30 Years of GBR: Development phase, fine-tuning efforts and current surgical procedures Daniel Buser, Prof. emeritus, University of Bern

This lecture will present the development of GBR procedures in implant patients since the late 1980’s. During the development phase, different biomaterials including barrier membranes, bone grafts and bone substitutes were tested, and surgical techniques constantly improved to optimise treatment outcomes and reduce post-surgical complications with GBR procedures. Since the millennium change, a phase of fine-tuning efforts started. Significant progress was based on a much better understanding of the related tissue biology including the post-extraction ridge alterations and the principle of bone conditioned medium. Today, implant placement with simultaneous GBR procedures is done with a 2-layer composite graft by using locally harvested bone chips and a low-substitution bone filler, such as DBBM (deproteinized bovine bone mineral). The autograft bone chips stimulate bone formation during initial healing, whereas DBBM particles offer excellent volume stability over time. The two synergistic bone fillers are covered by a resorbable collagen membrane. The membrane provides a temporary barrier function, and stabilizes the applied bone fillers. In some cases, fixation pins are utilized to further improve membrane stability. The surgery is completed with a tension-free, primary wound closure. The surgical procedure will be presented with different case reports, and documented by clinical and radiographic long-term cases and studies using CBCT up to 10-years of follow-up. 

Aims & Objectives

• After this lecture, the participants will have a much better understanding of tissue biology.

• They will understand the selection criteria, when to use the various treatment options in implant sites with bone deficiencies.

• They will know the synergistic properties of a 2-layer composite graft with autogenous bone chips and a low-substitution bone filler such as DBBM.

• They learn what surgical factors are important to achieve predictable regenerative outcomes.