Lists and uses of different kinds of dental membranes
Dental membranes have many uses in our field and the variety of types can be overwhelming.
Why use a dental membrane?
There are many types of membranes that we use in many different ways. Different doctors have different preferences and that is typically why one gets use over the other.
- Need them to help contain graft material. A membrane may be all we need to exclude the soft tissue and let bone form, especially in the case of socket preservation post extraction.
the barriers alone produced better clinical results than grafts+barriers or grafts alone. It could be argued that the protective, space-making effect of the barriers on the blood clot inside the socket and on the remaining bone walls outside the socket is responsible; ie, the barrier, acting as a shield, could enhance the physiologic healing process, minimizing bone loss and maximizing bone repair, with a resulting net effect of improvement versus untreated extraction sockets in terms of bone height and width.
it could be argued that socket preservation techniques are effective regardless of whether primary flap closure is achieved
Allograft dental membrane
Allograft dental membranes are those that are of human origin.
Alloderm by Biohorizons – regenerative tissue matrix
Perioderm by Dentsply – acellular dermal allograft that is derived from donated human skin
Puros Dermis by Zimmer – assume same above
Puros Pericardium by Zimmer – allograft
BioXclude by Snoasis – allograft amnion and chorion tissue. This membrane can tolerate some exposure and has growth factors. If doing GBR then need collagen under it if there is some exposure. For basic socket preservation can have exposure like this video. It is great for socket grafting and sinus perforations. Not much evidence though.
- No need to trim
- No orientation, may be folded onto itself
- Place DRY, very last when bone graft particulate is in place
- Once placed, have an assistant use a blunt instrument(like a #9 periosteal) to apply pressure in the center of the BioXclude membrane.
- Continue suctioning near adjacent tooth/incision so that the site is not too wet
- As asst. holds the graft in place, tuck buccal/lingual. (a small, curved curette works excellent.)
- Use REVERSE suturing (from the inside-out;), to avoid nicking the membrane
- Reverse, figure-eight suturing (on the horizontal plane) is ideal. Tie at the buccal. PTFE suture is recommended
- BioXclude can be left exposed, however no rinsing, swishing, spitting for 3 days post-op, and NO Chlorhexidine(Peridex) or any OTC mouth rinses for 10 days post-op. Tap water only
Pericardium membrane
CopiOs by Zimmer – bovine pericardium
Puros Pericardium by Zimmer – allograft
Metal and metal reinforced membranes
Print a custom titanium mesh like Yxoss CBR from ReOss. Kurtiş JOI 2023 shows same process.
Dentoalveolar Bone Fixation System by Synthes Dento – Ti mesh with fixation screws
Stryker by Medpor – Ti with polyethylene mesh
Cytoplast Ti reinforced – Although primary closure in ridge augmentation procedures is recommended, Cytoplast® Ti-250 membranes incorporate a high-density PTFE base that is engineered to withstand exposure as long as soft tissue has 360° coverage around the edges of the membrane. The textured Regentex™ surface increases the surface area available for cellular attachment, thereby assisting in stabilization of the membrane and prevention of soft tissue retraction.
Pro-fix by Osteogenics – Tenting and retention screws
Collagen membrane
Cross-linked membranes can elicit more of a host response. Non-cross-linked are therefore more “biocompatible”. However, this may be due to the method of cross-linking. Gluteraldehyde cross-linking can induce more inflammation. Other methods such as ribose cross linking may not elicit the same response. Cross-linking helps with vertical gains in VBA GBR. Urban JCP 2019
Biomend and Biomend Extended by Zimmer – purest bovine Type 1 collagen
CurV Presahped Collagen Membrane by Zimmer – type 1 collagen derived from bovine Achilles tendon
Socket Repair Membrane by Zimmer – Type I Collagen
Bio-Gide by Geistlich – bilayer pure collagen membrane composed of both a smooth and rough layer. The smooth upper layer is a catalyst for the attachment of fibroblasts that lead to favorable healing of the gingival tissue. The dense porous layer acts as a guide for osteoblasts. So smooth layer goes up.
