Journal of Otolaryngology and Rhinology Review Article: Open Access ClinMed International Library Citation: Rispoli L, Fontana F, Beretta M, Poggio CE, Maiorana C (2015) Surgery Guidelines for Barrier Membranes in Guided Bone Regeneration (GBR). J Otolaryngol Rhinol 1:008 Received: May 30, 2015: Accepted: November 10, 2015: Published: November 12, 2015 Copyright: © 2015 Rispoli L, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Rispoli et al. J Otolaryngol Rhinol 2015, 1:2 ISSN: 2379-948X Surgery Guidelines for Barrier Membranes in Guided Bone Regeneration (GBR) Rispoli L 1 *, Fontana F 1 , Beretta M 1 , Poggio CE 1,2 * and Maiorana C 1 1 Implant Center for Edentulism and Jawbone Atrophies, University of Milan, School of Dentistry, Maxillofacial Surgery and Dentistry UOC, Italy 2 Division of Prosthodontics, Eastman Institute for Oral Health, School of Medicine and Dentistry, University of Rochester, USA *Corresponding authors: Rispoli L, Implant Center for Edentulism and Jawbone Atrophies, University of Milan, School of Dentistry, Maxillofacial Surgery and Dentistry UOC, Fondazione IRCCS Ca’ Granda, Milan, MI, Italy, E-mail: rispolisurg@hotmail.com Poggio CE, Division of Prosthodontics, Eastman Institute for Oral Health, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14620, USA, E-mail: carlo_poggio@urmc.rochester.edu slower migration rate of osteogenic cells to the bone defect [2,3]. e underlying concept of GBR was first introduced more than 50 years ago, when cellulose acetate membranes were tested in the orthopedic field, for radial bone regeneration, rib and femoral bone defects [4,5]. Later, a series of animal studies provided evidence to show GBR concept can predictably facilitate healing of critical-sized bone defects or atrophic alveolar ridges prior to implant insertion [6,7]. Melchers hypothesis of selected cell repopulation formed the basis of the biological principle of guided tissue regeneration (GTR) [8]. ese concept further evolved to a more compartmentalized principle of guided bone regeneration (GBR) developed by Nyman, Lindhe, Karring and Gottlow in the 1980s [2,3,9,10]. is introduced the importance of suitable environment for osteogenesis by excluding ephitelial and connective tissue cells from bone defects during the healing phase of the periodontal regeneration, faciliting the colonization of ligament cells, to form new connective tissue and alveolar bone. ese concepts were later applied to bone regeneration and experimental studies [11] demonstrated that membrane can predictably faciltate bone regeneration by enhancing angiogenesis and osteoprogenitor cells proliferation. In the 1990s, thanks to many clinical trials [12-15], principles of GBR were applied to the atrophic jaws. Biological Bases of Guided Bone Regeneration (GBR) Bone regeneration with membranes focused on three main biological principles: 1. Cell occlusiveness 2. Wound stabilization 3. Space making and maintenance. Cell occlusiviness A physical barrier is necessary to prevent the proliferation of competing soſt tissue cells from the mucosa into the defects. Abstract Objectives: To analyze the biological principles of guided bone regeneration and to provide the clinician with information regarding the use of different membranes. Materials and Methods: The choosing criteria among different membranes and the clinical options are presented. Finally, the surgical technique is described in details. Results and Conclusions: Guided bone regeneration is one of the several surgical techniques that have been introduced in the last two decades for bone regeneration prior or at the time of implant placement. The rationale of this technique is the positioning of a barrier membrane between the bone and the connective tissue to create a secluded space and to enhance the proliferation of bone forming cells. Keywords Bone regeneration, Barrier membranes, Non resorbable membranes, Resorbable/absorbable membranes, Bone defect, Bone grafting, Jawbone atrophy, Alveolar ridge augmentation, Ridge morphology, Dental Implants Introduction Since Branemark et al. introduced the concept of osseointegration, bone volume is considered a prerequisite for successful implant treatment [1]. Inadequate bone quantity in cases of large bone defects secondary to trauma, tumor resection, advanced periodontitis, infection and/or iatrogenic injury represents a great challenge for an ideal implant placement. In the last two decades several surgical techniques were introduced to overcome horizontal and/or vertical bone lack in implant sites in either a non-staged or staged approach. One technique of ridge augmentation is the guided bone regeneration (GBR) that uses barrier membranes, in order to prevent the invasion of surrounding ephithelial and fibrous tissue. Regeneration by GBR depends on the