New Implant Practice: Recommendations for Membrane and Graft Material?
I am a young general dentist just starting out in a new practice that I have bought. The prior dentist did not do extractions or dental implants. I do extractions and I do simple implant caes. I would like to do socket preservation, but I cannot afford to invest in a variety of membranes and graft materials. Could someone please recommend, if I could only buy one membrane and one graft material, what should they be? How much should I have on hand in inventory for a new implant practice, like mine?
37 Comments on New Implant Practice: Recommendations for Membrane and Graft Material?
New comments are currently closed for this post.
CRS
11/30/2012
The best bang for the buck, I find is Allosorb made by Reimser human allograft cortical cancellous and Ace surgical has decent collagen membranes. This is in my experienced hands. The best thing you can do is take really good courses because diagnosis is key. My mother always said if you use good ingredients the dish will taste great. Remember your perio skills and crown and bridge skills and treatment planning are the most important. May the force be with you young sky walker!
Pynadath
11/30/2012
Fortoss vital
Not ideal in all cases but good. No need for membrane with it
Pynadath
11/30/2012
Or bio OSS and bioguide?
sb oms
12/1/2012
terrible idea bio-oss or bioguide- these are the most expensive materials of their kind on the market.
I also do not think bio-oss is a beginner friendly material. It is a technique sensitive material, and in my opinion, has little place in a socket preservation. (another string altogether)
Go to a good CE course on socket preservation. Talk to the teacher and others.
Products from ACE are a good way to keep costs down. Not my materials of choice but their prices are low.
Most importantly, see your patients for follow up, one month, 4 months, 6 months, etc.. to see if your techniques and materials are working.
ELIE
12/2/2012
Dear Colleague,
I feel very confident with Cytoplast products, distributed in my area by Osteogenics.
Encore: Combination allograft
RTM collagen membrane
PTFE membrane: TXT-200 singles
PTFE titanium reiforced membrane
NB:2 pcs from each on hand in inventory
greg steiner
12/3/2012
All of the previous suggestions are materials that have been around for at least 25 years. I suggest you move past inert calcium compounds and ground up body parts and look for materials that actually stimulate bone regeneration and produce healthy bone. Greg Steiner Steiner Laboratories
Peter Fairbairn
12/3/2012
For your level of experience best to use Easygraft from Sunstar , no membrane or closure needed and as it says very easy handling .
Peter
Mike C.
12/4/2012
1. Most important, remove all periodontal tissue from socket, make sure you are placing graft into bone only.
2. I use sterile saline and hand instruments, avoid CHX and other cytotoxic irrigants.
3. ACE particulate 2/3, 1/3 ACE calcium sulfate mix wet with sterile saline
4. I use large amalgam carriers and amalgam condensers eventhough I haven't
placed an amalgam in almost 20 years for delivery and compaction of graft.
5. At bone level, place 100% Calcium sulfate "top cap" and cover with a disc of ACE
Collaplug and X suture to retain with silk.
6. I've got a premade collagen barrier and graft puddy for that rare graft I will tackle that has lost the buccal plate, but that will usually be a "lost leader" if I am going to place the implant and restore in house with CEREC.
This is the most cost effective I've been able to get good predictable results.
Robert Teague
12/4/2012
You will received a plethora or brands and materials-each clinician will have their preference, not all of which are going to be available in your country.
In the scheme things none of the typical materials are high cost and should fall well within the minimum inventory. In most instances the material cost can be passed to the patient and in the case of a socket preservation can be seen as an investment in a future implant case.
where are you based?
ahmed elsharkawy
12/4/2012
autogenous bone remains the gold standerd, take a course to learn how to get some using easy techniques
Don Rothenberg
12/4/2012
Keep it simple....Synthograft (Bicon) mixed with the patient's blood. I have used them all at one tine or another....and Synthograft is the most predictable,easy to use, material...at a fair price....but you have to mix with the patient's blood.
Robert Teague
12/4/2012
There really is a life after autogenous bone, especially I general practice
larry
12/4/2012
i would love to hear what the group says about foundation from morita. simple to use. curette socket, place material. suture. low cost
Dr T
12/4/2012
The only product on the market specially design for socket preservation is Alvelac from MPM . A synthetic scaffolding made of PLGA .
There are all sorts of graft materials available. I use Adbone TCP/BCP . But they are not design for socket preservation ! They are to be used as graft material in connection with implant placement for reparation of small bone defects.
