Frequency and reasons for the use of autologous bone in combination with resorbable membranes in maxillofacial and dental surgery at the present time: analytical literature review

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Introduction

Restoration of bone tissue defects is one of the most current issues of modern oral and maxillofacial surgery [1–3].

This is due to a number of reasons: high level of traumatism with no tendency to decline [4; 5]; an increasing incidence of oncological lesions of the jawbones [1]; changing in dietary habits, which inevitably affects the degree of atrophy of the alveolar process of the maxilla as well as the alveolar part of the mandibular bone, serving as an indication for augmentation [2; 6]; a significant rate of congenital genetic disorders [7]; a rise in military conflicts, which is directly linked to an increase in gunshot injuries to the maxillofacial region [8; 9]; the frequency of chronic odontogenic infection foci, requiring surgical management (such as root apex resection and/or cystectomy) [3]; the widespread occurrence of odontogenic infectious-inflammatory processes leading to jawbone defects [10]; and the rapid advancement and popularization of maxillofacial implant surgery, which is associated with a growing number of complications in this type of dental rehabilitation [11].

Today, autogenous bone remains the best graft material and is most widely used in the form of small fragments [6].

Autogenous bone grafts can be categorized as: cancellous bone grafts, non-vascularized cortical bone grafts, and vascularized cortical bone grafts [12; 13].

Autogenous cancellous bone, due to its lack of immunogenicity, exhibits excellent osteogenous and osteoinductive properties. Its optimal structure also ensures osteoconduction, making it biologically the best grafting material.

Autogenous cancellous bone, due to its lack of immunogenicity, exhibits excellent osteogenous and osteoinductive properties. Its optimal structure also ensures osteoconduction, making it biologically the best grafting material. Therefore, autogenous cancellous bone is considered the gold standard for developing artificial bone substitutes. Nevertheless, it is not without limitations, such as insignificant volume availability and insufficient mechanical strength [12].

Currently, both resorbable and non-resorbable membranes are successfully used for guided tissue regeneration [14; 15].

In reconstructive procedures using local bone flaps (intercortical osteotomy, sandwich bone grafting) or bone grafts (veneer restoration), resorbable collagen membranes are more commonly employed. These membranes do not detect the shape of the future regenerate and serve as a barrier only [16].

Simultaneously, all membranes—regardless of their specific function—must meet the following requirements: they must demonstrate excellent biocompatibility; possess controlled biodegradation rates (or its absence); and maintain proper ergonomic properties [17].

Resorbable membranes completely resolve within 2 to 6 months. Their main advantages are that they do not require additional surgical removal and provide faster soft tissue healing over foreign bodies such as titanium plates, mesh, microscrews, and dental implants, as well as over uneven bone contours. These membranes are easy to use—when moistened, they adhere well to surfaces, greatly simplifying fixation. Typically, their resorption occurs without causing inflammatory reactions [18].

However, these membranes also have several significant disadvantages, such as unpredictable resorption rate, which impacts the rate of bony tissue formation [16]; rapid degradation leads to insufficient membrane stiffness, often requiring additional support of the membrane, particularly in cases of large defects [19]. When inflammatory reactions occur in adjacent tissues, the enzymatic activity of neutrophils and macrophages may accelerate membrane resorption, which negatively affects the regenerative process [14]. In addition, there are several inherent limitations specific to either collagen-based or synthetic membranes: 1) Collagen membranes exhibit antigenicity that can only be eliminated through specific chemical processing, along with rapid resorption rate, that can be partially controlled using glutaraldehyde, the latter having cytotoxic properties [20]; 2) Synthetic membranes, on the other hand, demonstrate poor resorbability requiring post-regeneration removal, and complete lack of osteoinductive capabilities unless modified with biologically active molecules [16].

The presented material indicates the wide range of unresolved issues, which demonstrates the relevance of the chosen topic.

At the same time, only a limited number of studies [12; 15; 16] have addressed the combined application of bone autografts and bioresorbable membranes, none of which provide comprehensive standardized histopathological data supported by evidence-based medicine.

Taken together, these findings provide compelling rationale for conducting a profound analysis of frequency and underlying factors associated with the combined use of autogenous bone grafts and resorbable membranes in contemporary oral surgical practice.

Objective of the study: to analyze the current rationale and frequency of autogenous bone graft use combined with resorbable membranes in oral and maxillofacial surgery, identify key fundamental and applied clinical tasks in their use, and propose solutions to address these challenges.

Materials and Methods

To analyze specialized literature on the rationale and frequency of using autogenous bone grafts in combination with resorbable membranes in current oral and maxillofacial surgery, two search queries were created in the PubMed biomedical research database [21]: 1) autotranslantate, maxillofacial surgery, jaw bone defects; 2) bioresorbable membrane, maxillofacial surgery, jaw bone defect.

The search system provided 1090 sources of specialized literature for analysis, with 417 sources (38 %) corresponding to the first search term and 673 sources (62 %) to the second term.

