Can Membrane Exposure Change the Results?

  


Bone grafts have been used for some time in dentistry. This technology is especially used when the jawbone needs to be built up so that a dental implant can be placed in the jaw. Oftentimes, a membrane (mesh) of various materials is used to help guide the growth to ensure that the bone will be suitable for the implant. 

About Bone Resorption

After a tooth is extracted or lost, the jawbone under that tooth will be partially absorbed by the body. This loss could be as much as 25 percent in width, as well as a loss in height. In order for the tooth replacement to be at the correct height, the bone needs to be built back up and given time to adequately heal. This process is called ridge augmentation.

Bone loss may also occur as a result of the extraction. Some bone may have been removed for the extraction to take place. The remaining bone may not be enough to satisfactorily support an implant. A bone graft will be necessary to prepare the site for the implant.

Types of Bone Grafts

Bone grafts are made in several types. The dentist, along with the patient, may choose to use bone from the patient (autogenous), the bone that comes from a donor (allograft), the bone that comes from an animal (xenografts), or synthetic bone (alloplastic). Most synthetic bone is made from hydroxyapatite, but ceramics and bioglass types are increasing in use. 

The Bone Graft Procedure

After the gums are opened over the graft site, and the bone material introduced, dentists will often add a membrane over the site. It can be placed directly on the bone graft, or some space can be added below the membrane to develop a certain form or shape. This is called guided tissue regeneration (GTR). Growth factors may also be added to speed up the healing process. Once it is in place and firmly attached, the gums are closed on top of it and stitched together. 

Dentists use membranes to keep other types of cells (gum cells, etc.) out of the bone. This enables the bone to heal strong and to be able to support a dental implant. If other tissue cells get into the bone, it may result in a bone that is not as strong as it should be. This can occur because the cells of various types will compete for space. 

Two Types of Membranes

After a bone grafting, the dentist will often add a membrane to cover the graft. Membranes come in two different types – resorbable and non-resorbable. The resorbable type will simply be absorbed into the formation of the new bone. In some cases, it will be replaced as the new bone forms. The non-resorbable material requires that a second surgery be made later to remove it. 

Non-resorbable membranes have an increased risk of being exposed. This can cause infection. Their advantage is that they prevent soft tissue cells from getting into the bone for a longer period. Soft tissue grows faster than bone and it could be a problem. 

An Experiment

In order to test the benefit of membrane placement after a bone graft, a test was made with 14 participants. The bone graft was used to build up the alveolar ridge for dental implants. Each of the participants was given an allogeneic bone graft with a membrane using resorbable alloplastic materials. 

The participants were divided into two groups. Seven of them had successful primary flap closure and the membrane was not exposed – they were the control group. The other group did not have good closure and the barrier may have been exposed in the first week. They were the test group.

Measurements were taken of the ridge height and width at the time of the placement of the dental bone graft and at the opening of the site for the actual implant placement – four months later. When the measurements were retaken, it was discovered that there was a considerable difference in the reduction of the ridge during the healing time. The ones who had the membrane exposed had a greater reduction (4.7mm) during the healing period than the other group, which had an average reduction of just 3.1mm. 

The Implantation

At the end of the study, each of the participants did have the dental implants installed. Although one group had less bone, the implants were still successful. 

Another study indicated similar results. It revealed that in bone grafts where the membrane was not exposed, there was a 74 percent greater gain in horizontal bone growth than in cases where the membrane had been exposed. The bone also showed less loss in the event of peri-implantitis. 

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