35 years of GBR: The surgical key factors to achieve successful outcomes with excellent long-term stability

In 2023, we celebrated the 35th anniversary of the first GBR procedure done at the University of Bern/Switzerland.

Since then, GBR has become the most important bone augmentation procedure with estimated 3 million GBR procedures per year globally. GBR offers predictable regenerative outcomes for horizontal and vertical bone augmentation. 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 in animal studies, and the surgical techniques constantly improved to optimise treatment outcomes in patients 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 local bone anatomy driven by progress with CBCT, and 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 by our team with a two-layer composite graft using (a) locally harvested bone chips and (b) a low-substitution bone filler, such as DBBM (deproteinized bovine bone mineral/Bio-Oss). 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 (Bio-Gide). 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, often called sausage technique. The surgery is completed with a tension-free, primary wound closure to protect applied biomaterials. The surgical procedure for horizontal bone augmentation will be shown in various clinical situations with different case reports and documented by clinical and radiographic longterm cases and studies using CBCT up to 25-years of follow-up.

Aims and objectives
• After this lecture, the participants will have a much better understanding on tissue biology
• They unterstand the selection criteria, when to use the various treatment options in implant sites with bone deficiencies
• They will know the synergistic properties of a two-layer composite graft with autogenous bone chips and a low-substitution bone filler like DBBM
• They will learn why resorbable collagen membranes are routinely used for horizontal bone augmentation with GBR
• They learn what surgical factors are important to achieve predictable regenerative outcomes