![]() ![]() Moreover, the composition and handling properties of collagen membranes vary, and many bioabsorbable collagen membranes cannot be stabilized with screws and pins without tearing. Although the use of pilot holes in the dense cortical bone, strong pins and screws that do not bend, and improved protocols have led to better treatment outcomes with the combination of fixation pins and resorbable collagen membranes, 10,11 the increased technical demands of the procedure are apparent. 8-10 Membrane fixation screws and pins can be challenging to place for practical reasons such as the presence of dense cortical bone and difficult access at various locations in the oral cavity. ![]() When utilizing a nonresorbable membrane, sufficient long-term stabilization of the rigid device must be provided, and therefore, the use of screws and membrane pins are recommended. 5-7 In addition, optimal stabilization allows for a greater volume of particulate bone to be placed within the defect to maximize space maintenance. 4 This is because substantial stabilization is required to minimize micromovement, which can result in the formation of granulation tissue as opposed to new bone formation. 1-3 Regardless of the type of membrane used, stabilization of the graft-membrane complex has been identified as a key requirement for optimal regeneration. Guided bone regeneration (GBR) involves the use of a cell-occlusive barrier membrane to confine a particulate bone graft to a defect, creating a space where a blood clot can form and bone formation can occur. Guidelines and limitations for the use of periosteal biting sutures are also discussed along with considerations and protocols that may be useful for improving treatment outcomes. Two cases are presented that highlight the utility of this technique. This article reviews the concept of stabilization using sutures in periodontal regeneration and describes an alternative method, the Ribroast technique ™, to stabilize a bioabsorbable membrane, whereby single periosteal biting horizontal mattress sutures are placed along the length of the defect to achieve sufficient stabilization. Several articles in the dental literature have introduced the utilization of periosteal biting stabilization sutures, rather than fixation screws and pins, to stabilize a bioabsorbable collagen membrane. Abstract: Stabilization of the graft-membrane complex during guided bone regeneration is a critically important aspect of implant dentistry.
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