**2.1 Barrier membranes**

*Oral and Maxillofacial Surgery*

• Vertical bone defects

• Horizontal bone defects

• Fenestration bone defects

• Dehiscence bone defects

• Extraction sites

key principles: P-A-S-S [2, 8].

• Combined vertical and horizontal defects

• Circumferential peri-implantitis defects

Over a decade, autogenous bone block grafting was the standard procedure in augmentation of bone defects. Due to its' invasive harvesting technique, morbidity at the donor site and limited availability, new techniques are developed. With rapid progress in biomaterials, GBR became one of the safest and most common techniques as it's less invasive and causes less discomfort post-operatively. Particulate grafts used in the procedure can easily be adapted into complex defect geometries [2, 5]. Urban et al. demonstrated a new bone formation of 5.45 mm vertically as a mean value when GBR protocol is performed utilizing xenograft and autogenous particulate graft mix with d-PTFE membranes [10]. Still, GBR has its own tech-

To achieve successful and repetitive outcomes, guided bone regeneration has 4

To provide a tension-free closure, incision design must be considered carefully.

• Vertical releasing incisions should be as far as possible from the augmentation

*Angiogenesis* provide nutrients and oxygen to the augmentation site and enhances

*Space creation and maintenance* prevents soft tissue collapse to the surgical site thus osteogenic cells can proliferate and gradually form bone tissue. Biomaterials and particulate grafts along with barrier membranes can be used for this process. While barrier membranes prevent migration of soft tissue cells to the regeneration space, bone grafts and biomaterials provide structural strength. Depending on the type of barrier membrane in use, tenting poles can be used to provide additional strength.

• Incision should be kept within the keratinized tissue as much as possible.

• Subperiosteal scoring incision and flap release should be performed.

healing process in this way. To ensure an ideal angiogenesis, patients must be examined thoroughly in terms of systemic diseases which affect healing mechanisms such as diabetes mellitus and osteoporosis. In these cases, an internist or an endocrinologist may be consulted if necessary. Any uncontrolled systemic disease should be taken into consideration as a contraindication. Smoking habits also reduce vascularization and proper blood supply in the surgical site. Measures like using local anesthetics without vasoconstrictors or encouraging patients to regulate

*Primary wound closure* is an important key factor for an optimal healing and success. In the augmentation sites, biomaterials and membranes increase the tissue

nique-sensitive challenges and is need to be practiced meticulously.

volume so it becomes harder to close the wound without tension.

site and help create a wide-base flap.

their smoking cycles can be taken.

**144**

A barrier membrane is an essential component in guided bone regeneration procedures. Various membranes with different features are available on the market [12]. Barrier membranes should fulfill some basic requirements to be safely utilized in dental applications [3].


There are two main groups of membranes: resorbable and non-resorbable [7].