For the analysis, the first 100 consecutive sources from each search query were selected, resulting in a total of 200 reviewed publications. The timespan of publications for the first query covered 1974–2024 (50 years), while the second query encompassed 1990–2024 (34 years).

A descriptive analytical method was employed for data evaluation.

Results and Discussion

The chronological distribution of the analyzed literature sources according to their publication periods is presented in Fig. 1.

Fig. 1. The chronological distribution of the analyzed literature sources according to their publication periods

Figure 1 data reveals that among publications from the first search query, 31 % (31) were published within the last 5 years, 62 % (62) within the last decade, and 82 % (82) within 15 years. The second query showed similar recency: 38 % (38), 64 % (64), and 74 % (74) for the same time intervals, respectively. This distribution confirms that the analyzed literature – and consequently the derived conclusions – reflect current knowledge regarding contemporary use of autogenous bone grafts combined with resorbable membranes in oral and maxillofacial surgery.

The clinical rationale for surgical treatment using either isolated or combined applications of autogenous bone grafts and resorbable membranes is systematically presented in the table.

Analysis of publications reporting bone defect size revealed three distinct categories: large defects, small defects, and unspecified defect sizes. The distribution analysis demonstrated that in Query 1 results, large defects accounted for 18.0 % (36), small defects for 11.0 % (22), and unspecified cases for 21.0 % (42). The Query 2 dataset showed a different pattern: large defects represented 9.5 % (19), small defects 28.0 % (56), and unspecified cases 12.5 % (25).

Rationale for using autogenous bone grafts and resorbable membranes in jawbone defect surgical reconstruction: evidence from PubMed literature analysis

The ratio of publications focusing on reconstruction of major jawbone defects to those addressing treatment of minor defects is presented in Fig. 2.

Fig. 2. The ratio of publications focusing on reconstruction of major jawbone defects to those addressing treatment of minor defects using autogenous bone grafts and resorbable membranes.

Evidently, surgical interventions involving dental implantation and resorbable membrane application are addressed in 2.5 times more publications than those focusing on autogenous bone grafts in a similar clinical case, the findings consistent with the data reported by A.A. Dolgaev and association [22].

At the same time, 3.5 % (7) of publications were dedicated to augmentation using autogenous bone in the maxilla, while 6.0% (12) were focused on resorbable membrane applications. For the mandibular bone, these figures were 2.0 % (4) and 10.0 % (20) respectively.

According to specialized literature sources, orthognathic surgical procedures using autogenous bone grafts are addressed in 1.9 times more studies. Analysis of publications reporting jaw defect reconstruction after tumor removal revealed the following distribution: tumor-like lesions (cysts) with autogenous bone grafting accounted for 3.5 % (7), defects following removal of other tumors reconstructed with autogenous bone – 4.0 % (8), and jawbone defects restored using bioresorbable membranes –1.5 % (3). At the same time, publications addressing the reconstruction of jawbone defects resulting from infectious-inflammatory processes include: osteomyelitis cases treated with autogenous bone grafts – 4.5 % (9) and with bioresorbable membranes – 2.0 % (4); in periodontal surgery – 1.0% (2) and 2.0 % (4), respectively. This aligns with the report by V.P. Vasilyuk and co-author, who emphasize that the significance of the addressed issue, that is the necessity for effective reconstruction of jaw defects resulting from odontogenic cysts, benign neoplasms, traumatic injuries, and osteomyelitic lesions, lies in restoring bone integrity and functional capacity, which critically influences the course of reparative osteoregeneration processes [23].

The analysis of publications reporting on the use of autogenous bone grafts combined with resorbable membranes in oral and maxillofacial surgery currently demonstrates that studies focusing on minor defects outnumber those on major defects by 1.4-fold, with bioresorbable membranes being 1.5 times more frequently employed in minor defect reconstruction.

It should be noted that the exclusive use of bioresorbable membranes was reported in 14.5 % (29) of publications, indicating stronger clinical interest in combined autogenous bone-membrane approaches. However, current domestic and international literature lacks studies providing experimental morphological justification for this combined protocol, conducted under evidence-based medicine principles with systematic evaluation of both immediate and long-term treatment outcomes.

Conclusions

Analysis of the literature confirms its alignment with current evidence standards in the field. The findings substantiate the necessity for experimental studies incorporating mandatory morphological evaluation to fundamentally assess the efficacy of combined autogenous bone grafts and bioresorbable membranes in reconstructing minor jawbone defects.

About the authors

I. O. Pohodenko-Chudakova

Author for correspondence.
Email: ip-c@yandex.ru
ORCID iD: 0000-0002-0353-0125

DSc (Medicine), Professor, Head of the Department of Dental Surgery

Nilupaer Nijiati

Email: ip-c@yandex.ru
ORCID iD: 0000-0003-4895-2281

PhD (Medicine), Dental Surgeon

References

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2. Fig. 1. The chronological distribution of the analyzed literature sources according to their publication periods

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3. Fig. 2. The ratio of publications focusing on reconstruction of major jawbone defects to those addressing treatment of minor defects using autogenous bone grafts and resorbable membranes.

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