Titanium-reinforced Membrane: Am I Required to Tack this in Place?

Last Updated: Nov 15, 2010

Dr C asks:
I performed lateral GBR [Guided Bone Regeneration] in the mandible to increase the crestal bone width in the #19,20 area [mandibular left first molar and second premolar; 35, 36] about 4 months ago. After de-corticating the buccal cortical plate at the graft site and placing Puros [Zimmer], I covered the surgical site with titanium-reinforced membrane. I felt I was able to adequately stabilize membrane with flap and sutures. I obtained tension free primary closure with no problem. The patient returned for 2 and 6 six week follow-ups with no problems. The patient came in last week for the final exam prior to implant placement. The patient has developed a soft tissue infection in the area with a draining sinus tract right over the crest of the ridge more towards the adjacent tooth #21 [mandibular left first premolar; 34]. The only thing I can think of is that the membrane has been moving since it was not tacked in place. Is it always a requirement with a non-resorbable membrane to tack in place? Anyone have any similar experiences? Any thoughts or ideas on what has happened?

11 Comments on Titanium-reinforced Membrane: Am I Required to Tack this in Place?

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Ljungberg

11/16/2010

How you mean by "titanium-reinforced membrane"?? Do you mean Gortex?? This type of membrane must be tacked in my opinion. Once it was exposed, even it was an invisible fistula after would closure, it must result in failure.

Dr. C

11/16/2010

PTFE membrane with Titanium reinforcement.

Dr. Jim Cope

11/17/2010

The titanium 'struts' that give shape and stability to the membrance can also give place to a biofilm deep into the graft site.

Dr. Shalash

11/17/2010

Had the exact same problem when was doing lateral GBR in The anterior maxilla. The co. does claim that the membrane can be stabilized without tacks. i experienced infection after a few weeks and when the membrane was removed there was no bone regeneration at the site. we all learn from our mistakes and now i know that definitely u would have to tack it in place!

psbudi

11/17/2010

I always tacked non reorbable membrane, be careful with sharp edges of the membrane.

King of Implants

11/18/2010

I tack 75% of my resorbable membranes and have seen a huge improvement in my results since I started this a couple of years ago. I tack 100% of the non-resorbable. Fugazotto has some very good studies out that indicate the need to tack membranes for optimal results.

Peter Fairbairn

11/18/2010

Guys, you still using traditonal membranes? not used one in the last 800 GBR cases.. Peter

Rob Smith

11/27/2010

2 questions: 1)I thought PTFE membranes titanium reinforced membranes were the best to use. Am I wrong? 2)Do you place just one tack at the apical end of the membrane or do you place multiple tacks to really make sure it is solid?

Dr. Vaziri

11/28/2010

Titanium reinforced membrane would get in touch with root of the ADJACENT TOOTH, so the must lagical reason would be for infection the area. Hopefully help. Dr. Vaziri from Iran Tehran.

Richard Hughes, DDS, FAAI

11/28/2010

Tack the membrane.

Richard Hughes, DDS, FAAI

11/28/2010

Two tacks usually will do!

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