M. Rapani*, L. Ravera, V. Perrotti, A. Piattelli, L. Ricci, G. Iezzi GUIDED BONE REGENERATION USING AUTOLOGOUS BONE AND TITANIUM MEMBRANE VBR M. Rapani*, L. Ravera, V. Perrotti, A. Piattelli, L. Ricci, G. Iezzi *Department of Odontostomatologic Science, University of Chieti-Pescara, Chieti # 008 ABSTRACT Aim: Guided bone regeneration (GBR) has been used for the augmentation procedures in conjunction with the placement of oral implants in order to allow an adequate prosthetic rehabilitation. The purpose of this study was a clinical evaluation of periimplant defects treated with autogenous bone grafting and a new titanium membrane VBR (Valve Bone Regeneration). Materials and Methods: Ten patients received a total of 25 implants. Thirteen implants were inserted in sites with adequate bone volume (group control); 12 implants showing after placement periimplant defects were treated with GBR technique using autologous bone graft stabilized with a VBR (group test). A 2-year clinical and radiographical follow-up was performed. Results: No soft tissue complications were observed during the healing time, only for 1 patient who showed a dehiscence with membrane exposure but without inflammatory signs. At re-intervention, in all cases, the space under the titanium mesh was completely filled by bone. At clinical observation, in all the patients no residual bone defects were observed and all the implants were in function at 2-year follow-up. Discussion and Conclusions: The clinical data of this study showed that very satisfactory results can be obtained with the use of autogenous bone graft and VBR to treat periimplant bone defects at the time of implant placement. INTRODUCTION The guided bone regeneration (GBR) technique has been successfully used to treat periimplant bone defects at the time of implant placement. Membrane stability seems to be very important for wound healing; a concern is tendency of the membrane, due to the lack of stiffness, to collapse toward the defect when the sites are not space-making. In literature, several study showed that the use of titanium membranes, in addition or not with biomaterials, can assist bone regeneration in non-space-making defects, since it does not interfere with the blood flow to the underlying tissues because of the presence of microholes within the mesh. The aim of the present study was to clinically evaluate the healing of periimplant defects treated with autogenous bone graft in association to a new titanium membrane VBR (Valve Bone Regeneration, Oralplant, Cordenons, Pordenone, Italy). MATERIALS AND METHODS Ten partially edentulous patients received a total of 25 implants (Oralplant, Cordenons, Pordenone, Italy). Thirteen implants (control group) were inserted in sites with adeguate bone volume; 12 implants (test group) were placed and the periimplant defects were filled with autologous bone graft stabilized with a VBR. Surgical re-entry for the VBR membrane removal and healing screw application occurred after about 4 months. In the same day defects filling have been measured with a dental probe. Metallo-ceramic prosthesis was delivered 6 months after membrane removal. A 2-year clinical and radiographical follow-up was performed. RESULTS The postoperative healing was uneventful in all patients and only 1 dehiscences of the soft tissues with membrane exposure was observed, but without inflammatory signs, at 2 months. At re-intervention, in all cases of test group, the space under the VBR membrane was completely filled by tissue presenting the macroscopic features of mature bone: it was not possible to probe that tissue. In the case where there was the dehiscence with exposure of VBR, no untoward effects on the bone regeneration were found. In all the cases, a significant increase of the alveolar height was observed; the vertical regeneration mean value was 5,25mm in the test group. No residual bone defects were found in all the patients at clinical observation and all implants were functioning successfully at 2-year follow-up. In all the examined cases, at the 2-year follow-up a good esthetic outcome and patient satisfaction was evident. Newly formed bone 4 months after surgery, when VBR membrane was removed. DISCUSSION AND CONCLUSIONS The clinical results of present study point out that autogenous bone graft stabilized with VBR could be successfully used to treat periimplant bone defects at the time of implant placement. Moreover, clinically, autogenous bone grafting and titanium membrane VBR with simultaneous implant placement did not perform differently from implants placed into native bone with respect to periimplant soft tissue healing, marginal bone height and implant survival (100%). Radiographic examination at the implant placement. Delivery of the metallo-ceramic prosthesis 6 months after VBR removal. Peri-implant bone defects (vestibular view). Defect filling with autologous bone graft stabilized with VBR.