Surgicel: Use as a Barrier Membrane for Guided Bone Regeneration?

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Dr. A. asks:

A prosthodontist has recently told me that he has been using Surgicel [Johnson and Johnson], which is an oxidized cellulose mesh, as a barrier membrane for guided bone regeneration, such as in socket preservation procedures. His justification for using Surgicel this way was that Surgicel is a resorbable hemostatic dressing that converts to a gelatinous mass that incorporates the blood clot to form a membrane. Surgicel is also biodegrable. It is also cheap. He said that he has not encountered any complications and that healing has progressed uneventfully. What do you think? Have any of you heard about this kind of use of Surgicel? Do you agree?

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11 Responses to “ Surgicel: Use as a Barrier Membrane for Guided Bone Regeneration? ”

• Nicholas Toscano DDS MS July 14th, 2008

  
  

  I would not recommend using surgicel for the purpose of a membrane. Surgicel was designed as a hemostatic measure, not as a membrane.

  Oxidized regenerated cellulose based products such as Surgicel® are derived from plant based alpha-cellulose and function hemostatically in a manner similar to absorbable gelatin sponges. A unique property this product has is relatively low pH. The low pH has an antibacterial effect. A broad range of gram negative, gram positive, and antibiotic-resistant bacteria have proven to be locally susceptible to oxidized regenerated cellulose. When used for oral applications, this product typically resorbs with 7-14 days. However this product should not be utilized as a membrane.

  In terms of regeneration you want a cell occlusive membrane that has several properties and be beneficial based on the wound healing studies: 1) it needs prevent epithelial and soft tissue downgrowth, 2) Wound and clot stabilization 3) graft containment 4) space maintenance

  You also want a membrane to be around a minimum of 6-8 weeks based on the wound healing studies, but you may want it longer if the area your trying to regenerate is a large defect. In some of the italian studies by Tinti or other articles by Buser they want membranes to be around for 6 months or greater depending on the type of augmentation your trying to achiever (vertical, horizontal or both).

  I myself like collagen membranes (Ossix, biomend, bio-guide) they have easy handling properties and last a while, and have the properties you need to enhance regeneration. Gortex membranes also are great, but they are technique sensitive and can become exposed. I tend to favor Ossix especially when doing a block graft or particulate grafts, the results are great, at least in my hands.

  There are many other aspects to why you need a membrane and tons of good articles to read if you do a lit search. I tried to give you some of the basics of membranes but to long to write in a blog. Hope thats helpful.

• david,omfs July 15th, 2008

  
  

  i agree,just because a non surgeon uses a product with questionable results, there is no sound science behind his treatment other to save money, all the above descriptions are correct.

• Dr. F July 15th, 2008

  
  

  At what point in time is surgicel supposed to be cell occlusive. It has absolutely no properties of a membrane material necessary to contain cellular compartments for bone regeneration.

• jerry Drury July 15th, 2008

  
  

  There are studies which I recall that showed surgicel can delay soft tissue healing.
  This is not a desirable side effect for guided bone regeneration.

• eric wallace July 16th, 2008

  
  

  Agree with all above, and to add,
  How can you fixate surgicel- the only kind I have ever seen will not hold a suture or a tack. Also, it is so delicate, can it really be tucked into place? I just don’t see how this can be effective. Cheap it is, bit useless as a membrane.

• Dr O July 16th, 2008

  
  

  I have problems with the use of surgicel for GBR, but have for many years used it or gelfoam for socket preservation in conjunction with an alloplastic graft material. I have not had any complications with its use and have often followed with implant placement there and have not had any failures.

• satish joshi July 16th, 2008

  
  

  Meaning of barrier is anything which bars(stops) passage of other thing.Dressing is a dressing not a barrier in true sense when you want to bar passage of cells.Most grafts need more than three months to be replaced by real bone,surgicell may not stay even 3 weeks.
  But it can be used to hold grafts in small intact sockets like incisors or bicuspids with cross sutures.You may loose some graft and final site may not be as good as site covered with barrier membrane.Means you may end up with some crestal defet of ridge which may not be as important.
  For larger sockets or in case of defective walls of socket it is must to use true barriers to avoid defective final sites.

• R. Hughes July 16th, 2008

  
  

  I use Gel Foam and it works just fine for a membrane used in socket grafts!

• eric wallace July 17th, 2008

  
  

  To R. Hughs
  Sounds like you do a lot of socket preservations. How long does the gel foam actually stick around? I used to use colla-plug with a crossed vicryl. it looked great when i was done, but at two weeks there was no sign of the foam. i found that patients with busy tongues displaced the collaplug even while the suture was in. I would imagine gel foam would be even less resistant to moving. I was getting a lot of graft wash out so i switched to a biomend-zimmer. i tuck it under the tissue without raising a flap and cross suture. with this technique i get no washout and reliable results every time. i’ve done about 200 this way. only drawback is expense - about 100$ for a molar. i just don’t see how gel foam can be an effective barrier. it did not work in my hands. any way to post some photos???

• R. Hughes July 18th, 2008

  
  

  Busy tongues are an issue. Try to protect the site with a barrier like perio pack, Elman’s isodent (superglue). Pack the material very densely, decorticate the palatal or lingual aspect of the socket, disinfect and degranulate the site. You should disinfect with tetracycline (3 minutes by the clock and irrigate with saline). Tetracycline has a pH of 4.0. The periopack has to stay in place till the tissue granulates over which is about 7-10 days. You han also protect the site with a flipper. Tell the patient not to suck through a straw etc. Yes, I do alot of these and socket lifts. They are simple procedures that prevent alot of work down the road! An ounce of prevention is worth a pound of cure.

• R. Hughes July 18th, 2008

  
  

  You have to compress the gel foam, sometimes fold it over. Do tuck it in under the gingiva and criss cross the sutures. Here again protect the site with an essex retainer, flipper, perio pack, plaster of paris etc.

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