JADA+ CONTENT
This review does not in any way substitute for professional advice and should not be regarded as clinical guidance. As always,
any evidence should be carefully considered by clinician and patient to ensure that in their views, all potentially desirable
consequences outweigh all potentially undesirable consequences.
JADA+ CLINICAL SCANS






























































Romina Brignardello-Petersen, DDS, MSc, PhD
GUIDED BONE REGENERATION WITH
NONRESORBABLE AND RESORBABLE
MEMBRANES MAY NOT RESULT IN
DIFFERENT RATES OF COMPLICATIONS
OR ACHIEVE DIFFERENT VERTICAL BONE
GROWTH
Cucchi A, Vignudelli E, Napolitano A, Marchetti C,
Corinaldesi G. Evaluation of complication rates and
vertical bone gain after guided bone regeneration with
non-resorbable membranes versus titanium meshes
and resorbable membranes: a randomized clinical
trial. Clin Implant Dent Relat Res. 2017;19(5):821-832.
https://doi.org/10.1111/cid.12520.
Key words. Implantology; bone augmentation; com-
plications; dental implants; edentulous mandible; guided
bone regeneration; randomized clinical trial.
Clinical relevance. Patients with mandibular atrophy
who wish to replace their missing teeth with implants
may undergo bone augmentation procedures. The choice
between alternative techniques for achieving bone
growth should be supported by high-quality evidence
regarding their comparative benefits and harms.
Study summary. The researchers conducted a ran-
domized clinical trial (RCT) to compare the outcomes of
guided bone regeneration with a nonresorbable mem-
brane and a resorbable membrane in patients with
mandibular atrophy receiving implants. The researchers
enrolled 40 participants* and, after placing submerged
implants, assigned the participants to receive guided bone
regeneration with a nonresorbable titanium–reinforced
membrane (NRM)y or a titanium mesh collagen-covered
resorbable membrane (RM).z The researchers exposed the
implants 9 months after surgery and loaded them 2 to 3
months later. Ten percent of participants had surgical
complications, and all the complications were paresthesia.
Eighteen percent of participants had healing complica-
tions, and most of them (5/7) were complications that
affected the amount of newly formed bone. There were no
statistical differences in complications between the
groups. The average vertical bone gain was 4.2 millimeters
in participants who received NRM and 4.1 mm in par-
ticipants who received RM; these differences were not
statistically significant.
Strengths and limitations. This RCT had a moderate
risk of bias. There are some issues with the researchers’
descriptions of how participants were assigned to receive
NRM or RM, but the information provided allows us
to assume that this was done properly. However, the
researchers did not describe any comparison of partici-
pants’ characteristics that could have influenced the
outcomes between the groups, and the overall sample
size was small, so we cannot be completely confident
that the 2 groups were balanced. The likelihood of bias
owing to performance and outcome assessment and data
analysis is minimal because the researchers blinded all
parties to the treatment that each participant received.
Approximately 10% of participants were not examined
at the time of the second surgery, because the implants
were removed owing to major complications. Unfortu-
nately, most of these participants belonged to the RM
group, which disrupted the balance achieved through
randomization and may have introduced bias for the
measurement of other outcomes. In addition, the lack
of statistical differences in complications between the
groups may have been due to the small number of
participants included, which was unlikely to have been
enough to detect differences important to patients.
Consequently, we have low confidence in the results
of this RCT. n
https://doi.org/10.1016/j.adaj.2017.10.032
Copyright ª 2017 American Dental Association. All rights reserved.
Address correspondence to Dr. Brignardello-Petersen at e-mail
rominabp@gmail.com.
Disclosure. Dr. Brignardello-Petersen did not report any disclosures.
* 67.5% female; mean age, 52 years; no periodontal disease, 58%. Partici-
pants had to have residual bone height of 5 millimeters or greater and not be
heavy smokers.
y Polytetrafluoroethylene titanium–reinforced membrane (Cytoplast
Ti-250XL, Osteogenics Biomedical).
z Titanium mesh (Trinon Titanium) covered with cross-linked collagen
(Osseoguard, Zimmer Biomet) membrane.
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