Consensus on Using FGG or CTG as a Membrane over the Top of Graft Sites?

If you use a ct graft you must make sure it will survive with adequate blood supply. If blood supply is lost then it will sluff. The free graft will most likely sluff early since this would be more difficult to get any blood supply. If you just want a temporary barrier try surgical foil. It is best to use releasing incisions and use pedicle grafts to gain primary closure.

I would suggest you use some resorbable collagen. This works very well and will offer much less morbidity and cost for your patient. Unless the case demands an augmentation of soft tissue I think you will find this is a good way to go. I happen to like using Biomend Extend.

Esta situacion puede ser en ciertas ocaciones solucinada realizando pequeños cortes en el area interior del tejido gingival que se retrae y con esto nos proporciona cierta elasticidad en nuesto colgajo para un ierre primario satisfactorio y con el apropiado aporte sanguineo que este procedimiento conlleva.

In my experience the use of CT grafts have been successful, but I would also emphasize that flap design, partiularly undermining of buccal or labial flaps to provide tension free closure is important. The use of pediculated CT grafts as described by Mathews and Osterberg has offered advantage particularly in the esthetic zone when trying to gain back lost height or width of soft tissue.

If you are worried about the the ingrowth of epithelium and coverage of your graft then try a collagen membrane to prevent the ingrowth and loss of your graft material. If you are really worried about it then use a cytoplast membrane to cover it. I have used them and they are as good as the company touts them. Go to Osteogenics website and watch the videos and decide for yourself. But personally "if it ain't broke don't fix it". There are no hard and fast rules in this arena of implants. If what you are doing works then stay with it . If not then change. But cytoplast membranes work very well and will definitely protect your graft.

In my experience flap design is of utmost importance to obtain primary closure of grafted sites. I sometimes use counterinsicions of periosteum at the base of the flap to obtain primary closure. I this is not done, one might use Platelet Rich Plasma membranes (obtained by centrifugation 7 minutes at 3500 RPM of the patients own blood) which can be sutured and might be able to achieve closure of the remaining few millemeters of mucosa. It is however essential to achieve the mucosal cover of the bone grafted area, since the membrane will slough while achieving secondary cover by mucosa.

how about a coat of calcium sulfate troweled over the granular implant material to be a barrier?

I've had success with calcium sulfate mixed at 25% with the grafting material then using a "cap" of 100%CA as a barrier for ridge preservation prior to implantation. It is definitely economical as are Collapugs cut into varying dimensions to act as "sheets" of barrier.

Release the flap as much as you can to allow for tension free closure and you will not need to worry about CTG or FGG or anything else.

The CaSo4 route can be very sucessful once you master the techniques as we have done hundreds of sucessful cases without full closure. As we all have found out judging by the responses , FGG ( inclu tissue punch methods) and FCG are very unreliable in these situations. We use 2 Caso4 products Fortoss Vital and Bond Bone in these cases. Peter

Peter, I have seen many ads for CaSo4 as a graft material. I am still using a combination of CaSo4 with FDBA and a trace of tetracycline mixed in for GBR. I have used Caso4 alone as a filler for apicoectomies and the healing is excellent. What is your take on CaSo4 as a pure graft material for socket preservation, sinus lift, or GBR?

It bio-absorbs too quickly at 3 to 5 weeks dependant on patient physiology thus only use mixed with another graft material or use as a "membrane" over a graft site . Vital or Genex is a combination of CaSo4 ( 30 %) with BTcp ( 70 % , particles 150 to 500 ) with a negative zeta potential . I know Bond Bone is marketed as a "biphasic" graft material , but not am sure about that so best mix with another material which will be around longer for bone regeneration or use as a cover to prevent soft tissue ingrowth where it is very useful. Regards Peter

Podrias modificar la incision del lecho receptor a 5mm mas alla del fondo de surco y levatar el colgajo desde fondo de surco hacia reborde , evitando que el injerto pueda exponesrse y asegurar un cicatrizacion por primera intension.

If anyone is wondering why I have responded to almost every subject, I am in a vehicle with four children and a grumpy wife. While I admit it's been almost two decades since I finished formal training on the subject, I remain very current and read almost four nights a week, in that I am a solo omfs that practices full scope surgery. With that being said almost everything I do still is based on the fundamental principles of surgery and dentistry, wether it be cancer surgery, trauma, cosmetics or implants. It never ceases to amaze me that flap designs vary so much, with little or no consideration to blood flow when I read the implant literature today. As far as getting primary closure or what type of membrane used for your gtr, this is a subject more volume than your I-phone can handle. To suggest you can suture prp, is laughable ,and in my opinion to compromise the flap by making significant releasing incisions(vertical), frankly is an abortion of the principles of surgery, with the exception of providing visualization. Resorbable membranes have stood the test of time and unless,I am trying to augment soft tissue in a cosmetic zone, I use it exclusively. If one is looking for water tight primary closure of a large graft, the only true way to succeed with this is to access the sight extraorally. In my hands the best membrane to date for small defects is the small rigid gore membrane, that is being discontinued. When push comes to shove, regardless of what we are augmenting , creating and maintaing that space is the most important fundamental. This has been proven in multiple studies of sinus lifting where space was created and bone grew with no graft material. Lastly I am amazed that " implantologist" as you might call them have taught themselves to drill holes in bone above cranial nerves, near sinuses, with no training in how to treat a comication when it occurs , but they are frightened to learn how to harvest gold standard graft material( autogenous bone). Harvest techniques have become simple and safety records with mineralized and demineralized bone are well above satisfactory. Let's not forget genetically engendered bmp. . It has been proven time and again that for small defects even around implants primary closure is not necessary , hence the formation of an entire industry . B. Vinci. Omfs

i mostly agree with all suggestions including CTG & to a certain extent FGG ,but have u clinicians ever tried PLATELET RICH FIBRIN not only to cover particulate grafts ,but i have extensively used tham to cover immediate implant extraction sockets and get great results in terms of wound healing ,primary closure ,increase in terms of soft tissue vol ,defect resolution (between surface of implant & socket wall since most cases i do not graft),and most importantly very little papillary collapse, thank you dr vinayak mds perio

Does anyone know of a resorbable gtr membrane similar to the small "gore" , that has been discontinued? I stocked up on as Many as they would allow and I'm running out . I have sampled a few and not found anything close. Bv