Recommendations for Ensuring Membrane Stability?
Dr. R. asks:
I just extracted a tooth, delivered a bone graft and covered the graft and socket with a resorbable membrane. My objective was to preserve as much of the socket walls as possible and to augment the bone volume in the socket. After 4 days, the membrane became dislodged, exposing the socket and the graft. Should I remove the current graft material, do a new graft and place a new membrane. Should I just monitor the graft to see what happens? What do you recommend at this time? Also, I felt I had sutured the membrane well and did not have any mobility of the membrane. Any recommendations for ensuring membrane stability?
4 Comments on Recommendations for Ensuring Membrane Stability?
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dr GM
2/15/2011
a love the queston you ask beacuse that happen to me also,i 'll be waitng for the coments
ttmillerjr
2/16/2011
Hi guys,
When suturing you have to keep in mind the inflammation you will get later, that's why a tension free graft is so important. You really don't need to suture your membrane, if you elevate the palatal/lingual gingiva and tuck 4 mm of it under, as well as have it extend well onto the buccal bone it should stay in place. For bigger grafts or if you really want to be sure use tacks to hold the membrane. What you might want to do now is have your patient come back in, tell them the membrane came loose that it happens sometimes and you need to address it. I would remove the membrane and verify that the bone is okay. Then either do the above with another membrane or even easier take a Collaplug pellet, get in nice and wet with blood and put a cross suture over the top. A good idea is to use use some kind of periodontal dressing over the top, I like the light cure Barricaid. Don't push it too hard into the socket and kinda wrap it around adjacent teeth. It will stick to the sutures too so that kinda keeps it in place. I don't know if you were going for primary closure or not. For sockets it's probably not worth the effort. Put your graft into the socket, ONLY TO BONE LEVEL NO MORE, put Collaplug over that, one cross suture and put a barrier, it will work great.
Dr. D
2/16/2011
What work well for me for the past couple of years is the use of nonresorb membrane such as the TXT-200 Cytoplast by osteogenic. I did an atraumatic extraction on a hopeless #3 yesterday, place graft to bone level only, then tuck the TXT buccal/lingually 4-6 mm on either side. Make sure that there are about 1mm away from the root surfaces, then suture. The membrane can be left exposed for about a month. Remove it should require no more than topical anesthetic. After that, just sit and wait. Attached gingiva will fill in the rest of the way. Very nice and relative easy to do. The nice thing is you can leave it exposed. Sometime it's very difficult (for me) to completly closure a molar socket. Hope that help. I will try to find some picture if anyone interested
JC
2/22/2011
When grafting an extraction socket with all four walls intact, then I like to use Novabone capsule delivery because I can quickly and completely fill apical areas, then a collagen plug and sutures.
If a wall (most often buccal) is missing (partially or completely), then I will use non-resorbable or long-resorbing membrane, sometimes with tacks for better stabilization.
If the tooth being extracted was periodontally involved and you can save the 'ugly looking' granulomatous tissue (think lots of stem cells)of the perio pocket, and use this to help achieve primary closure, all the better.
Remember to curette the socket well and lavage with lots of sterile saline.
Best Wishes, Jim
