I placed bone grafting on the left alveolar ridge in sites 18 and 19 for implants 8 weeks ago. The PTFE membrane was covered with the flap, but has become exposed measuring 10mm x 5mm. I am reluctant to recover with another flap procedure and thinking that I may remove the membrane to allow for the mucosa to cover the exposed bone naturally. Has anyone experienced this? Any suggestions?
It appears that the bone grafting took as when I apply pressure to the membrane, it is solid and the xrays show bone formation.
Thanks for your input!
this commonly happen to PTFE membranes. Do not try to “recover” w/ another flap. once the PTFE is exposed there’s bacteria and biofilm on the PTFE membrane. no use trying to obtain a primary closure again. that will NOT work. Just leave it exposed. and make sure pt has good OH and chlorohexidine rinses to keep bacteria count low. soft tissue will granulate under the PTFE membrane after another 4 weeks. so just leave it alone. as long as you don’t have infection and the graft takes, tissue will grow between the membrane and graft by secondary intention. you can check w/ a probe and poke through the membrane. if you get bleeding after 4 weeks then you can remove the membrane carefully. if you don’t get any bleeding that means the graft either failed or no tissue has grown to cover the graft. so just wait for another 2-3 weeks. only thing you can do is wait.
What you see on radiograph is just the graft you placed showing up as radiopaque. new bone will not form or consolidate till after 4-6 months.
good luck
2 Likes
also after you do get bone consolidation which usually takes 6-9 months from grafting. Dont forget you still need to do FGG b/c there are no keratinized tissue at all which determines the health of your implants in the future.
2 Likes
Remove the membrane and allow healing to continue. You likely have a soft tissue covering over the bone under the membrane already at this point. This soft tissue will likely keratinize to become gingiva so grafting may not be needed. I do agree a gingival margin around the implants is really important.
1 Like
I rarely ever use a PTFE membrane but my understanding is that this is normal. Recall the old socket graft protocol where they would intentionally leave these things exposed and then just remove them at 3-4 weeks only to discover an epithelial covering over the graft material. I would remove it now and then plan on doing a connective tissue graft at the time of implant placement because Teng is right about no soft tissue… the soft tissue is actually more important to the long term success. The epithelial lining that forms between the membrane and the graft will cover the material and protect it after membrane removal but it is not of adequate thickness for long term success so I would suggest planning for a soft tissue augmentation procedure either via a connective tissue graft or a free gingival graft.
1 Like
