Dentistry in Practice: Biomaterials - How to select, prepare and use them in procedures.

Biomaterials in Dentistry in Practice

How to select, prepare, and use biomaterials in dental regenerative procedures

Introduction

Biomaterials have revolutionized regenerative dentistry by providing more predictable treatments for bone reconstruction, alveolar preservation, and regeneration of periodontal tissues. Currently, they are part of the routine in several specialties, especially Implantology, Periodontology, and Oral and Maxillofacial Surgery.

However, the success of these procedures does not depend solely on the choice of biomaterial. Surgical planning, correct clinical indication, selection of instruments, proper handling, and adherence to the manufacturer's recommendations are equally important factors for achieving predictable results.

In this practical guide, you will learn about the main biomaterials used in dentistry, their functions, clinical applications, necessary instruments, and the basic operational workflow employed in regenerative procedures.

When to use biomaterials?

Biomaterials are indicated when there is a need to regenerate, reconstruct, or preserve hard tissues and, in some cases, soft tissues.

The main clinical indications include:

• Alveolar preservation after extractions.
• Guided bone regeneration (GBR).
• Guided tissue regeneration (GTR).
• Maxillary sinus lift.
• Alveolar ridge reconstruction.
• Correction of periodontal defects.
• Regenerative peri-implantitis treatment.
• Placement of immediate or delayed implants.
• Horizontal and vertical augmentation of the alveolar ridge.
• Reconstructive surgeries in Implantology.

Main Biomaterials Used in Dentistry

Which biomaterial to use in each procedure?

Important: The choice of biomaterial should consider the characteristics of the bone defect, tissue availability, surgical planning, the practitioner's experience, and the manufacturer's recommendations. There is no single biomaterial indicated for all clinical situations.

⚠️ Important — Interpretation of Flowcharts

Illustrated Procedure Flowchart

Although each regenerative procedure has its particularities, the use of biomaterials follows a logical sequence of planning, preparation, insertion, and follow-up. The flowchart above provides an overview of the clinical workflow, facilitating the understanding of the steps that will be detailed next.

Operational Workflow

Although each procedure has its particularities, the use of biomaterials follows a logical sequence that contributes to clinical predictability and the preservation of the material's characteristics.

Clinical Evaluation
        ↓
Diagnosis and Planning
        ↓
Biomaterial Selection
        ↓
Surgical Field Preparation
        ↓
Access to the Surgical Site
        ↓
Recipient Bed Preparation
        ↓
Biomaterial Preparation
        ↓
Biomaterial Insertion
        ↓
Membrane Adaptation (when indicated)
        ↓
Suturing
        ↓
Post-operative Instructions
        ↓
Clinical Follow-up

Most Used Instruments

Regenerative procedures require specific instruments for preparing the recipient bed, handling biomaterials, and surgical closure.

Support Materials

In addition to biomaterials and instruments, some materials are frequently used during procedures:

• Resorbable and non-resorbable membranes.
• Sterile physiological saline solution.
• Absorbable or non-absorbable sutures.
• Surgical needles.
• Sterile surgical drapes.
• Gauze pads.
• Surgical suction tips.
• Implantology kits.
• Irrigation equipment.
• Biosafety equipment and PPE.

Step 1 – Clinical Evaluation and Planning

Every regenerative procedure should begin with careful planning.

In this step, the following are evaluated:

• medical and dental history;
• patient's systemic conditions;
• quality and quantity of available bone;
• thickness of soft tissues;
• radiographic and tomographic examinations;
• type of bone defect;
• treatment objective.

Proper planning allows for the selection of the most suitable biomaterial for each clinical situation.

Step 2 – Biomaterial Selection

The choice of biomaterial depends on several factors, such as:

• type of bone defect;
• need for volume maintenance;
• desired remodeling speed;
• graft stability;
• possibility of combining materials;
• professional's clinical experience.

