BioXclude Frequently Asked Quesitons
SIMPLE. VERSATILE.
How do I Bill for BioXclude?
As of 2019 CDT coding standards, BioXclude is to be coded separately from bone graft. It may be coded as D4266- Resorbable Membrane; OR as D4265- Biologic Materials.
The code choice will be based on application, and practice preference. In general, D4266 is more likely to be covered by insurance than D4265, which will typically be a set patient fee.
Fees for a barrier membrane for socket preservation typically range from $200 - $500, based on practice demographics and preferences.
The code choice will be based on application, and practice preference. In general, D4266 is more likely to be covered by insurance than D4265, which will typically be a set patient fee.
Fees for a barrier membrane for socket preservation typically range from $200 - $500, based on practice demographics and preferences.
Why Can't I Use OTC Rinses or Chlorhexidine Post-Operatively When BioXclude is Left Exposed?
There are two reasons:
(1) Is simple mechanical disruption. When a patient is told to "rinse" with a product, they tend to do so more vigorously. All rinsing/swishing/spitting should be avoided for 3 days post-operatively; followed by tap water rinses only for the following 7 days post-operatvely.
In general, the use of Cholorhexidine post-surgically has decreased due to literature indicating that it inhibits fibroblast activity. Specifically, regarding use wth BioXclude, the issue is that Chlorhexidine's cationic nature causes it it bind with the proteins in BioXclude.
Remember BioXclude is inherently antibacterial, and therefore decreases concern experienced with other exposed materials.
(1) Is simple mechanical disruption. When a patient is told to "rinse" with a product, they tend to do so more vigorously. All rinsing/swishing/spitting should be avoided for 3 days post-operatively; followed by tap water rinses only for the following 7 days post-operatvely.
In general, the use of Cholorhexidine post-surgically has decreased due to literature indicating that it inhibits fibroblast activity. Specifically, regarding use wth BioXclude, the issue is that Chlorhexidine's cationic nature causes it it bind with the proteins in BioXclude.
Remember BioXclude is inherently antibacterial, and therefore decreases concern experienced with other exposed materials.
Is BioXclude Post-Operative Appearance Normal or Could it be an Infection?
This requires a full examination and is ultimately determined by the clinician. However if the patient is not demonstrating any typical signs of infection, (i.e., fever, erythema, purulence, etc.), and the sole concern is the membrane appearance, please note that BioXclude can have a "milky", opaque appearance in some patients post-operatively when left exposed. This seems more prevalent in smokers and slow healing patients; however, this is still considered a "normal" healing appearance.
Appearance During Healing
Using BioXclude with Non-Primary Closure
Using BioXclude with Non-Primary Closure
Variation in healing appearance, including translucent, opaque, and yellowish appearance, are all normal and common.
4 day post-op
Anthony Del Vecchio, DDS
3 day post-op
Dan Holtzclaw, DDS, MS
4 day post-op
Anthony Del Vecchio, DDS
4 day post-op
Dan Holtzclaw, DDS, MS
10 day post-op
Mathew J. Fien, DDS
2 week post-op
Dean Licenblat, BDent, MSc
2 week post-op*
(*pt is a smoker)
(*pt is a smoker)
Vinay Bhide, DDS, MSc
10 day post-op
Vinay Bhide, DDS, MSc
Is BioXclude Gone at Post-Operative Evaluation?
BioXclude can sometimes appear translucent post-operatvely. If you can see particulate bone graft, but there is not substantial sequestered graft material, your membrane is likely intact, as demonstrated in this 4 day post-op patient:
4 day post-op
Anthony Del Vecchio, DDS
4 day post-op
Anthony Del Vecchio, DDS
If graft material is lost, see suturing technique recommendations, as that is a common culprit.
Post-Operative Guidance
When the membrane is exposed to the oral environment:
Post-Operative Guidance
When the membrane is exposed to the oral environment:
Appearance During Healing
Using BioXclude with Non-Primary Closure
Using BioXclude with Non-Primary Closure
Variation in healing appearance, including translucent, opaque, and yellowish appearance, are all normal and common.
4 day post-op
Anthony Del Vecchio, DDS
3 day post-op
Dan Holtzclaw, DDS, MS
4 day post-op
Anthony Del Vecchio, DDS
4 day post-op
Dan Holtzclaw, DDS, MS
10 day post-op
Mathew J. Fien, DDS
2 week post-op
Dean Licenblat, BDent, MSc
2 week post-op*
(*pt is a smoker)
(*pt is a smoker)
Vinay Bhide, DDS, MSc
10 day post-op
Vinay Bhide, DDS, MSc