WITHOUT FLAP ELEVATION, NON-PRIMARY CLOSURE
Courtesy of Matthew Fien, DDS, Plantation, FL
A contained extraction socket should be filled with bone graft to the height of crestal walls. BioXclude should be placed on top of bone graft material with minimal flap reflection.
Place dry, untrimmed 8x8 mm (anterior), or 12x12 mm (posterior) BioXclude using dry forceps. Orientation during placement does not matter. BioXclude may be placed UP or DOWN.
BioXclude will hydrate and adapt to bone particulate. Drops of irrigant can speed up membrane hydration. Damp gauze can be used to help adapt BioXclude over the underlying graft while absorbing excess fluids.
It is easiest to not manipulate the membrane, and instead suture from the inside of the socket (connective tissue side, out) to avoid nicking the membrane first. Using this reverse, inverted suturing method in a figure 8 (one for an anterior site; two for a posterior site) will approximate the tissues over the membrane. A PTFE suture is recommended. Continue to blot with damp gauze as needed. [link to suturing video]
Use a wetted instrument (Buser periosteal elevator works well), to tuck the edges of BioXclude as necessary. BioXclude only needs to be 1 mm under the gingival margin.
WITH FLAP ELEVATION, NON-PRIMARY CLOSURE
Courtesy of John Kim, DMD, MS,
Rocky Mount, NC
Rocky Mount, NC
- Note the necessity to overbulk the buccal defect with bone allograft, due to the likelihood of resorption (see photos)
- Choose BioXclude size to extend over all graft materials, and onto native buccal bone; over the crest, and tucked lingual
- BioXclude is placed last, after all bone particulate is placed.
- BioXclude is brought to the site dry, and held in place with cotton forcep
- Monoject syringe with sterile saline is used to hydrate BioXclude.
- BioXclude will naturally adapt and adhere to bone particulate
- A damp gauze may be pressed against site to absorb additional fluid, if necessary.
- After vertical release(s) are sutured, non-primary closure is obtained using 4.0 PTFE suture, and a reverse figure eight technique. [link to suturing video]
Appearance During Healing With Non-Primary Closure
Courtesy of Jin Sub Oh, DMD, MS, Mount Kisco, NY
2 Weeks Post-Op
"Is It Gone?" No - Healing Just Looks Different
Courtesy of Michael D'Hondt, DDS, La Crosse, WI
Post-Operative Guidance When Left Exposed To The Oral Environtment
For the first 3 days, the patient should refrain from rinsing, sucking, and spitting. Overly aggressive rinsing with any solution during this early phase of healing can dislodge BioXclude.
Oral rinses are used to kill bacteria. To varying degrees, oral rinses adversely impact the health of gingival cells, thus slowing wound closure. Fortunately, Purion® processed amnion-chorion allografts have demonstrated natural anti-microbial / anti-bacterial properties.
After 3 days, gentle rinsing with tap water may commence for the next 4-7 days. Only tap water should be used during this timeframe. At 10 days, the patient may begin using an oral rinse for plaque control.