Can a PTFE membrane be left exposed in oral cavity ?
I wanted to know if a PTFE cytoplast membrane (titanium reinforced or not) needs to be covered with a flap and primary closure or if it can be left exposed to the oral cavity?
Editors Note: Related previous questions that deal with this topic are:
9 Comments on Can a PTFE membrane be left exposed in oral cavity ?
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drdavid
3/21/2018
I don't know the particulars of your case, as they have not been provided. If possible, try to upload radiographs, so we can help you more. That said, in most cases (and again your case may have factors that change this), Cytoplast d-PTFE membranes can be left exposed. In fact, that is a major benefit of these membranes. d-PTFE membranes are manufactured specifically to eliminate expansion, and greatly reduce pores (submicron (0.2 μm) pore size). Because of this tiny pore size, bacterial infiltration into the site is eliminated with d-PTFE. It should also be mentioned, that there are microporous ePTFE membranes available which have micro-pores that are miniscule enough to block bacterial penetration keeping the site safe from infection (so these can also be used in primary coverage and exposed in non-primary coverage situation), but the micro-porous material still allows nutrient permeation across the membrane. The textured Cytoflex Tefguard has superficial macro texture overlapping the micro pore texture on both surfaces, providing additional grips for flap attachment, and easier suture closure.
Howard Abrahams
3/21/2018
see https://www.osteogenics.com/v/product-group/GBR-200-GBR-200-Singles/v9/. YES! you can leave it
harold Castañeda
3/21/2018
Hello! I’m a periodontist. I think you should cover it all with the flap. You may do it with the primary closure so this membrane does not get infected.
Ed Dergosits D.D.S.
3/21/2018
Harold primary closure is indicated for organic collagen based barrier membranes. The great advantage of a PFTE barrier(Cytoplast PFTE) is that primary closure is not needed and therefore advancement of a flap is not needed. Neither is reflection of a flap. This make the procedure much less invasive and less painful for the patient. One simply tucks the PFTE membrane under the extraction site a couple of mm's and closes the extraction site with a figure 8 suture pattern using a PFTE suture. The suture is removed at 10 days and the membrane is removed at 30 days. When the membrane is removed one finds very pink and vascular "Osteoid" that will be almost covered with surrounding gingival tissue and in 3 months will be ready for an implant if one does NOT use allograft to graft the site. . The best graft material is Calcium Sulfate. A simple blood clot works just as well or better. It quickly resorbs and is replaced with vital bone. Allograft is never completely resorbed and sites grafted with allograft almost always have "dead spaces" where the allograft was not resorbed. There are several companies that offer Calcium Sulfate type of material. I personally use Bond Apatite made by Augma. I have several containers of allograft cadaver bone in my office that I will likely never use after the experiences I have seen using Calcium Sulfate. .
Implant guy
3/21/2018
Cytoplast PTFE can be exposed in the oral cavity that is the point of the non resorbable membranes. They are great for when you cannot get primary closure then you can go back in in about 3 to 4 weeks and just pluck them out
Ed Dergosits D.D.S.
3/22/2018
Cytoplast PTFE can be exposed in the oral cavity that is the point of the non resorbable membranes. They are great for when you cannot get primary closure then you can go back in in about 3 to 4 weeks and just pluck them out.. I would add to the discussion that planning to elevate a buccal flap and then advance it to cover a grafted site is a concept in history. There are many good reasons why this is not a good technique.
Jeffrey Brook
3/22/2018
I've been using Cytoplast Membranes without obtaining primary closure for 10+ years with minimal issues. As stated in previous comments, the beauty of the membrane is you don't need primary closure. There was a beautiful lecture 3 weeks ago at the A.O. meeting in Los Angeles by Dr. Eiji Funakoshi on this topic (Open Barrier Membrane Technique). You should be able to find research papers from the above references to gain a greater insight into this treatment modality.
Kevan Green
3/22/2018
d-PTFE works well with relatively intact walls as an exposed membrane, extending only 2 to 3 mm peripherally with 3 to 4 week removal. If the ridge/extraction site defect is complex with loss of buccal and or lingual cortices (large dehiscence type defects or fenestrations), the d-PTFE would not be the best choice unless primary closure can be obtained and maintained. Once the edge of the membrane becomes exposed, collects plaque and starts to develop suppuration, it must be removed, decreasing the chances for successful regeneration of the deeper aspects of the defect. There are membranes that can tolerate exposure with exfoliating or developing infection. We have been using Pericardium (allograft membrane), Porcine Collagen (Mucograft), Placental, and various types of calcium sulfate (biphasic/monophasic) for such scenaria.
Great topic. Cytoplast is frequently misused as an exposed membrane where one is trying to create bony walls.
Thanks- kevan
Greg Kammeyer, DDS, MS
3/22/2018
I agree with Kevin: If you leave a larger dPTFE membrane exposed you have to baby sit the site, seeing the patient regularly (wasting time) and hopefully keep it in for 6 weeks. If ANY signs or symptoms of infection remove it STAT.
