Guided Bone Regeneration with Collagen Membranes and Particulate Graft Materials: A Systematic Review and Meta-Analysis

Purpose: The aim of this meta-analysis was to evaluate different methods for guided bone regeneration using collagen membranes and particulate grafting materials in implant dentistry. Materials and Methods: An electronic database search and hand search were performed for all relevant articles dealing with guided bone regeneration in implant dentistry published between 1980 and 2014. Only randomized clinical trials and prospective controlled studies were included. The primary outcomes of interest were survival rates, membrane exposure rates, bone gain/defect reduction, and vertical bone loss at follow-up. A meta-analysis was performed to determine the effects of presence of membrane cross-linking, timing of implant placement, membrane fixation, and decortication. Results: Twenty studies met the inclusion criteria. Implant survival rates were similar between simultaneous and subsequent implant placement. The membrane exposure rate of cross-linked membranes was approximately 30% higher than that of non-crosslinked membranes. The use of anorganic bovine bone mineral led to sufficient newly regenerated bone and high implant survival rates. Membrane fixation was weakly associated with increased vertical bone gain, and decortication led to higher horizontal bone gain (defect depth). Conclusion: Guided bone regeneration with particulate graft materials and resorbable collagen membranes is an effective technique for lateral alveolar ridge augmentation. Because implant survival rates for simultaneous and subsequent implant placement were similar, simultaneous implant placement is recommended when possible. Additional techniques like membrane fixation and decortication may represent beneficial implications for the practice. Keywords: alveolar ridge augmentation, barrier membranes, collagen membranes, decortication, guided bone regeneration, membrane fixation