Calcium Phosphate: Do you use a membrane?
I recently saw a video demonstration of bone augmentation on You Tube in which the surgeon used calcium phosphate, during GBR, to replace lost bone. The material was delivered to the defect in the bone and no membrane was used to cover it. The surgeon explained that the calcium phosphate surface acted like a membrane itself and epithelium cannot invade. Is this true? I wanted to get your views on this. For those of you who use calcium phosphate for bone augmentation, do you cover it with a membrane or leave it uncovered?
3 Comments on Calcium Phosphate: Do you use a membrane?
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Sam
7/28/2016
By Calcium Phosphate, I assume you mean, bTCP? If so, Peter is the expert on this one and hopefully he will chime in to provide an expert perspective. I believe Peter mixes bTCP with Calcium Sulfate to create a composite, and that he does not use a membrane. You can see a video here: https://www.osseonews.com/courses/bone-regeneration-pre-molar-case-calcium-sulfate-b-tcp/ and another one here https://www.osseonews.com/courses/bone-regeneration-anterior/
Dr Bob
8/2/2016
It will work with primary closure.
Peter Fairbairn
8/3/2016
Thanks Sam , yes has been used in Bone regeneration since the 1890s and Sottosanti published a fair amount of work on it in the Dental field .
But it generally resorps to fast so need to be mixed with another material and I have preferred BTcP for the last 14 years , although have mixed it with Allografts , HA , BCP and even a few cases with Xenograft ... and it works well .
The use of a membrane makes no sense to me at all as it inhibits the host healing due reduced blood access to the healing site ( due to publish an animal study showing 50% reduction in new blood vessels with membrane ) but also may inhibit the induction of Stromal Cell derived factors which are critical in Bone regeneration ..
Stability is the key issue and the CS helps stabilise the BTcP ( along with particle shape design ) ..... as for soft tissue ingrowth there is no real scientific evidence that this occurs nor any logical reasons .....
When HA grafted sites were opened and the was granulation tissue around it was assumed this was " soft tissue ingrowth " , but it was possibly a poorly cleaned site or unstable particles ( motion led Mesenchymal cells to differentiate to fibroblasts ) in motion .
Generally closure is preferred ( Hence my Protocol in Pubmed ) but is not essential in most cases and again we have publications ( Pubmed ) to show open sites healing by secondary intention over a stable graft material .... We have a case where it was socket grafted and the photographed every day for 3 months until Implant placement ...... this was a few years ago and will publish some time ( Has been a Poster at EAO ) ..
Regards
Peter
