Implant Site Development: Easier Way to Accomplish Graft Fixation?

Dear Dr. P. Removing fixation screws or non-resorbable membrane in second-stage surgery is not a complex technique. The screws are removed easily. They do not osseointegrate. In addition, re-entry for installing the implant(s) is inevitable. Removing the membrane or screws is very easire than placing them in the area. If someone has not the skill of bone augmentation, doing the procedure by himself is not mandatory. On the other hand, resorbable membranes do not have enough stability and rigidity to work well in such cases. Hope you success Neda Moslemi

I agree! The membrane and the bone tacks aree easy to remove.I like using the titanium reinforced teflon membranes by Cytoplast. They are Ieal since membrane exposure does not threaten the graft and can help in gaining more attached gingival tissue.If a resobable membran is eposed to the oral environment it disappears almost before your eyes. I also suture with teflon sutures to prevent wicking and a secondary infection site. Helps.

The titanium reinfored membranes offer very little regidity even when resting on surgical screws placed to act as tent poles to hold up the membrane. With time the nonresorbale membrane will begin to break down and lose its stability, even though there are thin titanium struts in them......they are also very expensive. I find that if one wants to contain the particulate graft, a very simple and inexpensive method is to contain the graft under a titanium "sugarmesh" . The sugarmesh comes in sheets and can be cut to size for each site. It is relatively inexpensive and will keep its shape.It is available from all the surgical suppliers......i.e. Salvin or Ace. It is not always mandatory to stabilize the mesh with fixation screws, as it can be bent to shape, placed over the defective site, with a PTFE membrane on top of it prior to suturing. PTFE sutures are excellent for suturing, and cause very little inflammation to the soft tissue, and plaque and food particles do not stick.... so there is less inflammation. Should the PTFE membrane (cover)start to disintegrate earlier than you want to keep the metal mesh in place, there is no fear, as the developing osteum under the mesh has an immature layer of non keritanized gingiva protecting the developing bone.THe mesh is porous, so patient are instructed to use Chlorhexidine rinses daily. In 4-6 months time, when you feel the bone has been regenerated, simply open a flap, and with an orthodontic plyers, pull the sugarmesh out. If there are pre exisitng implants in close approximation to the site being developed, then drill holes in the mesh, and stabilze with the implant cover screws. It is a simple process and works very well. As the titanium mesh is being cut and formed during the surgery, we usually place it in a glass bead sterilized prior to plascement to ensure sterility . Gerald Rudick dds Montreal, Canada

About 15 years ago, I had the Ti reinforced Gore-Tex used on me without extra graft underneath (just bent to shape and suture retained) buccal of 3 cuspids to correct traumatic recession with great success. Probably grew 5-7 mm tall by 3-4 mm thick across them. From a patient perspective; the procedures took a while in the chair, had lots of post-op checks (we might do fewer nowadays) but only very minor discomfort at first and second stage surgeries. Now that I think back on this, I'm less worried about the second-stage surgery for my own patients. I'll remind my doc. We placed some membranes with tacks just today...

actually There is one company that makes resorbable membranes and screws (Tacks).it is called inion. i have used it a couple of times and it is really nice. A little expensive though. There are also techniques that allow u to stabilize the membrane as u suture the flap.

Dr. p, Bone pins. Mtf.org, non-profit, took over red cross tissue bank. Use pilot drill, channel 3-4 mm in recipient site. Section the pin using a diamond disc to lengths needed. Angle two pins such that they converge on the site to tent membrane. Trim pins as needed with a bur. Awkward tacks not necessary. No second stage. Dr. P