Using graft material into a socket for socket preservation is very expensive and will interfere with the natural healing . Try Alvelac !
Joe Endo
12/4/2012
Hello,
Dr, as one periodontist told me, we practice, socket grafting, not socket preservation ( the meaning is that we would wish to preserve the socket, which is not the case)
My favorite grafting material would be Platelet Rich Fibrin (PRF)
You make it from the patient's blood. Cost is inexpensive, about $1 USD a membrane. The membrane is also used as the grafting material, so all in all, the material cost is under $5 USD a site. Phlebotomy knowledge is necessary (and easily learned)
Depending on the centrifuge you buy, it can be as low as $500 USD
Dr Jin Kim will be having a class in Marina Del Rey, Ca on or about Jan 6, 2013 on PRF
Robert J. Miller
12/4/2012
Where did we go wrong here? Old thinking gives us predicatably mediocre results. If you use a resorbable bone graft material, you have to go through a catabolic phase of graft resorption before the anabolic phase of bone growth begins. Why waste time with an allograft or alloplast when an autogenous material with growth factors will jump start the process. If you want to talk about creating a new standard, consider L-PRF as your graft. Your per patient cost averages $5, and you will compress your treatment time by one-half. Platelet Rich Fibrin is extraordinarily easy to create, handles beautifully, and is the first autogenous biologic that delivers the kind of response that is the most desireable of all potential graft materials.
RJM
greg steiner
12/4/2012
Excellent Robert I agree completely however the growth factors that exist in autogenous bone are found in the organic matrix of mineralized tissue that require resorption(catabolic) by osteoclasts to release the growth factors. Your concept of moving directly from extraction to regeneration is what we have done with our socket graft material. Our graft material is a growth medium that selectively permits osteoblasts to migrate into the graft material and skips the catabolic and vascular phase. As a growth medium energy and nutrients are supplied so the regenerative process does not need to wait on the establishment of a vascular supply. In addition SL Factor upregulates the production of all of the growth factors to a significantly higher level than found in autogenous bone or PRF. Your concept in addition to stimulating osteogenesis is why we can advise implant placement in 8 weeks. Greg Steiner Steiner Laboratories
Dr Vipul G Shukla
12/4/2012
After almost 7 years with bovine cancellous bone chips, I am now moving to allograft, especially the cortico-cancellous blend, like Raptos from Citagenix. Economical too. If you wish to place an implant in say 3 months, then mix it up with some DBM putty with lots of inductive potential, say ACCELL Connexus putty aslo from Citagenix. Whatever technique you use, it is better than letting the socket heal on its own (there are some exceptions though), the difference being how soon you can go in to place an implant.
Often, placing a wide diameter implant in the inter-radicular bone septum of a lower first molar right at extraction time, and packing in a graft around it gives radically good results, but this will come with time and training.
Wish you all the best!
cliff Leachman
12/4/2012
L-PRF and Sacco"s CGF seem to be the du jour membrane of the year. Take some courses before you buy anything and ask your more experienced specialists for some guidance. Osteogenics is a great membrane company as was previously stated and Dr Miller offers some l-PRF courses you might want to take first. These are the cheapest membrane I've ever used and the results have been exceptional. CaSO4 is cheaper than borscht and great material when used properly and autogenous bone is still this years gold standard.
Peter Fairbairn
12/5/2012
I agree with Greg on this Robert introducing Autogenous is merely introducing osteoclasts at an early stage . As to not having a scaffold that can be difficult in larger defects .
As to speed of healing no membrane is the best as long as you know how to use materials ( CaSo4 ) to "bond" your graft .
We can load at 10 weeks when the implant ( the "gold standard" graft material ) has primary stability from 1 thread and the rest is a 360 degree defect .We use Osstell to measure and can take the ISO from the twenties to the seveties in this time spell.
The body does the healing we just try and help.
But here the Dentist lacks the skills in his own words thus maybe Easygraft due to its handling.
Regards
Peter
Baker k. Vinci
12/5/2012
The best "bang for your buck" is autogenous bone. If you are proficient at removing teeth, then harvesting enough bone for socket preservation is a breeze. Since they discontinued the gortex membrane, I have yet to find a comparable replacement, but a membrane is a membrane. Gortex was just easier to use. Remember, some sockets don't need grafts, if you are waiting to place your implant. If you are doing simple implants, then I would suggest placing the implants in clean extraction sites of premolars are other narrow teeth. The volume of autogenous bone needed in these cases is minimal. Bvinci
Robert Teague
12/5/2012
Hi Baker - No doubt others will dive in with arguments regarding the rights and wrongs of autogenous bone - osteoclast resorption etc etc.
