Daniel Buser - 30 Years of Guided Bone Regeneration

Last but not least, I also cordially thank Bryn Grisham and Marieke Zaffron of Quintessence Publishing for their excellent collaboration to realize this book. The quality work and the quality printing of Quintessence was again superb and is highly appreciated. It reflects almost 30 years of close collaboration with Quintessence Publishing, both in Berlin and in Chicago. I thank Horst Wolfgang Haase, Christian W. Haase, as well as Alexander Ammann for this excellent collaboration over so many years, which was based on trust, respect, and friendship.

Contributors

Mauricio G. Araújo, DDS, MSc, PhD

Head of the Research Group in Periodontics and Implant Dentistry

Department of Dentistry

State University of Maringá

Maringá, Brazil

Thomas von Arx, DDS, Prof Dr med dent

Deputy Clinic Director

Department of Oral Surgery and Stomatology

School of Dental Medicine

Faculty of Medicine

University of Bern

Bern, Switzerland

Maria B. Asparuhova, PhD

Research Group Leader

Laboratory of Oral Cell Biology

Dental Research Center

School of Dental Medicine

Faculty of Medicine

University of Bern

Bern, Switzerland

Urs C. Belser, DMD, Prof em Dr med dent

Professor Emeritus

School of Dental Medicine

University of Geneva

Geneva, Switzerland

Dieter D. Bosshardt, MSc, PhD

Professor

Robert K. Schenk Laboratory of Oral Histology

School of Dental Medicine

Faculty of Medicine

University of Bern

Bern, Switzerland

Vedrana Braut, DDS, Dr med dent

Research Collaborator

Department of Oral Surgery and Stomatology

School of Dental Medicine

Faculty of Medicine

University of Bern

Bern, Switzerland

Private Practice

Matulji, Croatia

Daniel Buser, DDS, Prof em Dr med dent

Professor Emeritus

School of Dental Medicine

University of Bern

Bern, Switzerland

Vivianne Chappuis, DDS, Dr med dent

Professor

Department of Oral Surgery and Stomatology

School of Dental Medicine

Faculty of Medicine

University of Bern

Bern, Switzerland

Stephen T. Chen, MDSc, PhD

Clinical Associate Professor

Department of Periodontics

Melbourne Dental School

The University of Melbourne

Parkville, Australia

Francesco D’Aiuto, DMD, M clin Dent, PhD

Professor and Chair

Periodontology Unit

Eastman Dental Institute

University College London

London, United Kingdom

Adam Hamilton, BDSc, DCD

Director of the Division of Regenerative and Implant Sciences

Department of Restorative Dentistry and Biomaterials Sciences

School of Dental Medicine

Harvard University

Cambridge, Massachusetts

Simone F. M. Janner, DDS, PD Dr med dent

Senior Physician

Department of Oral Surgery and Stomatology

School of Dental Medicine

Faculty of Medicine

University of Bern

Bern, Switzerland

Simon S. Jensen, DDS, Dr odont

Professor

Section of Oral Biology and Immunopathology

Department of Odontology

Faculty of Health and Medical Sciences

University of Copenhagen

Professor

Department of Oral and Maxillofacial Surgery

Centre of Head and Orthopedics

Copenhagen University Hospital

Copenhagen, Denmark

Sascha A. Jovanovic, DDS, MS

Founder and Academic Chairman

gIDE Institute

Los Angeles, California

Alberto Monje, DDS, MS, PhD

Adjunct Clinical Assistant Professor

Department of Periodontics and Oral Medicine

School of Dentistry

University of Michigan

Ann Arbor, Michigan

Assistant Lecturer

Department of Periodontology

Faculty of Dentistry

Universitat Internacional de Catalunya

Barcelona, Spain

Federico Moreno, Lic Odont, M Clin Dent

Clinical Lecturer

Periodontology Unit

Eastman Dental Institute

University College London

Private Practice

London, United Kingdom

Ausra Ramanauskaite, DDS, Dr med dent, PhD

Assistant Professor

Department of Oral Surgery and Implantology

Faculty of Medicine

Goethe University

Center for Dentistry and Oral Medicine (Carolinum)

Frankfurt, Germany

Isabella Rocchietta, DDS, MSc

Honorary Senior Research Associate

Periodontology Unit

Eastman Dental Institute

University College London

Private Practice

London, United Kingdom

Frank Schwarz, Prof Dr med dent

Professor and Chairman

Department of Oral Surgery and Implantology

Faculty of Medicine

Goethe University

Center for Dentistry and Oral Medicine (Carolinum)

Frankfurt, Germany

Istvan Urban, DMD, MD, PhD

Assistant Professor

Department of Restorative Dentistry

School of Dentistry

Loma Linda University

Loma Linda, California

Associate Professor

Department of Periodontics and Oral Medicine

School of Dentistry

University of Michigan

Ann Arbor, Michigan

1

The Development of Guided Bone Regeneration Over the Past 30 Years

Daniel Buser, DDS, Dr med dent

Modern implant dentistry based on the concept of osseointegration recently celebrated its 50th birthday. 1 The tremendous progress made in the rehabilitation of fully and partially edentulous patients is based on fundamental experimental studies performed by two research teams. One team was located in Sweden and headed by Prof P-I Brånemark from the University of Gothenburg; the other was located in Switzerland and headed by Prof André Schroeder from the University of Bern. In the late 1960s and 1970s, the two research groups independently published landmark papers describing the phenomenon of osseointegrated titanium implants. 2 – 4 An osseointegrated implant was characterized by direct apposition of living bone to the implant surface. 5 – 7

In the early phase of this development, several prerequisites were identified for osseointegration to be achieved. 2 , 3 Some of these have been revised over the past 50 years; others are still considered important. In order to achieve osseointegration, the implant must be placed using a low-trauma surgical technique to avoid overheating the bone during preparation of a precise implant bed, and the implant must be inserted with sufficient primary stability. 5 , 8 When these clinical guidelines are followed, successful osseointegration will predictably occur for nonsubmerged titanium implants (single-stage procedure) as well as for submerged titanium implants (two-stage procedure), as demonstrated in comparative experimental studies. 9 , 10

When clinical testing of osseointegrated implants first began, the majority of treated patients were fully edentulous. Promising results were reported in retrospective studies. 11 – 13 Encouraged, clinicians increasingly began using osseointegrated implants in partially edentulous patients, and the first reports on this utilization were published in the late 1980s and early 1990s with promising short-term results by various groups. 14 – 18 As a consequence, single-tooth gaps and distal extension situations have become more and more common indications for implant therapy in daily practice. Today, these practices dominate in many clinical centers. 19 – 21

One of the most important prerequisites for achieving and maintaining successful osseointegration is the presence of a sufficient volume of healthy bone at the recipient site. This includes not only sufficient bone height to allow the placement of an implant of adequate length, but also a ridge with sufficient crest width. Clinical studies in the 1980s and 1990s showed that osseointegrated implants lacking a buccal bone wall at the time of implant placement had an increased rate of soft tissue complications and/or a compromised long-term prognosis. 22 , 23 To avoid increased rates of implant complications and failures, these studies suggested that potential implant recipient sites with insufficient bone volume should either be considered local contraindications for implant placement or should be locally augmented with an appropriate surgical procedure to regenerate the local bone deficiency.