Titanium-reinforced Membrane: Am I Required to Tack this in Place?
Dr C asks:
I performed lateral GBR [Guided Bone Regeneration] in the mandible to increase the crestal bone width in the #19,20 area [mandibular left first molar and second premolar; 35, 36] about 4 months ago. After de-corticating the buccal cortical plate at the graft site and placing Puros [Zimmer], I covered the surgical site with titanium-reinforced membrane. I felt I was able to adequately stabilize membrane with flap and sutures. I obtained tension free primary closure with no problem. The patient returned for 2 and 6 six week follow-ups with no problems. The patient came in last week for the final exam prior to implant placement. The patient has developed a soft tissue infection in the area with a draining sinus tract right over the crest of the ridge more towards the adjacent tooth #21 [mandibular left first premolar; 34]. The only thing I can think of is that the membrane has been moving since it was not tacked in place. Is it always a requirement with a non-resorbable membrane to tack in place? Anyone have any similar experiences? Any thoughts or ideas on what has happened?