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ePaper created 2014-11-07, 14:16:52 | version 1.30.01
I research Fig. 3_By bending the inner titanium frame, the desired room volume above the bone defect can be fixed and kept stable, similar to today’s commercial tent poles. Fig. 4_Patient with a clear buccal retraction of the processus alveolaris, about 18 years after loss of teeth and following bone resorption in regio 24, 25 as well as narrowing of gaps by a mesial migration of 26. Fig. 5_After implant insertion 24 and simultaneous augmentation of the buccal defect area by a mixture of autologous bone chips and Bio-Oss granulate with a particle size 0,25 to 1,0 mm, Fa. Geistlich Pharma AG, Wolhusen, Switzerland, a clear widening of the processus alveolaris is prepared and the desired bone regeneration is supported evidence-based. Fig. 6_After tailoring and examination, the Bio-Gide membrane is placed on the augmentation material. Already since 1996, I increasingly switched to the clinical application of collagen membranes. Besides theeffectivebarrierfunction,thegoodwoundhealing propertieswereandstillarethereasonwhyIamus- ing these materials almost exclusively for my pa- tients’ treatment now. Both the handling as well as the patient compliance is in most cases superior to the old methods using titanium mesh reinforced ePTFE membranes (Tab. 1 & 2). As Plöger described in 2003 already, natural col- lagen membranes do influence tissue integration in apositiveway.Amongstourtreatments,only1.5per cent of the cases of membrane application showed lowdehiscenceaftereightdaysandabout5percent after30days.Thiswasarevolutionaryimprovement compared to the titanium mesh reinforced, non-re- sorbableaswellasresorbableePTFEmembranes.Un- der a local antiphlogistic treatment, the lowly ex- posedcollagenmembranesdohealwithoutcompli- cations,whereastheothermembranetypesneedbe removedpromptlyincaseofawounddehiscence.In principle,allmembraneexpositionsorwounddehis- cenceareclinicallycontrollable.Buttheyalsorequire the frequent scheduling of patients and at least weeklyfollow-upsandwoundcleaning,whichisre- flectedbyalowerpatientsrating(Tab.1).Forthis,the reason can be seen in the fact that collagen chemo- tacticallyworksonfibroblastsandthusenhancesthe primary wound closure. Today it seems to be undis- putablethatitsupportsthedevelopmentandstabil- isation of the wound coagulum and promotes the proliferation, migration and adhesion of cells. Fur- thermore, when reducing the membrane materials thereisnoneedtofearirritationsofthetissuesorthe desired regeneration processes, which in contrast can occur for synthetic materials. In Table 3, the membrane materials used in my practice from 2001 until 2014 are listed with their different properties. In the direct clinical comparison, the handling of the native collagen membrane—in our case Bio- Gide® by Geistlich Pharma AG, Wolhusen, Switzer- land—was remarkably easier. After unpacking out of thedeliveredsterilebox,thismaterialcanbetailored without problems and thus adapted to the defect and configuration size (Figs. 4–6). Soaking or mois- tening with any liquids before application is not needed;shortlyaftertheapplication,themembrane material becomes saturated with the surrounding blood and the below defect area (Figs. 7 & 8). Re- gardless of autologous bones or bone graft substi- tutesofdifferentorigins,theadhesiontobonewalls and the adaption to the augmentation material is much better than for synthetic membranes—if it is possible at all. Thus, I used resorbable pins for mem- braneconsolidationonlyinthebeginningofmyaug- mentativework.Today,Iamadaptingthebarrierma- terial below the adjacent periost (Fig. 7). However, collagenmembranesdoalwaysneeddimensionsta- ble bone graft substitutes or autologous bones to prevent the room volume from collapsing. 12 I implants3_2014 Fig. 5 Fig. 6 Fig. 3 Fig. 4