Cortical Perforations in Guided Bone Regeneration

Learn about cortical perforations and why they are often critical for predictable bone regeneration.

One of the key principles for predictable guided bone regeneration is angiogenesis to provide necessary blood supply and undifferentiated mesenchymal cells. 1 This can be achieved with cortical perforations 2. This video reviews the importance of cortical perforations in GBR, explains via clinical photos how cortical perforations help ensure vasculature in growth, provides clinical tips for cortical perforations, including perforating to the cortical plate to get into the marrow spaces.


1. Implant Dent. 2006 Mar;15(1):8-17. doi: 10.1097/ "PASS" principles for predictable bone regeneration. Hom-Lay Wang 1, Lakshmi Boyapati

This article describes the 4 major biologic principles (i.e., PASS) necessary for predictable bone regeneration: primary wound closure to ensure undisturbed and uninterrupted wound healing, angiogenesis to provide necessary blood supply and undifferentiated mesenchymal cells, space maintenance/creation to facilitate adequate space for bone ingrowth, and stability of wound and implant to induce blood clot formation and uneventful healing events.

2. Int J Oral Maxillofac Surg. 2017 Feb;46(2):261-266. doi: 10.1016/j.ijom.2016.10.017. Epub 2016 Nov 16. The influence of cortical bone perforation on guided bone regeneration in humans. S A Danesh-Sani 1, D Tarnow 2, J K Yip 3, R Mojaver

This study found that cortical bone perforation favourably affects the amount of new bone formation in the grafted sites after 7 months of healing. Cortical bone perforation significantly increase number of new vessels (angiogenesis) of the regenerated bone.

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