Membrane exposure : complication or not ?
“ Treating dehiscences requires time and patience .”
Amely Hartmann | Germany Oral surgeon , Private Practice Dr . Seiler and colleagues , MVZ GmbH , Germany
Interview conducted by Marjan Gilani
Amely Hartmann is an oral surgeon who has contributed to the clinical development of Yxoss CBR ® since its early days .¹ She answered our questions about membrane exposure after major bone augmentation with 3-D printed mesh .
Dr . Hartman , let ’ s start with a frequently asked question : how predictable are implants placed in regenerated bone with 3-D mesh technique ?
Dr . Hartmann : The implants are very predictable . Different studies show implant placement is possible in 100 % of cases ,² - ⁵ with an implant survival rate of almost 98 % after 5 years of follow-up .³ And this is no surprise – implants are predictable since we place them in the patient ’ s own , regenerated and vital bone . In practice it is easy to see the stability and vitality of bone volume when the implants are inserted .
“ Membrane exposure doesn ’ t necessarily mean complications .”
Does the etiology of the defects affect the success rate ?
In my experience , etiology does not play a major role , though scars from previous surgeries may lead to more difficulties when handling soft tissue .
Still , dehiscence is a complication that can occur during major bone augmentation with Yxoss CBR ® …
No therapeutic approach in such a difficult area is without disadvantages . But morbidity is lower with Yxoss CBR ® compared to harvesting bone blocks from intra- and extraoral donor sites or the iliac crest . Exposure occurs in 20 – 30 % of cases with Yxoss CBR ® , but we have shown this doesn ’ t have an impact on the survival rate of implants and long-term clinical outcomes .
What does this mean ?
One factor is time – when exposures occur . ⁵ Early exposure happens within the first four weeks after surgery , mostly due to wrong surgical handling of the soft tissue and putting too much tension on it .
To avoid this , wound closure should be without tension . I always insert additional deep sutures with resorbable materials . Early exposure may also happen when the soft tissue edges are not well protected by the dressing template ( suck down splint ), so the patient can play with their tongue in the area . It is why using a dressing template has positive effects .
When the early exposure happens , we visit the patient in closer time intervals , e . g . weekly , and clean the area with the saline solution without disturbing wound healing .
On the other hand , the exposures which happen later are often due to mechanical factors e . g . when the patient has no pain , feels good , and gets careless during the healing period . In this scenario , I prescribe 0.05 – 0.1 % Chlorhexidine solution which patients can use for disinfecting the area on their own .
Once exposure occurs , when do surgeons need to wait and see , and when do they need to intervene ?
We should remember that exposure doesn ’ t necessarily mean complications . Of course , we hope no exposures occur , but I personally do not panic if they do . When we panic we may immediately want to re-suture or remove the mesh , which are more harmful . Instead , we should have the patience to wait . But , of course , we must deal with infections .
How do you discuss exposure with your patients ?
Well , you must talk to them in advance – tell them that there is always a risk of
20 GEISTLICH NEWS 1-2022