Regeneration for implant dentistry

The ability to place an implant in an edentulous space in the maxillary and/or mandibular arch is often hindered by surrounding tissues in the oral cavity, which alters the planning of treatment for oral rehabilitation. Ideally, oral rehabilitation should regain normal physiological functions such as mastication, phonetics, and aesthetics, so these functions should be major considerations of treatment planning. Various methods for three-dimensional reconstruction of jawbones include alveolar distraction, guided bone regeneration (GBR), and bone grafting. Such methods are used most commonly for the reconstruction of the posterior region of the mandible. On the other hand, the posterior region of the maxilla is reconstructed using sinus lifting or ridge augmentation. GBR is the most widely used procedure for jaw reconstruction, and provides high predictability. It uses a selectively permeable membrane (resorbable or non-resorbable) that acts as a barrier, holding in place particulate bone grafts. It also maintains the space that allows for uniform bone growth. Non-resorbable membranes, bone block grafts and distraction osteogenesis can also be viable treatment options for the posterior region of the mandible, but these demand a large amount of autologous bone from intra or extra-oral origins, which can be challenging due to inadequate availability and patient morbidity. On the other hand, the posterior region of the maxilla has the maxillary sinus which can be encroached into with a variety of bone grafts to attain an adequate thickness of bone. The procedure of sinus lifting is a convenient approach with a good prognosis as the site is naturally sheltered by the palatine bone and the sinus walls. Bone tissue engineering has emerged as an alternative treatment modality for severely resorbed ridge areas. It uses biomaterials that have an osteoconductive property, in combination with bioactive molecules, and with progenitor cells that initiate osteogenesis and form healthy bone at the site. Much work has explored the interface between these biomaterials and fluids in the oral cavity such as blood, plasma, and saliva. Many researchers, clinicians, and healthcare professionals have a keen interest in this area. Current work focusses on methods to attain bone regeneration working from the molecular level to yields a meaningful quality and quantity of bone. More clinical trials are needed to verify progress, as newer materials are challenged by older techniques