Closing over Bio Gide or leaving it exposed?
I have just started doing socket preservation with bone graft materials and membranes. I have read that one of the more frequent problems is suturing under tension. Is it better to get partial coverage over the wound site and membrane with minimal tension or is it better to completely cover the membrane with a flap, even if it is under some tension? I am using the Bio-Gide [Geistlich] collagen membrane and according to the manufacturer it is okay to leave the membrane partially exposed. What do you recommend?
5 Comments on Closing over Bio Gide or leaving it exposed?
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CRS
8/11/2013
I like raising a flap so that I can inspect the buccal plate, remove any fistulous tracts and graft an close primarily. The key is undermining the flap and I feel you have a better blood supply and result. However the exception is when you are concerned about loss of vestibule,lack of soft tissue, then I like using a Teflon membrane to guide th soft tissue especially if there is loss of buccal plate. I will cheat and leave partially exposed membrane on the palatal of maxillary molar, collagen plug tech since I won't be placing the implant that far palatal. I also measure the socket depth and inspect the lingual and palatal heights since I use that as a reference fir implant placement along with the anatomy and quality of the bone. That's why I prefer to place my own grafts. It is very valuable to be able to suture without tension for primary closure in most cases. Teflon is a great material to tuck under the lingual and buccal margins, leave in 3-6 weeks exposed and use a peridex dabbing for hygiene while the tissue granulates underneath. I actually learned this from a GP who places his own implants! Observe what kind of results you are getting with your technique Good Luck!
DrT
8/13/2013
I agree...a definite "no-no" is suturing a flap with tension...if you do this to avoid any membrane exposure, you are very apt to have some flap slough and the result will be exactly what you were trying to avoid, namely some membrane exposure. The key to suturing a flap without tension is releasing the periostium adequately. This is pretty basic surgical technic which you need to master.
Jerome Bhunjun
8/14/2013
Hi, I learnt from the guy who visits numerous surgeries in Africa, M.Brian PFOHL, (Implants for Africa) that quite a few guys leave the Bio-Gide membrane exposed , immobilised with pins AND sutures through the membrane AND gingiva, but especially , they have a DOUBLE layer of Bio-Gide..
Try it, I have and while it takes more time to achieve full closure , it does!!
CRS
8/14/2013
Using the Cytoplast Teflon which is easy to remove when exposed is a lot less expensive and gives a better result. Price it out. This technique preserves the vestibule. I took Dr Sclars course on soft tissue to learn flap release. It is a necessary surgical technique. The hard part for me is having to redo these grafts done by the dds and periodontists but realistically we cannot control what a patient does so everyone myself included can have a graft failure. The better materials and technique will drive the success and understanding how a graft works it is part technique but part science. I still check my primary closed grafts at 7-10 days and breathe a sigh of relief! Another very promising membrane is the human chorionic product it can be left exposed, folded and does not have to be tacked. It actually stays where you put it and the price point is less the porcine and bovine products. Low inflammation. It has been used in eye surgery for years. Works great in smokers! Thanks for reading
Peter Fairbairn
8/15/2013
Having not used a membrane ( rarely a collagen fleece ) in 10 years of socket grafting , looking at other materials may be a solution . We will be showing 2 more research papers at the EAO in October on this.
Greg Steiner has some good products and solutions in the US ( Steiner labs )
Regards
Peter
