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Ask UsPTFE Membrane or Resorbable?
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Dr. C. asks:
I placed a dental implant in in the #4, 5 area 5-years ago using a 2-stage surgical protocol. The implant was restored with a cement retained PFM. The patient had excellent home care and minimal pocket depth.
Then the patient started chemotherapy for cancer. About that time, the implant started having problems with pocketing and suppuration on the palatal. The patient is doing an excellent job keeping the dental implant clean and is using subgingival irrigation, chlorhexidine, etc. But there is bone loss now down to the 4th thread (about 30 percent of a 4mmx12mm).
I am proposing removal of crown and abutment, detoxifying the implant fixture with citric acid, and grafting, then coverage with a barrier membrane to attempt bone regrowth. Which is preferable in this case: a ptfe membrane or a resorbable membrane? If so, which and why? How successful have been your experiences been with this technique? Any other suggestions?
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12 Responses to “ PTFE Membrane or Resorbable? ”
I have found either work, but the PTFE secured with a few tacks seems to be more predictable. I have seen, and confirmed with biopsies of tissues, as the resorbable membranes resorb, it is resorbed by and inflammatory response. Unlike polylactic acid (resorbable plates and screws) that is degraded by hydrolysis (although some inflammation is seen), the resorbable products, including collagen product, create an inflammatory reaction. I’ve noticed more in patients I’ve used resorbable membranes on some resorption of the graft moreso than in the PTFE groups. I’ve also used titanium shield with good success as well, but Goretex is so much easier to work with. Good luck
You may want to check with the patient’s oncologist; when people say they had “cheomotherapy”, it sometimes includes a regimen of intravenous bisphosphanate. If this is the case, no surgical treatment may be the best solution. Otherwise, i agree with the previous post - PTFE membrane is more predictable, with less inflammation.
Even one better, high density d-PTFE which does not require primary closure and cost 1/3 of Goretex, and almost zero complication rate.
I do not think that the membrane is the main issue here.In case of bone resorption around an Implant it is almost impossible to regrow bone especially in surface treated Implants.Detoxifying the rough contaminated surface is almost impossible.Perhaps detoxification with Eb-Yag laser might do it.
With smooth surface Implants it is easier to clean the surface.
For the past 8 years, we have had outstanding success using the Er,Cr;YSGG laser to debride/detoxify implant surfaces prior to grafting. I have published a paper on its use in the journal Implant Dentistry (2004) and have submitted case studies previously published in Osseonews.com. Chemotherapeutic treatment of implant surfaces is demonstrably inferior to laser treated surfaces and, for us, laser treatment has become the standard of care for treating the ailing/failing implant. Our SEM studies leave no doubt as to the efficacy of this modality. In addition to complete debridement, lasers also offer decontamination AND biostimulation of the bone/soft tissue complex, giving the clinician the best chance for reintegration of the implant.
I understand the concern of a “failing” implant, but colleagues, you must see the big picture here. Chemotherapy is not a simple entity it severely compromises the immune system and the inflammatory process. It disrupts cell signaling and induces apoptosis in cells that normal do not. It greatly hampers wound healing. The extent and damage may be larger than what we can see or measure on radiographs. Attempting to surgically treat a compromised host, could lead to more devastating results.
As Mike H. has given very good advice, to review the case with an oncologist and to review the chemotherapeutic agents used. Some regimens include IV bisphosphonates, which bone grafting or any bone surgery is a absolute contraindication. The patient has cancer and bone grafting is the last decision the patient should be concerned about. You may end up harming the patient rather than helping, even though your intentions are good.
SFOMS is right on target.patient is COPROMISED,In spite of meticulous efforts for good oral hygien,He/she not only lost bone but develpoed supuration.How do you expect good success in GBR IN PATIENT ON CHEMOTHERAPY specially on PALATAL aspect where flaps are not as easy to handle as buccal aspect.
Why don’t you just smooth and polish exposed threads and hope for good.
No barriers, no graft. The patients medical condition is first. Be preventive for now and take the advive of conservatism as given. Bill
If pt had IV bisphosphonate, you might end up with osteonecrosis if you try to do any surgery. The patient might lose more than just the implants, he might lose the whole jaw due to complications of osteonecrosis.
I have been experimenting with various membranes over the years, and have settled for PTFE non resorbable membranes as an overall preference.
My concern with the commercially available PTFE membranes that are not titanium reinforced, or are not supplied with a “plasticer”, tend to crumple and loose their shape, whether they are tacked or not.
Recently, I have been working with denser PTFE, pure and steam sterilized that is 1/64″ thick.
This density saves me from using a titanium mesh as a way to create a rigid form.
I will be publishing a paper on this material, and invite confreres to contact me should they wish to participate in the study.
The material will be supplied to you free of charge, as many pieces as you need, in exchange for your accurate documentation and photographs.
Your input will be published in the article.
I may be contacted at implants@total.net, please write PTFE STUDY as your subject matter.
Dr. Gerald Rudick, Montreal, Canada
You might want to contact the guys at Osteogenics. They pioneered the use of dense PTFE for grafting, and have papers on the subject dating back to 1994. Check out pubmed.
So we have a medically compromised patient, an infected recipient site,and a vertical bone loss. Where would this bone replacement graft get its blood supply from? the contaminated implant surface or the GBR membrane? I don’t think grafting is a good idea.
Like others mentioned, your best bet is to smooth and polish the surface and keep the area well maintained.
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