Dr. C. asks
I recently did a lateral ridge augmentation and after placing my bone graft, I placed a resorbable collagen membrane over the graft site. I then placed a PTFE titanium-reinforced membrane. I usually tack this in place for stability but this time I felt I was able to stabilize the PTFE with primary flap closure and did not use any tacks. How many people are placing membrane over lateral ridge grafts without tack/screw stabilization and what are thoughts and ideas about this?
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When the lateral ridge grafts are for ridge preservation as in the case of a large dehiscence or fenestration, then I think you will agree that no tack or stabilization screw is needed.
However, when you are augmenting the ridge laterally, the larger the augmentation, the more desirable a stabilizing tack or screw becomes. There are instances when the barrier will feel stable enough by itself, but a tack will always give you more peace of mind.
My two cents.
I believe it has great advantages to tack membranes in place, as these can be placed prior to the augmentation process, and give a barrier against which any augmentation material can be packed, thereby controlling the placement.
If dont use tack or screw the chance of earlier mambrane exposing will be high.
dr c,
never do it that way,
u will get regenerated tissue but lesser than desired.
always place screws around
With the putties, I’m not tacking it down as that formulation greatly assists at holding the graft in place. I tend to use a larger membrane though and tuck it in on the palatal/lingual pretty substantially.
Non-resobable membranes need to be tucked subperiostally 3-5mm to prevent migration
For lateral ridge augmentation, they should be screwed in place
The bigger the graft the more often I will tack a resorbable membrane, but there are plenty of times I don’t tack. I use a lot of putty and I think that reduces the need for tacking. I don’t get exposed membranes when I don’t tack, but I do tuck and get good tension free closure.
I hardly ever use a membrane at all these days. I use easygraft and/or fortoss vital for my lateral augmentations, and because these materials are inherently stable, particularly the fortoss, you just do not need to use a membrane, after all we are simply trying to create a stable tissue compartment into which bone will regenerate, a membrane will slow down the vascular invagination into the graft.
I dont know why you place two membranes, a resorbable one first and a non resorbable on top of it?
One membrane is enough, if you are performing a demanding regeneration as for a one or two wall defect, the best choice will be non resorbable membrane fixed either with tacks or with self threading miniscrews.
More favorable regenerations (more than three wall defects) can be solved with an easier procedure using resorbable membranes.
Is Fortoss available in the US? Who can I purcahse it from?