Collagen Plug vs Resorbable membrane in buccal plate resorption?

I am doing a lot of socket preservations these days and wanted to get some opinions on using a collagen plug vs a membrane. What do you do in these scenarios?

1. Significant buccal plate resorption; NO flap needed to extract. Do you graft with a collagen plug on top, or are you reflecting a flap at that time so you can place a barrier membrane? It seems as if the soft tissue should be able to contain the graft on the buccal, since no flap was needed, hence no need to reflect and place a membrane?

2. Significant buccal plate resorption; FLAP needed to extract. Barrier membrane sounds reasonable here.

What do you do in these two situations?

Thank you!



14 thoughts on “Collagen Plug vs Resorbable membrane in buccal plate resorption?

  1. Jason Larkin says:

    It will be neat to see some studys come out using osteogen strip as barrier membrane.
    Personally, I noticed slightly better bone volume using membrane over a squeezed down plug. Honestly, why not just do osteogen plug for simple sockets and particulate with membrane for buccal defect ones.

  2. Timothy Carter says:

    I have been doing this for over 10 years now and I rarely use a membrane even when the buccal plate is missing. As a periodontist I respect the 3 walled defect as a predictable one to regenerate. Even when the buccal plate is missing the site is a 3 walled defect so for me it is a collagen plug over the top of the graft with dermabond to seal/close it. I have had very good success with this and yes I have tried every membrane/technique/material out there.

    • Justin says:

      Paul,

      This is really fascinating to hear. If you’re not putting a membrane buccal to the defect site, don’t you see epithelial migration into your graft? Is the bone volume as great?

  3. Paul says:

    If you refresh your memory, you may realize that the membrane is not to keep the graft in place but it has a biological purpose which is to prevent soft tissue infiltration. Membranes are not placed for the purpose of keeping the graft in place in most instances.

  4. Greg Kammeyer, DDS, MS says:

    I agree with Paul. Where I haven’t used a membrane the xenograft bone particles are bound to the buccal flap. A cross linked collagen membrane works very well if it is a 4 walled defect.

  5. drdave says:

    Excellent questions. Instead of a membrane, you can consider Dentogen (calcium sulfate). I’ve found that the best use of calcium sulfate is as barrier (not to mention that it’s less expensive than a collagen membrane). Here is a link to study that compared Calcium Sulfate as barrier vs a collagen membrane: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3543940/ . Spoiler, the conclusion, was: “All of the above-mentioned comparable results achieved by calcium sulphate/DFDBA compared to collagen membrane/DFDBA indicated that calcium sulphateis as efficacious as that of collagen membrane as a barrier material. It holds a great promise for improved clinical performance and can be used as a cost-effective replacement for collagen membrane.” Another study can be found here: https://www.ncbi.nlm.nih.gov/pubmed/9347509

  6. Brian says:

    I tunnel down the buccal, no reflection, and get a long lasting collagen membrane in. Supported by adjacent buccal wall. Trying to prevent invagination in the area.

  7. Kenneth Arida says:

    I am a relative new comer to bone grafting and socket preservation and it seems that I have noticed a change in opinion over the last couple of years. I learned that a membrane/barrier of some type was necessary to prevent soft tissue infiltration into the new bone graft, as mentioned above. In the last year or so I have been hearing from colleagues with much more experience that they do not use membranes and are not concerned with soft tissue infiltration. I have seen doctors (online) reflect flaps and load up bone into sockets and even around newly placed implants and simple close the flap with primary closure. Has something changed? What have I missed? Some of my sources have caused me to use membranes routinely over buccal defects and collagen plugs over the top of a recent extraction if all walls are intact. Thanks for any input and clarification, it is a challenge to see all of the different treatment modalities and opinions but is also very valuable. Thanks again

  8. Joel Sardzinski

    I am in the same camp as Dr. Arida above. Can some of the more experienced clinicians comment on his post? Thank you in advance.

  9. Peter Fairbairn says:

    It is the arrival of Implant Dentistry that changed things , for thousands of years and millions of cases bone regeneration has been very capably dealt with by the periosteum , natures miracle . I do not ever use membranes to take advantage of this amazing healing potential . As long as the graft is stable , biocompatible the periosteum is sufficient .

  10. Paul says:

    Peter Faibairn, this is the way you treat each condition? By condition I mean, socket augmentation, bony defects with various numbers of walls. If the miracle is a miracle, why not just leave the socket to nature to fill in and skip the graft altogether? What do you mean by stable graft? You have a bony dehiscence, you pack it with some graft material, cover with periosteum any perceive the graft as stable? Where do you get this very interesting information? is the Bible, dental research reported in some publication, seminars in India or domestically ? I have been wasting money on membranes until now and you made me wonder.

  11. Paul says:

    In continuation to the comment by Peter Faibairn.
    This is a copy of an excerpt from NCDI-NH explanation of the GBR protocol:
    :
    “To accomplish the regeneration of a bone defect, the rate of osteogenesis extending inward from the adjacent boney margins must exceed the rate of fibrogenesis growing in from the surrounding soft tissue [24]. In a clinical situation, it is often hard to predict the efficacy of ridge augmentation. To ensure successful GBR, four principles need to be met: exclusion of epithelium and connective tissue, space maintenance, stability of the fibrin clot, and primary wound closure.”

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