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Dental Implant Resorbable Membrane Question
Dr. Huang asks:
Is it necessary to put a resorbable membrane over the Titanium mesh + bone grafting for GBR before dental implantation?
Periostum is a GBR membrane -like tissue for bone augmentation, isn't it? Are bone graftings with allograft/Xenograft or autogeneous grafts different approaches for this GBR technique?
April 3, 2006 in Techniques and Procedures | Permalink
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Comments
"Periostum is a GBR membrane", true! But only periostum! Not othes tissues.
Posted by: DrTooth | Apr 5, 2006 1:14:28 AM
If we can maintain bone graft and blood clot under the mesh, the resorbable membrane is not neccessary.
Posted by: Ajou | Apr 5, 2006 1:52:54 AM
i would line the underside of the titanium mesh with a membrane like neomem, but for the outerside, primary closure with a full thickness flap is all you need. if the titanium mesh starts to "show" thru the gingival tissue, do not panic, just snip away the excess and smooth edges-continue with peridex rinses.
Posted by: scott hamblin | Apr 5, 2006 9:20:51 AM
IF YOU GET PRIMARY CLOSURE WITH YOUR FLAP´S SUTURES, AND THE BONE GRAFT IS WET ENOUGH WITH BLOOD, YOU MIGHT NOT NEED ADDITIONAL SUPPORT OF ANY MEMBRANE BUT THE TITANIUM MESH. PERIOSTIUM IS A WELL NATURAL BARRIER. HOWEVER, IF YOU NEED A MEMBRANE FOR ADDITIONAL AIDS, IT SHOULD BE LOCATED IN THE INTERNAL SIDE OF THE TITANIUM MESH.
Posted by: ANTONIO DÓLERA, DDS | Apr 5, 2006 1:32:59 PM
Whose mesh and screws do you prefer and why?
Posted by: jml | Apr 5, 2006 5:13:42 PM
What's the Neomem ?
What's the difference between resorbable membrane insertion under and above the titanium mesh?
I had some case just put fast resobable TeruPlug(some kinds of collage sponge or tape)to prevent gingival cell early ingrowth. Is it stupid to do that?
Posted by: Ajou | Apr 5, 2006 11:55:39 PM
The placement of a titanium mesh is a delicate procedure, it works very nice to restore the integrity of a ridge with defects or when elevating the height of a ridge at the expense of a screw.
If you are thinking of using one it means you are familiar with the manipulation of soft tissues and split thickness techniques for extra tissue and tension free primary closure.
I recomend you use nylon 5.0, it is the nicest suture I have ever use for implant dentistry, nicer than vycril and goretex, make sure after you suture, you put security stitches as far from the incision area as possible, they will hold any tension from the manipulation of the soft tisues the patient may do.
It usually should have a membrane under the mesh (if you put it on top you will have to remove extra bone when you re entry the site), the periosteum will do the work but a good midterm resorvable membrane will help even nicer, specially when you are looking for extra height. Biomend from tutogen (zimmer) or a good membrane from ACE will do it.
Clorhexidine is a questionable solution to use unless you get it free of alcohol (in spain and colombia is available alcohol free) or if you mix it with water, one third of clorhexidine and two of water.
also, about the question of fixation screws, you need to be familiar with their use too, you can learn and practice in baby ribs.
If it gets exposed, pray, just kidding, you got to handle it, usually getting the exposed edges removed or softened, and AB, I like to use a lot of saline for a long time instead of clorhexidine.
I hope this is helpful.
Dr Ordonez
Posted by: alvaro ordonez | Apr 14, 2006 11:19:01 PM
By the way,
I have been using a titanium mesh from IMTEC ffor the last 7 years with great results, it is unexpensive and good. I recomend it to anyone who needs a mesh, it is small, about the size of a periapical film.
Posted by: alvaro Ordonez | Apr 14, 2006 11:21:53 PM
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