Page 16 - Academy of Osseointegration (AO) Academy News Vol 36, No 1 2025

Share Your Knowledge. It is a way to achieve immortality.
– The Dalai Lama
By: Paul A. Fugazzotto, DDS, Academy News Editorial Consultant and Jeanne Ambruster, Guest Contributor
What fruit has the meeting between Drs. Nyman and Karring borne? Is the orchard still vibrant, bringing forth new possibilities? Or does the land lay fallow, in need of new plantings? If this is the situation, what form need the regeneration of regenerative therapies take?
The impact on daily clinical practice of first Guided Tissue Regeneration (GTR), and to an even greater degree Guided Bone Regeneration (GBR), cannot be denied. All aspects of comprehensive patient care have felt the force of these regenerative treatment modalities.
In addition to creating exciting opportunities to treat seriously at-risk teeth, GTR therapies represented a détente between the resective periodontist, wholly committed to pocket and furcation involvement elimination and the expected extensive prosthetic commitment; and the “maintainist,” attempting to retain said periodontally diseased teeth, with the understanding that they would “eventually go.” GTR often offered significant advantages to patients treated in either “camp.”
Such treatment approaches have become less popular, as the predictability of implant therapies continues to increase. Ironically, the admirable efficacy of implant treatments owes much to GTR’s cousin, GBR.
In healthy patients, assuming appropriate clinical execution, regeneration of 6-7 mm of bone buccally, and 3-5 mm occlusally (and much more apically as a result of sinus augmentation therapies), is a predictable, “everyday procedure.”
Gone are the days of “putting the implant where the bone is,” and hoping the fixture will prove restorable, often through significant structural gymnastics. If the implant proved unrestorable, it was “put to sleep.” James Gandolfini would have welcomed such an operatic approach to dentistry.
Implants need no longer osseointegrate and be restored in thin, labile, inadequate bony housings, unable to predictably withstand the forces of daily function (not to mention parafunction). Indeed, an ideal diameter implant
for replacement of a given tooth, in an ideal
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restorative position, can now be carried out either following bone regeneration, or in conjunction with regenerative therapy. Extensive cantilevers are no longer necessary because “there wasn’t enough bone to place an implant back there.” Removable prostheses are viewed as persona non grata in all but the most severe situations.
Great! GBR allows us to help patients grow bone wherever needed. What a wonderful development. Time to move on to newer and better treatment modalities. Not so fast!
Assuming the impact of GBR ends with surgical treatment outcomes is akin to assuming Michelangelo’s clay character studies of David were the culmination of his efforts.
GBR’s impact on clinical practice is multi-level in nature and cannot be overestimated.
Therapeutic expectations, and thus comprehensive treatment planning, have been irrevocably altered by GBR. This is true both for the surgeon and the restorative dentist. The realization hits home when a restorative dentist refers a patient and says, “you will need to
grow a few mm of bone laterally and vertically in both mandibular posterior sextants.” While the phraseology
is misleading (the patient is growing the bone), the level of understanding and communication between all team members is enervating.
Better communication, treatment planning and therapeutic outcomes thanks to GBR: Holy Bone, Batman! Are we done now? Not yet!
The GBR-Implant nexus has transformed practice growth and success (which is not merely profitability) in many ways, including:
• Dentists preferentially refer patients to a “regenerative practice.” both for the good of the patient and because the ability to perform previously undreamt-of therapies