Tips & Tricks: Primary Closure, Membrane Stabilization, & Membrane Placement

Primary Closure

• The use of a non-resorbable monofilament suture is recommended; resorbable sutures that lose tensile strength during the initial 2-week healing period can lead to premature membrane exposure.
• Monofilament sutures are preferred for their non-wicking properties.
• Adequate flap release must be accomplished in order to achieve tension-free primary closure.
• Vertical incisions, if used, must be remote from the location of the membrane.
• A dual-layer closure with a deep layer of horizontal mattress sutures followed by a standard wound closure with interrupted sutures, is highly recommended.

Membrane Stabilization

• Titanium-reinforced PTFE membranes may be stabilized with sutures, tacks, or screws.
• Membrane stabilization is often critical in larger and vertical defects
• The membrane is fixed first on the lingual/palatal side using titanium pins or 3 mm titanium screws on at least two points.
• The bone graft is then placed into the defect and the membrane is folded over and fixed with additional titanium pins or screws.
• The membrane has to be placed to account for the future bone height and width, and the graft has to completely fill the created space to support the membrane.
• Self-drilling screws are preferred over screws that require a pilot hole for ease of placement.
• While self-drilling screws and tacks/pins can generally be used interchangeably, self-drilling screws have the advantage of not requiring a mallet; yet, tacks/pins have the advantage of not twisting thinner collagen membranes.

Membrane Placement

• Titanium-reinforced PTFE membranes may be cut to a desired configuration. Titanium is easily cut with sharp scissors. After trimming, there should be no sharp corners or rough edges. To enhance space-making capability, the material may be curved over the fingertips or a sterile instrument handle to create a 3D shape. The membrane should be trimmed to extend 3-4 mm beyond the defect margins to provide adequate protection of the bone defect and enhance membrane stability. The membrane should be trimmed to remain at least 1 mm from adjacent, uninvolved teeth. Trimming of the membrane close to the titanium frame or excessive bending of the frame back and forth can increase the risk of membrane delamination. Sections of the membrane that become delaminated during placement should not be used. In rare instances, the titanium frame may perforate through the PTFE material during handling. If this occurs, the membrane should not be used.