Which membranes can be exposed in bone graft sites?
When covering bone graft sites in fresh extraction sockets or ridge augmentation, can the membrane, whether resorbable or non-resobable be exposed? Which of the membranes
(resorbable or non-resorbable) can be exposed to the oral cavity?
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17 Comments on Which membranes can be exposed in bone graft sites?
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CRS
10/28/2014
I like Teflon for my non resorbable and Snoasis for my resorbable. They work well in my hands. I rarely allow an exposed membrane, I like primary closure unless I have inadequate tissue.
DRB
10/28/2014
I use cytoplast resorbable (bovine) and these I do not want to see exposed. As was stated above primary closure is preferable. For Non-resorbable I will leave an edge exposed near the gingival margin. This exposure doesn't influence the bone graft however some will cite bacterial wicking. In my hands it makes the retrieval easier and accomplished with topical anesthetic. I haven't has a failure with this method to date. Mid flap exposure is another story and if tissue doesn't granulate over you won't like the result
Cliff Leachman
10/28/2014
A-PRF and let it heal by secondary intention
Don Callan
10/28/2014
Best to have primary closure, if possible. If not, I have great results using a collagen membranes that has been hydrated in a Tetracycline solution (SS) and then covered with calcium sulfate paste. DO NOT ALLOW THE PATIENT TO USE CHX for a mouth wash until the area has healed for 4 weeks.
John Fazio
10/28/2014
You can use Cytoplast PTFE high-density membranes from a number of manufacturers. They come in a number of sizes and configurations to fit almost any GBR need. Place them without primary closure and use appropriate suturing technique to allow for proper healing. Simply remove at 8 weeks with college pliers and allow site to heal until soft tissue covers the area and proceed with treatment. Very easy and predictable use
Gordon Townsend Jr.
10/28/2014
An older article, but it has been noted that epithelial cells grow faster across calcium sulfate than bone, and that membranes are optional if grafting material is mixed with calcium sulfate? I think the addition of a tetracycline soaked membrane sounds solid.
Good luck.
peter Fairbairn
10/29/2014
Gordon is on the money , as I have said in the past I have not used membrane once in the last 13 years and 2,300 grafts of which over 2,000 used CaSO4 , to both stabalise and make the graft its own membrane . There is a lot of research showing this including our rabbit study ( Dental Implants Feb 2014 , just look on Pubmed ) as well as many clinical studies .
But the interesting study for the EAO in 2013 , where we socket grafted with CaSO4 and BTcp then photographed it every day from the same position for 3 months to study exactly what Gordon is talking about , the soft tissue re-growth over the stable graft .
Having said that there is another good material for this type of situation called Easygraft where again membranes are not needed .
We feel that membranes may be a hinderance to healing not merely due to impeding the periosteal blood supply but also impeding the periosteal induction of stromal cell derived factors critical for mesenchymal cells. we a have another animal study being completed a t the moment to help understand this aspect .
Just some thoughts
Peter
k e wirth
11/4/2014
How much plaster do you add to your graft? 20%? Just checking. k. wirth
peter Fairbairn
11/5/2014
HI , I use 35 - 40 % but can vary on what you are mixing with .
Regards
Peter
Yaron Miller
10/29/2014
For socket grafting I use a resorable collagen plug like ACE 20×10 and suture over with continous vicryl 4/0 and leave it fully exposed. Have been doing this for about 8 years and it has been very successful in my hands. All other membranes I will cover fully with tension free flap.
tranrobin
10/29/2014
Thank you for your advice
SAM
11/5/2014
Don Callan,
Why patient cannot use CHX for 4weeks?
DrT
11/5/2014
SAm..Re CHX, it has been shown to inhibit fibroblast proliferation
kurien
11/9/2014
i would like to ask a couple of questions ,regarding calcium sulphate will you sterlize it by autoclaving ,what about using PRF as graft membrane
Cliff Leachman
11/9/2014
I commonly use CaSO4 as a graft with A-PRF+ membranes over the open areas, helps prevent premature loss of graft as well.
Does the gingivae grow quicker over the A-PRF? Don't know but appears to be healing more rapidly. Got tired of picking out irradiated cow bone in graft sites and trying to convince patients of the efficacy of cadaver or a xenograft,, for those patients:
A-PRF+ and CaSO4, regenerative medicine and plaster of paris combined. Otherwise cortico-cancellous cadaver bone mixed with A-PRF+ particles.
With CaSO4 and A-PRF+, No allergy, no risk of Croat-contamination and patients LOVE the idea of using their own concentrated growth factors to heal themselves, never mind it's cheap as borscht! I think we are finally approaching regeneration techniques that are revolutionary as they are successful.
Gary
11/25/2014
Hi Cliff,
Do you mix CaSO4 with PRF only? Any bone particles?
Cliff Leachman
11/25/2014
No, I never mix CaSO4 with anything organic, it will never set.
Just mix according to directions and put the fast set fluid over the top of the graft and then apply A-PRF membranes to cover.
I do mix Raptos with chopped up particles of A-PRF routininely.
