In the second of our series of blog posts exploring the use of EthOss with other emerging technologies within the dental sector, Dr Peter Fairbairn takes a look at the benefits of combining EthOss with titanium membranes
Do I ever recommend using membranes with EthOss? My usual answer to this would be a straight “no” but that isn’t always true. It would be more accurate to say that I never recommend using a collagen membrane with EthOss, however, this would not always apply to titanium mesh membranes.
In some extreme cases, particularly on the posterior mandible, there is a strong argument for using titanium mesh membranes to increase the stability of the graft site and reduce soft tissue pressure. Whilst I don’t use these techniques very often myself I know a lot of other clinicians who do and they seem to get strong results. It is an area I’m interested in exploring myself more.
Using regenerative materials like EthOss in combination with titanium mesh membranes is particularly interesting. The titanium membrane can provide a very stable environment for the graft, allowing for impressive host bone regeneration in a single procedure (albeit with a second surgery necessary to remove the membrane).
“Stable” is the keyword here. I often say in my lectures that stability is a prerequisite for successful grafting. Many factors can influence the stability – the size of graft placed, flap design, suture technique, muscle tension on the site (more an issue on the mandible), the graft material used – it is a long list. If you don’t have a stable graft site then you can lose volume and potentially suffer micromovements between the graft particles, a key contributing factor to soft tissue ingress.
Titanium membranes can therefore obviously be a big help in increasing stability in challenging areas. However, we are doing this at the expense of a) incurring a second surgery to remove the membrane and b) placing a barrier between the periosteum and the graft site. The periosteum is a miracle of nature and is vital to regeneration, bringing the blood supply (including the BMPs) to the healing site. It is for this reason that I suggest using titanium mesh membranes with the largest holes possible, maximising the potential for vascular ingrowth.
If you are interested in exploring these techniques for yourself then please look through our “EthOss Case Studies” group on Facebook.
You should also watch the webinar by Dr Nicholas Widmer (Switzerland) from the EthOss Academy. Nicholas specifically looks at his experiences of using EthOss in combination with titanium mesh membranes and it was exciting to see his successful case studies. He also gives a fantastic live demonstration showing you how to apply the EthOss and place the titanium membrane. Watch now – (skip to 37:24)