Use of NO‐resorbable dPTFE membranes in preservation of the alveolar ridge‐ a case report

Abstract

Background: After the extraction, a biological remodeling phase of the alveolar ridge follows, resulting in resorption both vertically and horizontally. To a large extent, this has the effect of installing a dental implant in a correct 3D position. In order to maintain the width and height of the alveolar ridge, a large number of operative techniques for preserving the extraction wound are used. In our article, a preservation technique is presented using the NO-resorptive dPTFE membrane and xenograft. Aim/Hypothesis: Use of bone substitutes in combination with the NO-resorbable dPTFE membrane are examined, for preservation of the extraction socket. We expect to preserve the dimensions of the alveolar ridge in the vertical and horizontal direction in order to place the implant in the correct prosthetic position. Materials and Methods: At the University Dental Clinical Center “St. Pantelejmon – Skopje”, an intervention was performed for preservation of the alveolar ridge in the upper jaw after extraction, in projection of the premolar region. Alveolar preservation was performed using bovine xenograft (cerabone®, botiss biomaterials GmbH). Each preserved socket was covered with ultra-thin (˜0.08 mm) dPTFE membrane (permamem®, botiss biomaterials GmbH) and it was fixed with individual sutures (silk 3/0 Astra Med). The installed non-resorbable membrane was removed after 4 weeks without any additional surgery and the wound was left to heal freely, giving instructions to the patient to maintain oral hygiene by rinsing his mouth twice daily with 0.1% chlorhexidine gluconate. CBCT was performed before the time of tooth extraction and after 6 months from the application of the graft material. With this CBCT we measured the changes of the alveolar ridge and we accurately determined the extent of its dimensional remodeling. Results: Although the NO-resorbable membrane was left uncovered during wound healing, the patient showed no clinical symptoms such as pain, swelling, infection, allergic reaction, or loss. After removal of the membrane in the fourth week, a young granulation of NO-epithelial tissue was observed under the NO-resorbable membrane itself. Six months after the placement of the dental implants, complete healing and integration of the bone graft material was observed, and the performed CBCT images showed minimal remodeling in both horizontal and vertical direction of 1.5 mm. Conclusions and Clinical Implications: The use of NO-resorbable dPTFE membranes, which allow open healing of extraction wounds, in combination with bone substitutes of xenogenic origin, gives predictable and reliable results in the preservation of extraction wounds with minimal bone loss. Keywords: preservation of the alveolar ridge, NO-resorbable membrane