Regeneration Membranes Loaded with Non-Antibiotic Anti-2 Microbials: A Review

Abstract

Both guided bone and guided tissue regeneration are techniques that require the use of barrier membranes. Contamination and infection of the surgical area is one of the most feared complications. Some current lines of research focus on functionalizing these membranes with different antimicrobial agents. The objective of this study was to carry out a review of the use and antibacterial properties of regeneration membranes doped with antimicrobials such as zinc, silver, chlorhexidine, and lauric acid. The protocol was based on PRISMA recommendations, addressing the PICO question: "Do membranes doped with non-antibiotic antimicrobials have antibacterial activity that can reduce or improve infection compared to membranes not impregnated with said antimicrobial?" Methodological quality was evaluated using the RoBDEMAT tool. A total of 329 articles were found, of which 25 met the eligibility criteria and were included in this review. Most studies agree that zinc inhibits bacterial growth as it decreases colony-forming units, depending on the concentration used and the bacterial species studied. Silver compounds also decreased the secretion of proinflammatory cytokines and presented less bacterial adhesion to the membrane. Some concentrations of chlorhexidine that possess antimicrobial activity have shown high toxicity. Finally, lauric acid shows inhibition of bacterial growth measured by the disk diffusion test, the inhibition zone being larger with higher concentrations. Antimicrobial agents such as zinc, silver, chlorhexidine, and lauric acid have effective antibacterial activity and can be used to dope regenerative membranes in order to reduce the risk of bacterial colonization.

Keywords: antimicrobial; barrier membrane; bone regeneration; collagen; polymer.

Figure 1

PRISMA 2020 flow diagram.

Figure 2

RoBDDEMAT analysis for risk of bias of the included articles [33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56]. D1—Planning and allocation: 1.1 Control group; 1.2 Randomization of samples; 1.3 Justification of sample size. D2—Sample preparation: 2.1 Standardization of samples and materials; 2.2 Identical experimental conditions between groups. D3—Evaluation of results: 3.1 Appropriate and standardized test procedures and results; 3.2 Blinding of the test operator. D4—Data processing and reporting of results: 4.1 Statistical analysis; 4.2 Reporting of study results. Sufficiently Informed/Adequate. Insufficiently Informed. Not Informed/Not Applicable.

Figure 3

Articles grouped by publication year.