PTFE membrane has come off: recommendations?

Nothing to do now but allow the soft tissue to granulate over the socket. The socket will heal. Assumming no infection is present, the only complication is the loss of graft material and reduced bone volume. Basic knowledge of soft tissue and extraction socket healing is necessary and essential knowledge in dentistry. Respectfully, please continue to read textbooks and attend some of the many courses available .

Thanks. Should I have left membrane holding PTFE sutures for more than 3 week ?

Hi, So the best part of DPTFE membranes is that they can be exposed to the oral environment as long as there is no inversion of the membrane. If you wait for 4 weeks, an osteoid forms and then you can back the membrane out in most cases. Once you remove the membrane you will see pink osteoid, which means you are in the clear. If however you see bone graft material, then the membrane was inverted somewhere or was leaking. In that case you will find either bone graft exposed or even purulence. That happened to me on a recent case. Extracted #30 with a lot of infection, Cleaned judiciously, bone graft and I sutured the patient close to primary closure and Peri-acryl on top, Pt came back in 1 week with sutures and site destroyed. I re-sutured him. Came back for 4 weeks post-op to remove sutures and membrane, destroyed some sutures, but now on the lingual the membrane was inverted, took out the membrane, half of the socket had osteoid, the other half was full of purulence. Cleaned the socket really well. Irrigated with Saline, informed the Pt that bone will be deficient and will need to be addressed at the time of implant placement. This happens from time to time when the Pt does Not follow our post-op instructions and starts chewing on the site with gusto as if the fact that something is covering is like concrete, which leads to deficient bone. So, if it hasn't been 28-32 days, and no sign for infection, then wait to remove. If infected, then remove and curettage and irrigate. Possibly new round of Abx. Hope this helps. My $0.02

This is a common result. The trick is to tuck the dPTFE under the flap margins enough to get a seal and to follow the patient closely so you remove the membrane at the right time. This gets much more important as you graduate to Ti-dPTFE/GBR. Other options that work too: use collatape and peri-acryl instead of dPTFE use L-PRF layered over the bone use a collagen membrane and then place sutures. All methods will leave some amount of exposed bone when they fall out or are removed: I like these 3 that don't necessitate membrane removal, as I simply overgraft the site, don't get the infections that the dPTFE tends to have, the soft tissue over the site still needs to heal by secondary intent as with all these choices and I don't waste my time nor that patients time baby sitting a simple case. Yes, bacteria gets into the bone, and a very minor amount of surface bone is scraped off when the implant is placed.

Not an unexpected thing with dPTFE, as mentioned above. While dPTFE was a major advancement at that time, the issue is that due to its surface properties, attachment to tissues with dPTFE is weak. So you have to follow some of the protocol advice above. However, there are new microporous PTFE membranes that have now been developed to address this issue, while still providing all the other benefits of dPTFE. The micro porous texture enhances soft tissue attachment. You can read more here: https://forums.ddsgadget.com/t/cytoflex-ptfe-membranes-vs-dptfe-and-goretex/67

Using Dense PTFE to barrier off a socket site is an excellent and predictable method not only of achieving regeneration of native bone or bone with graft, but also of extending the zone of attached tissue. In my experience it is always desirable to have the membrane stay in position for 4 to 5 weeks but sometimes a corner will lift away prematurely. Usually with exposure at two weeks you can expect some loss of vertical height to occur due to degredation but it will still usually leave you with a reasonably good outcome unless the patient is just abusive. More PTFE sutures left longer helps. Also the use of cyanoacrylate to overlay will help to stabilize the suture-membrane-soft tissue complex. The patient also must understand to be very protective of the area during the healing phase.