Using
Implantation – is a surgical manipulation which involves placing the dental implant into bone tissues of the jaw. During planning of such operation, quantity and quality of the bone is the deciding factor. If available volume is not enough, bone tissue augmentation is required.
To provide optimal augmentation conditions, barrier membranes are being used.
Importance of their usage is associated with different regeneration speed of bone and soft tissues (connective tissue, epithelium). In case of germination of connective tissue or epithelium into the graft region, conditions for the subsequent prosthetics deteriorate.
Membrane is located between gums and bone, and separates soft tissues (periosteum, mucous membrane) from the graft or bone defect. It protects the bone from lysis by osteoclasts (which are located in periosteum) and lets bone tissue to grow freely under the membrane; performs function of separation and strengthening of bone substitutes.
Augmentation with usage of resorptive xenomembranes (derma, pericardium, peritoneum) has its advantages over unresorptive membrane utilization – additional surgical interference (to remove the membrane) is not required. The period of resorption is from 12 to 24 weeks. This is enough to create a new high-quality bone.
Membranes made of cell-less cryolyophilized xenotissues do not provoke inflammation processes and allergic reactions. Additionally, membrane performs a role of isolation, which doesn’t let external microorganisms to seep into graft area.
Usage of the membrane successfully militates bone atrophy, prevents its loss and provides good conditions for further dental implantation.
Cryolyophilized xenomembranes usage indications:
- Prevention of bone atrophy after tooth extraction
- Fixation of bone substitutes granules during jaw bone augmentation
- As a strengthening measure during implantations with simultaneous augmentation
- Root shunting during periodontal diseases treatment
Main aspects of working with membranes:
- Membrane must fully cover the graft, so should be quite larger than augmentation area
- Membrane fixation should be performed with titan pins, screws or sutures to the fixed marks in operation area, like bone or periosteum
- Mucous patch should be treated gently, so it can cover xenomembrane without extra tension
- Right thickness of the membrane should be picked, so it won’t resorb until a new bone tissue is formed
Operation protocol: under local anesthesia, incision from mucous membrane to the bone is performed, with next detachment of mucosal membrane from periosteum. After placing of bone substitutes granules into defect area, barrier membrane (porcine xenoderma) is used to cover the former. Membrane is fixated with titan screws to the periosteum and adjacent teeth. Mucous patch is relocated to its original place and the wound is sutured.
Implant is placed into alveolus of previously extracted tooth.
Wound is covered with xenoderma membrane
Situation after 6 months. RG-supervision
Sinus-lifting was performed
Bone material augmentation with simultaneous implants setting
Processus alveolaris is covered with lyophilized peritoneum membrane
Gingival recession is a pathological process that involves gingival margin retraction and exposure of the tooth root. Nowadays surgical method is main in the treatment of this decease. Most options of surgical treatment require usage of autotransplants (tissues from the same patient) or xenoimplants (tissues from other biological species). Guided tissue regeneration with resorbable and unresorbable membranes is the most common method.
However, protocols which include autotransplants or unresorbable membranes require additional surgical trauma, caused by autotransplant preparation or removing of the unresorbable membrane.
We have researched usage possibilities of cryolyophilized xenoimplants from porcine derma, peritoneum and pericardium as resorptive membranes during guided tissue regeneration treatment of gingival recessions.
With this goal in mind at our facilities (LLC “Institute of Biomedical Technologies” Ternopil, Ukraine) in 2017, quality management system has been implemented and medical products are certified to meet the requirements of DSTU ISO 13485:2005; EN ISO 13485: 2012.
Cryolyophilized xenoimplants technological process of production is as follows: xenopatches from porcine tissues (derma, pericardium, peritoneum) are prepared right after slaughter, then cryoconservated in liquid nitrogen, lyophilized in sublimation chamber, all according to instructions. After lyophilization, xenopatches are packed, sterilized by the radiation method and contained in dry conditions at 25 C°. Shelf life of the product is up to 3 years.
Operation protocol sample: under local anesthesia, intrafissural incision is performed, with next detachment of mucosal membrane from periosteum. Lyophilized xenotissues membrane (1mm thickness) is cut to have the same shape as the operation field. Then in is fixated to periosteum with vicryl sutures and covered with mucosal patch. Single nodule seams are used to fixate the patch. After 7 days, superficial sutures are removed.
Results: patients have been examined on 5th, 7th, 10th and 14th day and 3 months after operation. Gingival biotype thickening has been noted. Gingival attachment size was increased by 0,5-0,7 mm. These facts imply that pathological process has been stabilized and gingival recession is not progressing any further.
Summary: Cryolyophilized xenoimplants of porcine derma, pericardium and peritoneum can be successfully used as membranes during guided tissue regeneration treatment of gingival recessions.
