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E | A Intraoperative fitting of the customized titanium scaffold- see the extensive deficiency in the alveolar ridge . | B The augmented site with autologous bone chips mixed with Geistlich Bio-Oss ® granules in a 50:50 ratio augmentation . | C Geistlich Bio-Gide ® membrane is used to cover the customized mesh . | D Protection of the soft tissue edges , after suturing , using a dressing template . | E Radiological evaluation after insertion of implants into the regenerated alveolar ridge .
Photo : Amely Hartmann , Private Practice Dr . Seiler and colleagues exposure , and if it happens , you will keep it under control . There will be more frequent visits , and patients should be reassured that they can contact you if they have questions or problems . There is always benefit in having this dialog with patients in the beginning .
Is it possible to reduce the risk of exposure ?
Definitely . The risk for exposure depends a lot on the surgeon ’ s experience in following the protocols .¹ Today I have much less exposure than when I started . I use a two-step suturing approach , with resorbable sutures first and then non-resorbable sutures on top , without any tension . I also use Geistlich Bio-Gide ® to cover the mesh , and a wound dressing template . It is important to look at the soft tissue vascularity and biology . Our general protocol involves Geistlich Bio-Oss ® and autologous bone in a 1:1 ratio .
When was the last time you dealt with exposure ?
Three months ago . I had a patient with exposure in the augmented area in the maxilla . We maintained and controlled the exposed area for half a year . There was no infection , and no huge bone loss after removal of the mesh , so implants were placed as planned .
In general , in cases with major infection , I prescribe antibiotics . But usually cleaning the mesh is enough . And if we have more bone loss after mesh exposure , I use Geistlich Bio-Oss ® granules for alignment .
Are there situations in which you must do something immediately ?
Yes , for example , when there is an infection , or when there is a lot of food impaction . Then I clean the site with saline solution and prescribe antibiotics to control the situation . But I have never removed the mesh just because of exposure .
References
In case of exposure and inflammation , we may partialy lose bone . Early exposures with infection are more dangerous and should be watched carefully . But even then , we will not lose all the bone , but only a small part . And then , after we remove the mesh , a small GBR for alignment is usually enough . ⁷ Re-suturing , re-opening , and early removal of the mesh are the most common mistakes in dealing with exposures .
Is “ patience ” the right plan in other exposure scenarios other than Yxoss CBR ® ?
I remember some cases of membrane exposure with bone blocks . With blocks , revascularization is difficult . You may lose the block . So the problem is bigger , and an intervention more necessary .
1 Hartmann A , et al .: Clin Implant Dent Relat Res . 2021 ; 23 ( 1 ): 3-4 . ( clinical study ) 2 Hartmann A , Seiler M .: BMC Oral Health . 2020 ; 20 ( 1 ): 36 . ( clinical study ) 3 Hartmann A , et al .: Implant Dent 2019 ; 28:543-550 . ( clinical study ) 4 Sagheb K , et al .: Int J Implant Dent . 2017 ; 3 ( 1 ): 36 . ( clinical study ) 5 Chiapasco M , et al .: Clin Oral Implants Res . 2021 ; 32 ( 4 ): 498-510 . ( clinical study ) 6 Volkmann A et al .: Implantologie 2020 ; 28 ( 1 ): 79 – 86 . ( clinical study )
7 Seiler M et al .: J Oral Sci Rehabil 2018 ; 4 ( 1 / 2018 ), 38-46 . ( clinical study )
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