Bio-Gide Compressed is popular for GBR Urban and Dan Hsu
Mem-Lok by Biohorizons – highly purified type I collagen fibers
Vitala by Osteogenics – porcine derived collagen membrane
ConForm™ Membrane by Ace Surgical – Type I bovine collagen
RCM6™ by Ace Surgical – highly purified Type I Collagen
Mucograft by Osteohealth – collagen matrix
Fibro-Gide Nice to bulk out buccal defects. Puterman IJRPD 2022
Another case of buccal bulking using fibro-gide Artzi IJROD 2022
Ossix Plus by OraPharma – Porcine-derived collagen 4-6 months that uses ribose cross linking vs glutaraldehyde cross linking that some use. Maggie Misch uses here GBR:Membrane selection Dentistry Today
Ossix Volumax Ossix (ribose cross linked) can be used for minor GBR case. Chackartchi IJRPD 2022 On videos it appears ribbed side is on the tissue side.
Ez Cure by Biomatlante – porcine epidermis derived collagen
Genoss Collagen membrane by Dentium – bovine type 1 collagen .3mm thick
Renovix by Salvin – type 1 porcine
Creos Xenoprotect by Nobel case by Moishe
Mineralized collagen membrane
OsteoGen has a lot of cool videos from Robert Miller with fixing some implant issues. Miller says need to saturate strip in the autologous plasma to make his version of sticky bone.
OsteoGen strips – interesting idea about placing against the bone and overgrafting on top of it. Post number 7.
Bio-Oss collagen
Synthetic dental membranes – PLA and PTFE
Guidor by Sunstar- bilayer polylactic acid (PLA) = PLLA?
Gore Resolut by Gore – PLA discontinued
Atrisorb by Citagenix – PLA flowable 9-12 months
Epi-Guide by Kensey Nash – D, D-L, L polylactic acid – barrier for up to 20 weeks with complete bioresorption between 6-12 months
PLGC – poly L-lactide-co-glycolide-coepsilon- caprolactone = poly(lactic acid-co-glycolic acid-co-ε-caprolactone)
PLGA – same PLGC without the C, poly(lactic acid-co-glycolic acid
Cytoplast by Osteogenics – dPTFE membrane
PTFE Barrier Membrane by ACE through Henry Schein – dPTFE membrane
TR-PTFE by Osteogenics – titanium reinforced dPTFE membrane (Henry Schein is cheaper)
PEG polyethylene gel – experimental synthetic hydrogel (Not any more – see below)
Membragel by Straumann – polyethylene glycol (PEG). Its gelification is activated by the combination of PEG A (containing acrylate as terminal functional group), PEG B (containing thiol as terminal functional group) and activators A (viscosity modifier) and B (isotonic chemical solution creating an optimal pH to start the chemical reaction).
The chemical components of PEG A and PEG B create a molecular network of PEG, that acts as a barrier and avoids the migration of soft tissue cells; in the meanwhile it remains permeable to nutritional substances.
Research
TR-PTFE more bone but less dense than PLGC for lateral defects
Collagen Plug
OraPlug by Salvin- collagen absorbs in 10-14 days
Foundation by JMorita- collagen based
Zimmer products all 10-14 days
CollaCote by Zimmer – Palatal donor sites and Mucosal flaps
CollaPlug by Zimmer – Biopsy sites and Extraction sites
CollaTape by Zimmer – Closure of grafted sites, Repair of Schneiderian Membranes and Minor oral wounds
Osteophealth products all 10-14 days,HeliPLUG®, HeliTAPE® and HeliCOTE® are absorbable collagen wound dressing
HeliPLUG – Biopsy sites and Extraction sites
HeliTAPE – Repair of Schneiderian Membranes
HeliCOTE – Palatal donor sites and control bleeding