Various bone graft and alloplastic materials are available on the market. It is very difficult to select the best one for regenerative osseous surgery. Since we cannot do histopathology for confirmation of bone regeneration. Same as to select GTR membrane. Some absorbable membrane are dissolved very rapidly too.
It is tricky to answer it straight forward. Selection of graft and membrane would depend on the type of surgery, results expected, purpose of using graft, site of surgery, budget among others. I feel BioOss, Rockymountain graft, PerioGlass are among the most popular as far as i've heard. Personally i prefer using combination grafts. Mixing HA+TCP+DFDBA. That way i get the combined advantages of all of them.
For GTR amniotic/chorion membrane resorbs toooo fast, may be in 7-10 days so i doubt whether they are really of any use. Collagen membranes such as 'periocol' are economic and more widely used in our area. A new HA coated membrane is available here for GBR procedures.
I generally agree to Dr. Agrawal's opinion. Too rapid resorption may be collagen based membrane. Though many efforts have been done to delay collagen resorption using cross-linking agent, their usage is limited by cytotoxicity induced by chemicals.
I disagree about the comment on Amnion-Chorion.
I have published multiple articles on Amnion-Chorion for dental uses. In August 2013, I published one of the largest periodontal GTR studies ever published with an 'n' of 78 sites. All sites were periodontal intrabony defects treated with DFDBA/FDBA and covered with Amnion-Chorion. Average pocket depth reduction was 5.06mm and average Clinical Attachment Gain was 4.61mm. These results were statistically equivalent to other previously published studies with much smaller 'n'
Holtzclaw D. et al. Amnion Chorion Allograft Barrier Used for Guided Tissue Regeneration Treatment of Periodontal Intrabony Defects. Clin Adv Periodontics 2013; 3(3): 131-137.
Amnion-Chorion barriers do not function in the same manner as traditional barriers. They are not designed to keep cells out. They are packed with laminins and other growth factors such as PDGF, FGF, TGFB.. The laminins density is especially high and they promote epithelial cell migration across the amnion-chorion barrier. The epithelial cell migration happens so fast that the epitehlium seals the underlying bone graft.
I use amnion-chorion nearly everyday in my practice. The pictures attached to this response are of an extreme case which was treated with DFDBA/FDBA+Amnion-Chorion barrier.
With the good statistician you can get anything to look statistically significant, but the real answer is it clinically significant. Clinically I get the best results using Regeneform and a non-resorbable membrane fixated with a screw or tack. Nothing comes nearly as close in my hands.
If we lived in a perfect world there would be one answer and one product to address each portion of your question. Indeed the world is far from perfect. Today, if there were one material that could be used successfully in any clinical situation (there is no such thing), given the way industry works, that product would be slightly modified and sold by numerous sources which would then immediately cloud the answer that had been correct.
I think that Dr Domagala makes a statement that is critical. He says "noting comes nearly as close in my hands." Indeed dental practice is a clinically nuanced technical field. It has to work in our hands and it has to be scientifically valid. A product that is great for one person may fail for another while the opposite could be true for a third individual. We all search the holy grail but, to my knowledge, no one has found it yet.
of course the autogenous grafts are the best. other than the autogenous grafts, i am comfortable with BioOss, perioglass, Rockymountain graft. amnion chorion membrane is better.
This issue has several faces that need consideration. 1) Periodontal or alveolar site; different biology/regenerative potential. 2) Recipient site configuration, inlay or onlay which will predict the regenerative potential for either indication, periodontal or alveolar 3) Unobstructed space provision by the biomaterial which relates to particle porosity, size, and bioresorptiion taking advantage of the osteogenic potential of tissue resources circumscribing the defect site; this referred to osteoconduction. Biomaterials with long resident time may in fact accomplish the opposite which I have named osteoobstruction, they obturate the defect site disallowing space provision for a regenerate to form. If one takes in consideration these elementary principles, and there are more, there are few if any bone biomaterials that "fit the bill". The issue of membranes deserve a separate discussion.
If there was one material that works for all most of the bone substitute companies growing exponentially would be out of business. The answer is complex since there are different indications for different materials depending on the procedure,location and other factors.The ultimate goal is getting vital bone resembling patient's own bone and therefore resorbable materials such as allografts and alloplasts are prefered.On the other hand in order to avoid shrinkage and resorption non resorbable materials are used like xenografts.These materials are used as a superficial layer or mixed with the resorbable ones.In sinuses we know all materials work...so there is no clinical difference.
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