Suitable Barrier Material for Block Graft?

Anon. asks:
I have a patient with bone loss in the premaxilla as a result of trauma in a car accident. I have to do an onlay graft in order to increase bone volume for dental implant placement. I do not have much experience in this area. I am planning on using a block graft in the area. I do not plan to close the graft site using periosteum. I would like to apply a synthetic barrier over the block graft. Can anybody with experience in this kind of procedure recommend a suitable barrier material and technique?

16 thoughts on “Suitable Barrier Material for Block Graft?

  1. Dear Anon,
    From an experienced “Blocker” never leave a Block Graft to the mercy of a membrane.If the block is exposed you can kiss it goodbye.You should indeed cover the block with a resorbable collagen membrane-especially for allogenic blocks and close the flaps over it primarily without tension.If you can’t manipulate the soft tissue to get primary closure don’t even start.

  2. Couldnt agree more with Dr Mazor. I Would use a long lasting resorb membrane and if you can I would use prp. Maybe you should read some Petrungaro.
    cheers

  3. Dear Anon,
    From curasan you have the inion membrane. it is synthetic and resorps with less inflamation then the collagen membrane. The other good thing is that you can place it like a collagen membrane, it is a resorbable membrane but in contact with body fluid it sets to a pretty stable memebrane which can keep its dimensions. It is a little bit more expensive

  4. I have had great success with Ossix membranes in this situation. Ask any Ossix user and they will tell you that the membrane is very long lasting.

    Dr. Mazor is correct. For block grafts, primary closure is key. If your site opens to expose the graft, no membrane is going to save you. Significant release and tension free closure is an absolute must.

  5. If you are doing a block graft, it is necessary to have 100% closure, 100% of the time. Do not rely on a membrane to accomplish this. A sufficiently thick gingival flap with undisrupted vascularity and without perforations is necessary to accomplish this. Once you have primary soft tissue closure, almost any membrane beneath it will suffice.

    Membranes can be successful for closure of socket grafts, but not blocks, which at best will have some resorption anyway. Exposure of the block will cause loss of the graft and quite likely additional bone loss at the recipient site.

  6. I think that this is probably the worst type of case for someone who has never done a block graft before. I have done hundreds of block grafts and never use a membrane. Waste of time and money. You are grafting cortical bone what does the membrane do? Zero, anyone agree?

  7. Anon,

    Have you done a block graft before. It sounds like this may be your 1st one??? Why not save your patient the morbidity of a 2nd site and use Regenaform. Place Regenaform with a tenting screw and a resorbable membrane like RCM6 from ACE.

    Just a thought…..

  8. I100% agree with oregon omfs. Primary closure and no membrane. A membrane will only add to the difficulty of establishing primary closure.I have had great success for years with this method.

  9. Before making a sound decison, first of all we must know reasons of use of membrane.
    1,To stop ingrowth of soft tisues.
    2, To contain the graft.
    Now in case of auotogenos or allogenic block graft precisely fitting in to recipient site, do we have to worry about soft tisue ingrowth? or containment?
    Do we need to have extra risk of exposure?

    But many times even after fine trimming block grafts do leave some defects unfilled, and to fill those gaps we need to use particulate grafts.
    In those cases membrane is must.
    longer lasting rsorbable membranes are better choice.

  10. Dear Anon,

    I always use Ossix membrane when doing a block graft. The handling characteristics are great and it is very tissue friendly.

    Once my block is mortised in placed and fixated with screws using 2 point fixation I place particulate graft and prp around the block to fill in the voids around the block. I then trim my ossix and place it in the platelet poor plasma and then place it over my block graft. I will further place some prp over that.

    I then do my periosteal releasing to free up the flap and close the flaps over it primarily without tension. Primary flap closure that is tension free is key to the survival of the block graft, failure to get primary closure will doom you to failure.

    I usually go back and place the implants about 4-5 months after. Hope thats helpful.

  11. no membrane.take incision on palate away from recipient site.after reflection mobilise flap by giving small incisions on the reflected perioteum.check dr.dabir and dr. ajit shetty’s case.

  12. I love ossix membrane but I never found it absolutely necessary to use them for blocks. I have used them in the past but found no difference with well adapted blocks.

  13. Fully agree with oregonomfs! Recent publications showed there is no proven benefit of a membrane in autologous bone grafting. Membrane probably even hampers vascularization of block grafts. Apart from tensio-free soft-tissue closure, rigid fixation is another keyfeature of the procedure! This means leg-screw technique of the graft with at least 2 screws to prevent rotational movements of the graft. If you have no experience ask someone to do this procedure for you, who has! The patient’s “health” is more important than your “professional ego”!!!

  14. Always cover a graft with a bilayered resorbable membrane which takes time to resorb about 6 months like one from GEISTLITS.
    Ashish
    Email:info@drashish.com
    Web:www.drashish.com

  15. Have you tried using degradable barriers like calcium sulfate. Recently, a calcium sulfate product, DentoGen was featured on this forum. Has anyone used it and how was the experience?

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