Also to be considered are:

• manufacturer's indication;
• commercial availability;
• patient characteristics.

Step 3 – Surgical Field Preparation

Before opening the biomaterial, it is important to ensure that the entire procedure is prepared.

Good practices include:

• complete surgical tray setup;
• instrument verification;
• biomaterial validity check;
• packaging integrity inspection;
• organization of auxiliary materials;
• maintenance of the sterile field.

Step 4 – Recipient Bed Preparation

After surgical access, the area that will receive the biomaterial is prepared.

Depending on the procedure, this may involve:

• removal of granulation tissue;
• bone regularization;
• abundant irrigation;
• bleeding control;
• preservation of remaining bone walls.

The goal is to create a favorable environment for regeneration.

Step 5 – Biomaterial Preparation

Each biomaterial has specific recommendations described in the Manufacturer's Instructions for Use (IFU).

Depending on the product, it may be necessary to:

• use directly from the sterile packaging;
• pre-hydrate in sterile solution;
• associate with the patient's blood, according to clinical protocol;
• mix different biomaterials when indicated.

Preparation should be carried out immediately before use, using sterile instruments and strictly adhering to the manufacturer's guidelines.

Step 6 – Biomaterial Insertion

After preparing the recipient bed, the biomaterial is carefully inserted into the area to be regenerated.

During this step, it is recommended to:

• distribute the material evenly;
• avoid contamination;
• adequately fill the defect;
• do not exert excessive compaction;
• respect the anatomy of the region.

The objective is to provide stability to the biomaterial and favor the regenerative process.

Step 7 – Membrane Use (when indicated)

In various regenerative procedures, a membrane is used to protect the biomaterial.

Its main function is to:

• prevent soft tissue invasion;
• maintain the regenerative space;
• favor new bone formation;
• stabilize the graft.

The membrane must be adapted without tension and according to the manufacturer's recommendations.

Step 8 – Suturing

After positioning the biomaterial and the membrane (when used), the flap is closed.

Adequate closure should provide:

• tissue stability;
• biomaterial protection;
• minimal tension on the suture;
• adequate healing.

The choice of suturing technique depends on the characteristics of the procedure and the practitioner's clinical preference.

Step 9 – Post-operative Care

After the procedure, the patient should receive clear instructions regarding care during the healing period.

Among the most common recommendations are:

• maintain adequate oral hygiene as directed by the professional;
• avoid trauma to the operated area;
• attend follow-up appointments;
• correctly use prescribed medications;
• immediately report any unusual changes.

Clinical follow-up allows for the evaluation of healing progression and regenerative success.

Best Practices

Adopting best practices contributes to greater clinical predictability and safety of procedures.

It is recommended to:

• conduct individualized planning;
• use biomaterials within their validity period;
• check packaging integrity before opening;
• strictly follow the Manufacturer's Instructions for Use (IFU);
• maintain aseptic technique throughout the procedure;
• use appropriate instruments;
• record the biomaterial used in the patient's chart;
• monitor the patient's clinical evolution.

Main Mistakes to Avoid

Some failures can compromise the treatment outcome.

Among the most frequent are:

• inadequate biomaterial selection;
• incorrect indication for the type of defect;
• premature opening of the sterile packaging;
• biomaterial contamination during handling;
• inadequate hydration when provided by the manufacturer;
• excessive graft compaction;
• inadequate membrane adaptation;
• flap closure under tension;
• absence of post-operative follow-up.

Frequently Asked Questions

Does every regenerative procedure require a biomaterial?

No. The necessity depends on clinical evaluation, the amount of remaining tissue, the type of defect, and the treatment goals.

Can I combine different biomaterials?

In certain clinical situations, combining biomaterials may be indicated. This decision should be based on scientific evidence, manufacturer recommendations, and procedure planning.

Is it mandatory to use membranes?

No. The indication depends on the technique used, the characteristics of the defect, and clinical planning. However, in many guided bone regeneration procedures, their use is recommended to promote regeneration.