In the case highlighted (socket preservation/no defect) where would you get it from without making an access flap and compromising healing?
Re: Membranes; The function might be similar but the new clinician might find quite a difference between titanium, eptfe, PLGA polymer, collagen (cross linked or native) and Calcium Sulphate membranes.
Regards
Robert
Baker k. Vinci
12/5/2012
I use resorbable membranes for the small grafts and encourage that for all simple cases. Albeit, with the naked eye tuberosity grafts appear flemsy, it has been proven that the fat in our bone grafts caries greater volumes of BMP. I can't argue the osteoclast suggestion, because the discussion caries merit. I also take bone from the buttress and ramus routinely. Patients almost never complain about the second site, with the exception of the chin and I have yet to have a single infection at a harvest site. This works in my hands!! Bvinci
CRS
12/6/2012
Dear Baker, I like this rationale, I got away from using autologous since the allograft was working well. Based on your comments I'm going to revisit this. I also use PRGF the BTI product with the allografts. Do you ever have to use tacs to stabilize membranes? If so could you make a suggestion on what to use? Thanks.
Tyler
12/7/2012
CRS I like the Profix Tenting Screws from Osteogenics and either their membrane screws or the salvin tacks.
CRS
12/7/2012
Thanks
Baker k. Vinci
12/7/2012
CRS, I have never used tacs for single or double tooth preservation grafting, however I am considering sonic weld for cosmetic augmentation, as per M. Block. I know you all are growing tired of me referencing him, but I really like the premise behind his last publication . Again, I don't attempt to obtain primary closure and I take large bites, with no tension, when suturing the membrane into position. It's very technique forgiving and by leaving the wound margins in their original position, I feel like the attached tissue position is much better, this way. Bvinci
CRS
12/8/2012
I have heard Dr block speak and I like his techniques could you reference this article for me. I am also considering sonic weld. I'm trying to find a good tac for the Teflon membranes the ones I use are too flimsy and not dependable. I have had success with pacing the Teflon under the periosteum for stability. I've used the polygly membranes (Inion) they hang around awhile and have a filmsy absorbing tac. I am hoping the sonic weld is a better system. We had Michael Block speak at our local society some years ago very nice guy and very informative. thanks
Tyler
12/8/2012
Baker
Do you have any lit about using the sonic weld and not getting primary closure? This sounds pretty interesting! The only downside to the sonic weld is the cost of the unit. Heard Kevin Murphy speak recently about the material and his applications/results... Very impressive.
Baker k. Vinci
12/10/2012
Tyler, I asked the same question when M. Block presented this stuff last year and he does not obtain primary closure most of the time. He says the "membrane " stays in long enough to prevent migration. He did re-iterate the importance of controlled pocket formation, by not over-dissecting. In the same meeting Spagnoli made it perfectly clear that bioss was not to be used as a bone substitute and does not "integrate" like bone. This was obvious to me, but I was surprised to see how many surgeons in that room used bioss for socket grafting???? Bvinci
Baker k. Vinci
12/10/2012
Addendum: Tyler a lot of his cases were "expos implanto", so he couldn't get primary closure. Bvinci
CRS
12/12/2012
I think the bio OSS issue was fall out from the old bio-coll technique from Sclar good tech but I use allograft or autotologous not bio-OSS which has limited applications.I treat it like the old hydroxyapatite. So the sonic weld membrane can be handled like the Teflon membranes? Spagnoli likes the polyethylene membranes but does not remove them vs using titanium mesh. It is fortunate that we have these practitioners to lead the way with their experience all great speakers. I'll have to check the current literature.
Yacob
12/8/2012
Have you tried the guidor matrix barrier. It is a resorbable polymer which doesn't need tacking.
Baker k. Vinci
12/8/2012
Yacob, I just got a sample in the mail. It looks similar to the discontinued gore. I'm gonna use it Monday . Bv
peter Fairbairn
12/8/2012
Yes Yacob an interesting "new " membrane released by Sunstar the group that markets Easygraft in Europe.
It has been around for a while with lots of research nowre=marketed in the US.
Peter
Jayanti Singh
4/11/2013
Bioteck membranes are good . Their graft is mixed 1:1 ratio with patient's blood and placed in the socket .
Robert Teague
4/13/2013
Why are they good?
