BioMend : Features & Benefits
Placement and Suturing Technique
Given the membrane's ability to adapt to the tooth root and integrate with surrounding tissue, suturing the membrane in place is not always required. If suturing is desired, an absorbable suture of choice and noncutting needle can be utilized to secure the membrane. The suture must be absorbable to eliminate the need for a second surgical procedure for suture removal.
The membrane should be snug against the tooth root and draped over the surrounding alveolar bone to maintain regenerative space.
Placement and suturing technique will be demonstrated for several types of natural tooth defects commonly encountered in clinical practice.
Class II Furcation
GTR therapy is indicated for a Class II furcation on the facial aspect of a mandibular molar. Good interproximal bone height and long root trunks appear to increase the predictability of the procedure. This type of defect is well-suited to an apron-type configuration. The defect should be thoroughly debrided, paying particular attention to the furcation area. The BioMend membrane is trimmed with the aid of the template material, extending at least 3mm beyond the defect margins. For more information, see Surgical Procedure.
The modified membrane is placed into the defect site, avoiding salivary contamination. It should drape smoothly over the surrounding alveolar bone, maintaining space for tissue regeneration.
If sutures are utilized, an absorbable suture with a noncutting needle is required. The suture should engage the membrane approximately 2mm from the superior and lateral edges. The needle pierces the membrane at a buccal-lingual line angle and is slung around the tooth, engaging the opposite side of the membrane at a lingual-buccal line angle. The suture is passed back around the tooth and a knot is tied at an interproximal line angle. The coronal portion of the membrane should be snug against the tooth and inspected for folds, which are undesirable.
Primary closure over the BioMend membrane is very important. Gross exposure of the membrane to the oral cavity can result in premature degradation. The mucoperiosteal flaps should be coronally positioned over the membrane. A horizontal releasing incision may be helpful, although blood supply to the flaps should not be compromised. Supragingival extensions of the membrane are not recommended.
The incisions are closed using the suture of choice. Interproximal incisions closest to the material are done first, while any vertical incisions are closed last.
Care should be exercised to avoid disrupting the membrane during closure. Slight pressure with sterile gauze can be applied to the flaps for several minutes to ensure good adaptation and hemostasis, again avoiding disruption of the membrane.
Distal Defect
GTR therapy is indicated for a distal defect on a mandibular molar. A horseshoe-type or U-shape configuration is well suited, since no tooth adjoins the defect distally. Defects of this type may also extend into the furcation area. The defect is thoroughly debrided and the BioMend membrane is trimmed, as described in Surgical Procedure.
The membrane may be sutured into place using an absorbable suture with a noncutting needle via the sling-suture technique. The membrane is inspected for good adaptation to the tooth root and a lack of folds. Flaps are coronally positioned to ensure complete coverage of the membrane. Incisions are closed with the suture of choice. For more information, see Class II Furcation.
Interproximal Defect
GTR therapy is indicated for an interproximal defect. This type of defect can be treated by trimming an H-type configuration. The wound is thoroughly debrided, and the BioMend membrane is trimmed with the aid of the template material, as described in Surgical Procedure.
If the membrane is sutured into place, two options may be considered. The sling suture technique, using absorbable suture material with a noncutting needle (see Class II Furcation), can be applied to the tooth closest to the interproximal defect. Alternately, the membrane can be sling sutured around both teeth engaged by the H-type configuration. This prevents collapse of the membrane into the defect area.
The membrane is inspected for folds, and the mucoperiosteal flaps are coronally positioned over the material. Incisions are closed, as described in Class II Furcation.