Bone: From Grafting to Regeneration – Understanding Bone Reconstruction Strategies in Implantology

Bone: From Grafting to Regeneration – Understanding Bone Reconstruction Strategies in Implantology

Bone reconstruction is an essential step in dental implantology. Significant bone loss can compromise the primary stability of implants, making the success of the treatment uncertain. To address this, several surgical and biological strategies are now available, ranging from conventional bone grafting to the most innovative regenerative approaches.

1. Bone Grafting: The Classic Pillar of Reconstruction

Bone grafting aims to restore lost bone volume to create an optimal receptive site for the implant. There are several types of grafts depending on their origin:

Autogenous graft: harvested from the patient (chin, mandibular ramus, skull, etc.), considered the gold standard due to its osteogenic, osteoinductive, and osteoconductive properties.

Allogeneic graft: harvested from a human donor and treated to avoid immune reactions.

Xenogeneic graft: derived from an animal species (usually bovine or porcine) and offers excellent osteoconductivity.

Alloplastic graft: made from synthetic materials (calcium phosphates, bioglasses), biocompatible and resorbable.

Surgical techniques vary depending on the location and volume to be reconstructed: onlay grafting, sinus lift, interpositional grafting, etc. However, autogenous grafts have limitations: donor site pain, morbidity, and longer surgical times.

2. Guided Bone Regeneration (GBR)

GBR is based on the principle of cellular selectivity: preventing soft tissue invasion of the site using a barrier membrane, allowing time for bone-forming cells to repopulate the area.

Two types of membranes are used:

Resorbable membranes (collagen): easy to handle and do not require a second surgery for removal.

Non-resorbable membranes (PTFE, titanium): reserved for complex cases, they offer better volume stability but require a secondary removal procedure.

Combined with an osteoconductive biomaterial, GBR achieves quantitatively and qualitatively satisfactory new bone formation. Systematic reviews confirm its effectiveness in the treatment of bony wall defects.

3. Toward a Regenerative Approach: Growth Factors and Bioengineering

Recent advances have enhanced bone healing through biological methods:

PRF (Platelet-Rich Fibrin): this autologous platelet concentrate gradually releases growth factors (PDGF, TGF-β, VEGF) that stimulate angiogenesis and osteogenesis.

BMP (Bone Morphogenetic Proteins): powerful inductive proteins already used in the U.S. for orthopedic and maxillofacial surgery.

Mesenchymal stem cells: still in clinical research, offering the prospect of personalized tissue regeneration.

Additionally, custom 3D-printed implants and regenerative matrices combined with growth factors represent promising future directions.

Conclusion

The success of implant rehabilitation depends on a precise analysis of the available bone volume and the choice of an appropriate reconstruction technique. Today, the combination of grafts, membranes, and growth factors offers predictable and safe solutions aimed at biological regeneration.

Sur le sujet

PARASORB® Fleece HD

Haemostatic Sponges

DemePTFE non-absorbable monofilament nylon suture

Saline solution pouches