Regeneration Technique With Polylactide Membranes and/or Autogenous Bone Graft: A Preliminary Study on the Influence of Membrane Permeability

Cassio E. Sverzut, DDS, PhD
- Associate Professor, Department of Oral and Maxillofacial Surgery and Periodontics, Faculty of Dentistry of Ribeirao Preto, University of São Paulo, São Paulo, Brazil.
Paulo E.P. Faria, DDS
- Doctorate Fellow, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry of Aracatuba, University of the State of São Paulo, São Paulo, Brazil.
Carolina M. Magdalena, BDS
- Public Dental Practice, Brasilia, Brazil.
Alexandre E. Trivellato, DDS, PhD
- Senior Lecturer, Department of Oral and Maxillofacial Surgery and Periodontics, Faculty of Dentistry of Ribeirao Preto, University of São Paulo, São Paulo, Brazil.
Francisco V. Mello-Filho, MD, PhD
- Associate Professor, Department of Ophthalmology, Otolaryngology and Head and Neck Surgery, Faculty of Medicine of Ribeirao Preto, University of São Paulo, São Paulo, Brazil.
Cleber A.J. Paccola, MD, PhD
- Professor, Department of Biomechanics, Medicine and Locomotor Apparatus Rehabilitation, Faculty of Medicine of Ribeirao Preto, University of São Paulo, São Paulo, Brazil.
Sylwester Gogolewski, PhD
- Materials Engineer, AO-ASIF Research Institute, Davos, Switzerland.
Luiz A. Salata, DDS, PhD
- Associate Professor, Department of Oral and Maxillofacial Surgery and Periodontics, Faculty of Dentistry of Ribeirao Preto, University of São Paulo, São Paulo, Brazil.
- Address correspondence and reprint requests to Dr Salata: Departments of Oral & Maxillofacial Surgery and Periodontics, Faculty of Dentistry, University of São Paulo, Ave do Café s/n, Campus USP, 14040-904 Ribeirão Preto, São Paulo, Brazil

Purpose

Bone maintenance after mandibular reconstruction with autogenous iliac crest may be disappointing due to extensive resorption in the long term. The potential of the guided-bone regeneration (GBR) technique to enhance the healing process in segmental defects lacks comprehensive scientific documentation. This study aimed to investigate the influence of polylactide membrane permeability on the fate of iliac bone graft (BG) used to treat mandibular segmental defects.

Materials and Methods

Unilateral 10-mm-wide segmental defects were created through the mandibles of 34 mongrel dogs. All defects were mechanically stabilized, and the animals were divided into 6 treatment groups: control, BG alone, microporous membrane (poly L/DL-lactide 80/20%) (Mi); Mi plus BG; microporous laser-perforated (15 cm² ratio) membrane (Mip), and Mip plus BG. Calcein fluorochrome was injected intravenously at 3 months, and animal euthanasia was carried out at 6 months postoperatively.

Results

Histomorphometry showed that BG protected by Mip was consistently related to larger amounts of bone compared with other groups (P ≤ .0001). No difference was found between defects treated with Mip alone and BG alone. Mi alone rendered the least bone area and reduced the amount of grafted bone to control levels. Data from bone labeling indicated that the bone formation process was incipient in the BG group at 3 months postoperatively regardless of whether or not it was covered by membrane. In contrast, GBR with Mip tended to enhance bone formation activity at 3 months.

Conclusions

The use of Mip alone could be a useful alternative to BG. The combination of Mip membrane and BG efficiently delivered increased bone amounts in segmental defects compared with other treatment modalities.