This SEM view shows the micro-machined texture surface, which increases the area available for cellular attachment by 250% without increasing porosity.
CYTOPLAST® TITANIUM REINFORCED
THE ORIGINAL, PATENTED, HIGH-DENSITY PTFE MEMBRANE
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Cytoplast Q & A:
Alveolar Ridge Resorption
Ungrafted extraction sites heal by a physiologic remodeling process which results in the loss of as much as 40-50% of ridge height and 20-30% of ridge width in the first year following extraction.Progressive atrophy ultimately results in the thin,knife-edge ridge or total loss of the alveolar process.The complications of alveolar bone loss are well known.There is loss of prosthetic stability in the case of traditional removable prosthetics.In a fixed prosthetic reconstruction, the loss of ridge height may result in compromised esthetics, requiring over-contoured or long pontics. In cases where dental implants are planned, the loss of bone may require the placement of shorter or smaller implants or will require secondary bone grafting to provide adequate bone volume.
More than Just Tooth Loss
From the prospective of the patient, tooth loss is a complex event. There is fear of pain, aging, and loss of self-esteem as well. The ability of the surgeon to prevent the loss of bone which accompanies extraction is positively received by virtually all patients. Socket grafting is a high-value service which is ethically, biologically and physiologically sound.
Streamlined, Standardized Technique
While the benefits of ridge preservation with particulate bone replacement materials have been known for some time, technical problems associated with socket grafting have prevented its widespread use. The Cytoplast®Regentex technique has been developed specifically to solve these problems.
Problem 1:Particle Migration and Loss
The advent of biocompatible membranes for use in periodontal guided tissue regeneration inspired the development of this procedure. The use of dense PTFE barrier membrane serves two important functions. First, the barrier prevents graft particle migration in the early healing phase. Second, the barrier isolates and prevents soft tissue migration into the socket. The result: a modification of the healing process, using the concept of guided tissue regeneration, preserving the alveolar bone long-term.
Problem 2:Primary Closure
Obtaining primary closure over an extraction socket can be difficult and time consuming. The unique design of Cytoplast®Regentex barrier eliminates the need for primary closure. Less surgery is required; vertical incisions and flap manipulation are unnecessary. Since the membrane is non-resorbable, premature barrier degradation and particle loss are eliminated. Finally, since the membrane is left exposed, it is easily removed at the completion of the procedure by grasping with a tissue forceps and gently lifting it from the tissue bed. Barrier removal is accomplished in seconds, without surgery or local anesthesia.
Problem 3:Graft Material Selection
For ESR, the doctor only needs two materials. First is a non-resorbable graft such as dense hydroxylapatite or bioactive glass. This will result in low-term ridge maintenance and is best used under dentures and fixed prosthetics to preserve contour.
Resorbable graft materials such as anorganic bovine bone should be used when future implant surgury is planned. These materials facilitate complete bone healing, preserve ridge contour and improve bone density for implant placement.
This is a procedure that can be readily incorporated into the surgical practice. Patient acceptance is high. Doctor and patient satisfaction is maximized. The negative aspects of tooth loss are mitigated. Implant site development is facilitated and ridge contours are preserved for traditional prosthetic techniques, improving esthetics, form and function.
Q: How can this membrane benefit my periodontal patients and referring doctors?
A: There are three primary areas of benefit.
- Extraction site reconstruction (ESR)
- Use with endosseous implants in immediate implantation.
- Periodontal or periimplant defect repair.
Q: How does extraction site reconstruction fit within the periodontal practice?
A: This offers the periodontist/ oral surgeon an opportunity to repair large bone associated with the extraction of periodontally diseased teeth. These defects are often large and compromise adjacent teeth and may prevent future implant placement. Furthermore, severe bone loss associated with advanced periodontal disease makes the preservation of bone even more important for the referring doctor. Performing ridge reconstruction procedures at the time of extraction is a proven method of preserving bone mass and should eventually become standard practice.
Q: I've worked with GoreTex®. What about soft tissue coverage of the membrane?
A: Cytoplast membranes have been designed to use in procedures where soft tissue coverage is lacking. The membrane simply serves as a barrier to contain the ridge preservation material and prevent soft tissue ingrowth. In three to four weeks the membrane can be removed. Primary coverage in this case is not only unnecessary, it is not desirable. Exposure of the membrane does not result in infection and case failure, because the design of the biomaterial takes the reality of membrane exposure into account. Of course if primary closure and longer healing times are desired, that is at the discretion of the clinician.
Q: OK, so now that I know which membrane to use, how do I select an augmentation or grafting material for extraction sites?
A: One should be comfortable with selection of bone augmentation materials and their appropriateness for use use in different types of cases. For example, in cases where implants are to be placed within a few months following extraction, a resorbable material such as freeze dried bone and/or bovine bone could be used. In cases where long term ridge preservation is desired, such as under a fixed or movable prosthesis, then a non-resorbable material should be used such as a dense hydroxlyapatite particle. Remember, resorbable materials will generate bone faster, but some ridge bulk will be lost due to remodeling whereas the dense materials will offer long term ridge maintenance.