Osseoseal Collagen Membrane, a collagen membrane derived from purified porcine pericardium, is a great option for GBR when looking to contour and “seal” off particulate bone graft in a self-containing defect. The following case demonstrates how to properly handle and apply the Osseoseal Collagen Membrane.
An implant was placed in site #7 with an existing buccal bone defect (Pictures 1 & 2). Prior to placing the bone graft over the implant, the membrane is measured and trimmed and tucked under the palatal flap trying to avoid wetting the entire membrane (Picture 3). The particulate bone graft (DALI Classic Cortical Cancellous Mix) is placed over the implant surface to restore the defect (Picture 4). The membrane is folded over the crest and onto and slightly beyond the particulate bone graft while slowly dropping saline onto the membrane (Picture 5). This enables the membrane to contour and drape over the graft and “seal” the graft off from the surrounding soft tissue (Picture 6 and 7). Sutures are then used to achieve primary closure over the GBR site (Picture 8).
That looks good and due to the thick overlying soft tissue this should do great. I wouldn’t be too concerned with a 6 month sagittal view as fixtures placed with a facial dehiscence seem to hold up well so long as the overlying soft tissue is thick and healthy. Also if you look at the teeth on either sider you will notice dehiscence on both which tells me that the graft will likely flatten out to match the adjacent anatomy. This should not be a problem because the soft tissue is healthy. I have found soft tissue health to be of greater importance than bone volume as a predictor of implant success. Nice!!
Can you give some insight to your decision process?
I am new to implants, but have learnt the following principles that the based should ideally be wider of the flap, so wondering if there was a reason I don’t know about for why this wasn’t the case here?
Also could this have been achieved with just an envelope flap? Without relieving incisions?
