Horizontal Augmentation of Deficient Alveolar Ridges:
Advances in Guided Bone Regeneration
Dr. Matej Kuliš, DMD, MSc, Prosthodontist specialist
1000 Ljubljana, Slovenia
Abstract
Guided bone regeneration (GBR) has become a gold standard in bone regeneration for
localized ridge augmentation either prior to or in conjunction with implant placement. It
is a well-documented technique in the literature that ensures repeatable and clinically
predictable outcomes. The GBR procedure involves the use of a space-maintaining
scaffold in the form of a bone graft and blood clot, protected by a cell occlusive
membrane. The primary role of the membrane is to exclude soft tissue and stabilize the
regenerative site. Stabilization of the graft–membrane complex and appropriate soft
tissue management are critical to ensuring predictable new bone formation. The double-flap incision (DFI) design was developed as an alternative to periosteal releasing incision (PRI) for flap advancement. The key step is to separate the mucosal tissue from the periosteal layer (approximately 0.3 mm thick), leaving the periosteum attached to the underlying bone. However, isolation of the periosteum from the mucosa increase the flap elasticity while maintaining the supraperiosteal blood vessels which enables to easily accomplishing primary wound closure without stretching the flap and jeopardizing blood supply of the flap at the margins. This, in turn, reduces the risk of complications with post-operative healing. Moreover, the creation of a periosteal pocket contributes an internal periosteal layer, which enhances membrane stability and restricts apical migration of the graft material.
Keywords: Guided Bone Regeneration, Membrane Fixation, Flap Preparation, Suture
Techniques, Dental Implants.
Learning Objectives
- Apply proper surgical protocols for flap management and membrane stabilization in
GBR procedures to minimize postoperative complications and enhance regenerative
outcomes. - Understand the biological principles and clinical rationale behind Guided Bone Regeneration (GBR), including the role of membranes and graft stabilization in achieving predictable bone formation.
- Differentiate between the Double-Flap Incision (DFI) and Periosteal Releasing Incision (PRI) techniques, recognizing how DFI improves flap elasticity, preserves blood supply, and facilitates tension-free primary closure.