Exfoliating Alloderm Membrane?

When you placed the Alloderm how was the Basement membrane side placed? Against the bone or on the opposite side?

Simply remove the loose membrane with scissors. Have patient continue the CHX. The site will heal fine. I haven't found that orientation of the basement membrane side to be an issue. Perioderm dermal allograft seems to me to integrate more predictably, and hydrates quickly without the need for multiple rinsing.

Alloderm should be completely covered and systemic antibiotics Rx'd. Otherwise bacteria colonize the margins.

Dr Flanagan is right: Alloderm should be covered or have a periosteal base rather than a loose particle base. If you do get a small amount of exposure simply trim it off. It can be used as a free gingival graft, yet again it needs a solid vascular supply. When you are doing socket bone regeneration, I suggest using L-PRF over the bone graft material as it gives the best graft results I've found. My second choice is to use collatape and like the L-PRF, it is sutured down with criss-cross mattress sutures. With the collatape I use Periacryl (cyanoacrylate) to make the membrane stiff. Both the L-PRF and collatape fall out with the gut sutures and at that point the bone is attached to the host site and then the soft tissue will close over the opening. This preserves attached tissue. If you also want to thicken it with an Allograft product, then create a pouch between the buccal plate and the periosteum, tuck the graft in and suture it to place so it doesn't get exposed. Good luck.

The use of chlorhexidine immediately post -operatively is another reason for this. It is toxic to fibroblasts and delays closure of your flaps and subperiosteal adhesion.

I have been using AlloDerm/Perioderm/Dermis etc.. since 2004 and I will tell you that if it is exposed it will slough and stink regardless of the orientation. At this point just simply trim off the exposed necrotic portion and let it heal.

CHX is toxic to fibroblasts according to Don Callan and shouldn't be used for first week at least. If dermal allograft to be left exposed, it must be laid Basement Membrane side (pale side when soaked in blood) facing outward BUT it still should have CT side (red side) opposing periosteum for blood supply. That's how we can do vestibuloplasties so well with it. The BM side still even gets nasty white but pinks up at about one week.

Alloderm and a variety of collagen membranes are excellent materials when placed in the right environment.....however, if they are exposed to the oral cavity, they will attract bacteria and subsequently breakdown, and not contribute to good healing. If the membrane cannot be completely covered with soft tissue at the time of surgery, a good idea is to cover it with a piece of PTFE membrane, and this will be a protective barrier...eventually the PTFE breaks down as well, however, during the time it takes to breakdown, healing will be sufficient to protect the site and the Alloderm is no longer necessary. For those readers interested, please contact me and I will show you how to find a PTFE source for very little cost, which is excellent to use to cover extraction sites as well.

Take it out and don’t worry about it. It should of never been left exposed

Leaving a collagen alloderm membrane exposed to the fluids and contained bacteria of the oral cavity is not a good idea. In cases like this I use A PTFE non resorable membrane that is tucked under the buccal and lingual plaps with the textured side facing the soft tissue. It it is held in place with sutures that do not penetrate the membrane with a figure eight suture pattern. I use PTFE sutures and remove thewm at 2 weeks. The membrane is remove in 4 weeks. At this time the underlying graft is pink and vascularized.

For those interested in obtaining PTFE at almost no cost, please send me an email: geraldrudick@gmail.com or implants@total.net. I will be happy to send you one of my published articles on where to get the membrane ……..please write " PTFE at Zero Cost" as the subject matter, so that I will recognize it.