JIACD
The Journal of Implant & Advanced Clinical Dentistry
GBR techniques: Whats your protocol
Sat, 01/31/2009 - 13:19 — Dr90210
Looking for protocols on GBR? I would like to see what works for people. I myself use a modification of Hom Lay Wang's sandwich technique. I use DFDBA mixed with FDBA and I place bio-oss over that. It works great. I tend to cover it with a bio-mend or bio-guide membrane. I wait 6 months before I place the implant.
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GBR Technique: FDBA or Puros, Calcium Sulfate, Flagyl,
I tend to use FDBA or Puros, calcium sulfate mixed with flagyl. It gives me like a putty. I cover with biomend extend. I get consistent results and can build out about 4mm.
Primary wound passive closure is critical.
GBR technique: FDBA, BioOss and Gem 21
I get consistent results with FDBA, BioOss and Gem21. I can build out consistently 4mm of ridge width. I usually us a bioguide membrane.
I have not tried regenerform....whats the deal on it?
Jase: Regenaform for GBR, a follow on question for you?
Dear Jase,
I to use Regenaform and I get great results. Although I have a little different protocol then yours. I use a resorbable membrane and I always go for primary closure. Sometimes I use some tenting screws but most of the time I dont. I have some questions for you on your technique:
1) Your using cytoplast membranes with regenaform and you don't get primary closure, does it stay open for the duration of healing or do you find the soft tissue grows over the membrane?
2) How long do you wait before you re-enter the site using your protocol? 4 months? 6 Months?
Thanks in advance
Regenaform and Cytoplast: I love this stuff
1) Cytoplast dPTFE membranes are dense PTFE membranes. Because it is a dense barrier membrane,unlike Gore's ePTFE, there is no risk of bacterial invasion or epithelial downgrowth to your graft site. The soft tissue may regenerate somewhat over the membrane, but it will not generally grow over the membrane. This allows for a non-surgical removal of the membrane, with little to no anesthetic required. Remove the membrane after 3 to 4 weeks. The soft tissue will regenerate over the socket at a rate of about 1mm / day once the membrane is removed. You will be amazed. go to www.cytoplast.com. 2)5.5 to 6 months is indicated for Regenaform to regrow bone. But it is usually 100% vital bone at that time if used correctly. Regenaform holds a patent on DFDBA, cortical and cancellous chips. Once the collagen carrier becomes vascularized, it is truly the ultimate bone graft choice, osteoinductive, osteoconductive, and with a Cytoplast barrier membrane and good blood supply, becomes osteogenic.
Regenaform and Cytoplast: a response to Jase and a question
Dear Jase,
I understand the science behind cytoplast and use it on occasion but you didnt answer my question. Are you leaving the cytoplast membrane in place for the full 6 months with your regenaform technique or are you removing it 3-4 weeks as you say? And if you do leave it for 6 months do you get soft tissue closure over the cytoplast. I would think there could be issues with what amounts to an open GBR technique.
3-4 weeks may be to early to remove, the classic GBR studies had you remove the eptfe after 6 weeks, but some authors like Tinti would leave in for 6 months.
I know the difference between the EPTFE and Dptfe so you dont need to touch on that, I just have some concerns doing GBR with regenaform and not attempting primary closure. I would think there could be issues with what amounts to an open GBR technique with the cytoplast.
Thanks
Remove the membrane in 3 to 4
Remove the membrane in 3 to 4 weeks(21 - 28 days).
BECAUSE it is DPTFE you don't have to have primary closure. The very fact it is a dense membrane is what allows you to do that. When you remove it at 3 - 4 weeks, you will find a highly vascular, osteoid matrix. At about 6 weeks, keratinized gingiva will have formed over the grafted socket.
The bone still needs to heal for at least 5-6 months anyway. If you can get primary closure that's great! There is just an option out there if you can't. As long as you do not have any preforations or wrinkles in the membrane, you can leave the membrane exposed. Look at the case studies on their website, it is a proven technique that if done correctly, works everytime.
Regenaform and cytoplast
Jase thanks for your response. I will have to give your technique a try. I have used cytoplast in extraction sockets and understand the rational for leaving it uncovered. I have to say I have been uneasy trying it with traditional GBR (non extraction sockets) since in residency I was taught that primary wound closure is so important.
Ill give it a shot.
Thanks
Brooke
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GBR Techniques: Dynablast putty is a nice material
I tend to favor block grafting but as of late I got some great results with dynablast putty. The handling properties are great and its easy to use. You need to wait about 6 months before you go back in otherwise it may be on the soft side. Which is why I favor blocks since I can go back in at 4 months.
GBR Techniques
I tend to favor FDBA, I usually mix it with PRP and I cover it with a TI Reinforced Goretex membrane. I am old school with the goretex membranes. I know many people use collagen membranes, but I get consistent results with the goretex, and if you manage your tissue effectively, they will not expose.
GBR Techniques
It depends on the size of the defect. If the defect small and has 3 walls remaining then you can pretty much use FDBA with a resorbable collagen membrane. I am not a fan of sandwiching techniques, too much inventory and the you don't know which material is actually responsible for the regeneration. So clinician try to put everything in the defect and hope for the best. In larger defects I have had great results with rBMP Infuse with ti mesh and resorbable collagen membrane.