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Ask UsDr. Huang asks:
Is it necessary to put a resorbable membrane over the Titanium mesh + bone grafting for GBR before dental implantation?
Periostum is a GBR membrane -like tissue for bone augmentation, isn’t it? Are bone graftings with allograft/Xenograft or autogeneous grafts different approaches for this GBR technique?
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Sun July 20 2008
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11 Responses to “ Dental Implant Resorbable Membrane Question ”
“Periostum is a GBR membrane”, true! But only periostum! Not othes tissues.
If we can maintain bone graft and blood clot under the mesh, the resorbable membrane is not neccessary.
i would line the underside of the titanium mesh with a membrane like neomem, but for the outerside, primary closure with a full thickness flap is all you need. if the titanium mesh starts to “show” thru the gingival tissue, do not panic, just snip away the excess and smooth edges-continue with peridex rinses.
IF YOU GET PRIMARY CLOSURE WITH YOUR FLAP´S SUTURES, AND THE BONE GRAFT IS WET ENOUGH WITH BLOOD, YOU MIGHT NOT NEED ADDITIONAL SUPPORT OF ANY MEMBRANE BUT THE TITANIUM MESH. PERIOSTIUM IS A WELL NATURAL BARRIER. HOWEVER, IF YOU NEED A MEMBRANE FOR ADDITIONAL AIDS, IT SHOULD BE LOCATED IN THE INTERNAL SIDE OF THE TITANIUM MESH.
Whose mesh and screws do you prefer and why?
What’s the Neomem ?
What’s the difference between resorbable membrane insertion under and above the titanium mesh?
I had some case just put fast resobable TeruPlug(some kinds of collage sponge or tape)to prevent gingival cell early ingrowth. Is it stupid to do that?
The placement of a titanium mesh is a delicate procedure, it works very nice to restore the integrity of a ridge with defects or when elevating the height of a ridge at the expense of a screw.
If you are thinking of using one it means you are familiar with the manipulation of soft tissues and split thickness techniques for extra tissue and tension free primary closure.
I recomend you use nylon 5.0, it is the nicest suture I have ever use for implant dentistry, nicer than vycril and goretex, make sure after you suture, you put security stitches as far from the incision area as possible, they will hold any tension from the manipulation of the soft tisues the patient may do.
It usually should have a membrane under the mesh (if you put it on top you will have to remove extra bone when you re entry the site), the periosteum will do the work but a good midterm resorvable membrane will help even nicer, specially when you are looking for extra height. Biomend from tutogen (zimmer) or a good membrane from ACE will do it.
Clorhexidine is a questionable solution to use unless you get it free of alcohol (in spain and colombia is available alcohol free) or if you mix it with water, one third of clorhexidine and two of water.
also, about the question of fixation screws, you need to be familiar with their use too, you can learn and practice in baby ribs.
If it gets exposed, pray, just kidding, you got to handle it, usually getting the exposed edges removed or softened, and AB, I like to use a lot of saline for a long time instead of clorhexidine.
I hope this is helpful.
Dr Ordonez
By the way,
I have been using a titanium mesh from IMTEC ffor the last 7 years with great results, it is unexpensive and good. I recomend it to anyone who needs a mesh, it is small, about the size of a periapical film.
I have attended many lectures by experts using titanium mesh procedures, and the majority seem to feel they can get primary closure with good suturing, so that a membrane is not necessary…..
In my experience, I have never been able to maintain a perfect closure for the duration that the titanium mesh has to be in place.
I prefer to use a non resorbable PTFE membrane over the porous titanium sheet….. even if the tissues do pull apart after suture removal, the titanium is protected by the nonresorbable PTFE… a resorbable membrane will start to break down sooner than a non resorbable type, leaving the porous titanium exposed for bacterial invasion.
After a while, the nonresorbable membrane will start to change as it is subjected to the elements in the oral cavity, including the tooth brush which might cause it to destruct, as well as being coated with bacteria …… however, during all this time that the PTFE membrane was on the outside ( over the titanium mesh and hopefully under the mucosa), an ostium has began to form under the porous titanum, which in turn develops its own biological protective barrier.
The titanium mesh then serves the same purpose as the metal cage used to protect a glass window in a rough neighborhood. The holes allow fluids such as saliva, and peridex to pass underneath and maintain and protect the ostium without the fear of having this delicate growing soft tissue damaged before it can mature and allow it to be sustained until calcification takes place, and the titanium sheet be removed.
Dr. Gerald Rudick,Montreal
Dr Ordonez, would you elaborate on your exact flap design over the mesh. I suppose that it would be the same for a block graft. Dr Pikos recommends separating the mylohyoid with the finger on the lower arch and this works very well to assist in passive closure. The mylohyoid reattaches. The facial is another story since the muscle bed is much more unforgiving. And do you have a minimum KT requirement,say 3,4 or 5+mm width or does it depend on the size of the graft? Thank you for your comments. They are very helpful as are the others concerning technique. Bill
has anyone used the Biohorizons Ti mesh its 1.5×1 inches n works well with Biogide placed under it.
why do you say alcoho free Chlorhexidine??
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