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ePaper created 2017-01-11, 10:22:38 | version 1.38.0
Journal of Oral Science & Rehabilitation 24 Volume 2 | Issue 4/2016 O p e n h e a l i n g : A r e t r o s p e c t i v e a n a l y s i s reportedwithclosedhealingtoo.Inastudyusing NBCM in periimplant defects, Zitzmann et al. found wound dehiscences in 16% ofthe defects atthetimepointofsutureremoval.16 VonArxand Buser reported a complication rate of 9.5% duringhealinginhorizontalridgeaugmentation.1 The sites re-epithelized spontaneously within two to four weeks and the authors concluded that the membrane did not cause infections when exposed. Moses et al. found wound dehiscences in 39% of patients treated with cross-linked col- lagenmembranes.21 Inamulticenterrandomized, controlled clinicaltrial, bone augmentation pro- cedures using DBBM and NBCMwere applied in 90% of 208 patients undergoing immediate implant placementwithtransmucosalhealing.24 After one week, flap dehiscences were noted in 12% ofthe cases. After two weeks, the percent- age had decreased to 6.0% and after six weeks to 1.5%, indicating proper secondary healing even in the case of membrane exposure. In the retrospective analysis presented here, the over- allcomplication rate of9.4% indicatesthat open healing is not associated with an increased risk of healing complications compared with closed healing. Studies have indicated that native col- lagen membranes mayfacilitate angiogenesis.25 and allow for less compromised wound healing in comparison with cross-linked collagen mate- rials.19 Therefore, native collagen may promote uneventful soft-tissue healing under open- healing conditions too. Apart from material- relatedwounddehiscence,iatrogenicfactorslike suturetechniquemayplayanevenmoreimport- ant role, but to our knowledge, no study has reported on the rate and effect of tensionless wound closure compared with flaps under ten- sion. However, further studies are needed to investigate wound healing when the flap is not closed over the membrane. Owingtothelargevarietyofdefectmorphol- ogies, no clear correlation could be found bet- ween defect morphologyand healing complica- tions, although there was a small trend for a highercomplication rate in defectswith a higher number of missing bone walls. However, the positive outcomes for all defect morphologies indicatethat open healing is not limitedto a cer- tain defect type. While NBCM was applied in most of the areas, a few other materials were used too. The number was too small to draw a clear conclusi- on on possible differences in healing between thesedifferentmembranetypes.Furtherstudies are necessary to compare the suitability of vari- ous membranes for open healing. Conclusion The retrospective analysis of patients treated in a private practice indicates that open healing using suitable membrane materials allows un- eventful healing and sufficient bone formation. Thereby, soft-tissue problems associated with extensive flap mobilization and tension may be avoided.Therewasnocontrolgroupandthedata set included different indications, defect mor- phologies and defect sizes. While this limits the power of the study, it reflects the situation in private practice. Furthermore, if open healing allowsforachievinggoodresultsinanonuniform patient group, one may conclude that it could have the potential to become a general clinical option. Prospective studies with control groups are needed to further investigate this surgical approach. Competing interests The author declares that he has no competing interests.