The membrane I would recommend is something that is impervious to bacteria and comes in different sizes that are readily available, so that it allows for anything from a single-tooth extraction to a larger ridge augmentation. I prefer the Cytoplast Barrier Membrane (Osteogenics Biomedical, www.osteogenics.com). This membrane is manufactured by high-density PTFE and is specially engineered to withstand exposure. It offers predictability and increases the band of attached tissue so it’s good for esthetics as well. It avoids releasing incisions and displacement of other keratinized tissue, which is what would be obtained when trying to obtain primary closure.
ID: How do you ensure these materials integrate properly when it comes to preparation and compatibility with the patient?
Dr. Holtzclaw: In my practice, implants and their related procedures account for 95% of production. Proper site development for the future placement of implants is paramount, not only in terms of a successfully osseointegrated implant, but also in terms of optimal esthetics and functionality.
Dr. Hill: You want the membrane to be recipient to the site. You want it to be conducive to tissue growth and to preserve soft-tissue architecture, and you want it to be “tissue-friendly” to properly integrate. A non-resorbable, high-density, titanium-reinforced PTFE membrane can be trimmed, shaped, and adapted or modified in a way that allows and protects additional space for bone growth, making it ideal for the patient.
ID: Do you find that some products do not do what they claim, or would you try new methods or products for this procedure?
Dr. Pulver: There are a lot of products out there that I haven’t used. I’m still waiting for the perfect material that would allow us to leave a larger gap and allow for predictable bone healing. The whole idea with membrane placement is that it inhibits the fast-growing epithelial in-growth into the slow-growing particulate bone graft. If you can create an environment that encourages bone to grow, stimulate bone growth, and avoid the influx of epithelial tissue, it’s creating an environment conducive to a better volume and better quality of bone for the implant.
Dr. Wade: Even with products that claim they don’t need primary closure, they do desire that you get primary closure whenever possible but in some of those situations, we have really stretched the product’s capabilities and it’s come through very well. Among a multitude of clinicians, there’s always going to be controversial opinions but this has been successful for us for quite some time. When primary closure is essential, most surgeons have the capabilities to move a flap to gain primary closure where and when it’s absolutely necessary, but without going through further surgery, these barriers have worked really well for us.
Dr. Holtzclaw is a stock shareholder in Snoasis Medical.