Do all biomaterials need to be hydrated before use?

No. Some biomaterials are used directly from sterile packaging, while others require hydration or specific preparation. The Manufacturer's Instructions for Use (IFU) must always be followed.

What is the main factor for regeneration success?

Success depends on a combination of several factors, including proper diagnosis, planning, biomaterial selection, surgical technique, graft stability, infection control, and post-operative follow-up.

Do biomaterials completely replace the patient's bone?

It depends on the type of biomaterial and its mechanism of action. Some act as a scaffold for new bone formation, while others have different rates of reabsorption and replacement by bone tissue.

Conclusion

Biomaterials represent one of the main resources in contemporary regenerative dentistry, expanding therapeutic possibilities in implantology, periodontology, and oral and maxillofacial surgery. However, their use must always be associated with careful planning, correct material selection, appropriate surgical technique, and clinical follow-up of the patient.

By understanding the operational flow, knowing the available biomaterials, correctly preparing instruments, and following manufacturer recommendations, the dentist increases the predictability of procedures and contributes to safer and more lasting clinical results.

Technical Basis

This guide was prepared based on the main references used in regenerative dentistry, including clinical guidelines, scientific literature, manufacturers' technical documentation, and regulations applicable to the use of dental biomaterials.

The operational recommendations presented consider the consensus of specialized literature and should always be associated with the dentist's clinical judgment, the individual characteristics of the patient, and the Manufacturer's Instructions for Use (IFU).

Main technical-scientific references

Implantology and Bone Regeneration

• ITI – International Team for Implantology — Clinical consensuses on guided bone regeneration (GBR), alveolar preservation, maxillary sinus lift, and biomaterials.
• EAO – European Association for Osseointegration — Clinical guidelines for implantology, bone grafts, and peri-implant regeneration.
• AO – Academy of Osseointegration — International consensuses on regenerative procedures, biomaterials, and clinical predictability.

Periodontology

• AAP – American Academy of Periodontology — Guidelines for periodontal regeneration, guided tissue regeneration (GTR), and biomaterial use.
• EFP – European Federation of Periodontology — Clinical recommendations for periodontal and peri-implant regenerative treatment.

Oral and Maxillofacial Surgery

• International protocols for alveolar reconstruction and bone regeneration.
• Evidence-based scientific literature for reconstructive procedures.

Regulation and Safety

• National Health Surveillance Agency (ANVISA) – Regulations applicable to medical devices.
• Federal Council of Dentistry (CFO) – Code of Dental Ethics and norms related to professional practice.
• Manufacturer's Instructions for Use (IFU) for biomaterials.

Classic reference books

• Carl E. Misch – Contemporary Implant Dentistry — Considered one of the main works on modern implantology, surgical planning, bone grafts, and biomaterials.
• Edward S. Cohen – Atlas of Cosmetic and Reconstructive Periodontal Surgery — Reference in periodontal surgery and tissue regeneration.
• Jan Lindhe, Niklaus Lang, and Thorkild Karring – Clinical Periodontology and Implant Dentistry — Classic work on periodontology, periodontal regeneration, and evidence-based implantology.
• Hom-Lay Wang — Various scientific publications on guided bone regeneration, biomaterials, and alveolar preservation.
• Daniel Buser — Clinical research on bone grafts, guided bone regeneration, and implantology.
• Istvan Urban — International reference in vertical and horizontal bone augmentation using biomaterials.

Scientific literature

The operational recommendations presented in this guide are based on systematic reviews, international consensuses, and clinical studies published in the main scientific journals in the field, such as:

• Clinical Oral Implants Research
• Journal of Clinical Periodontology
• Clinical Implant Dentistry and Related Research
• Journal of Periodontology
• International Journal of Oral & Maxillofacial Implants

Read also: Technical Standards: Biomaterials Used in Dentistry

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