GUIDE Membranes
Depending on the indication, defect type and the preferences of the clinician, membranes with specific mechanical properties as well as resorption patterns may be favorable. botiss offers two native collagen membranes, Jason® membrane and collprotect® membrane. Jason® membrane is obtained from porcine pericardium and due to the preservation of the biomechanical properties of the tissue during manufacturing, the membrane has a naturally long barrier function and multidirectional tear resistance. On the contrary, collprotect® membrane is made of porcine dermis. The membrane is characterized by a natural compact collagen structure and a mid-term barrier function.
If a membrane of non-animal origin or with higher form stability is preferred, permamem® (non-resorbable) or NOVAMag® membrane (resorbable) may be chosen. permamem® is a very thin high-density PTFE membrane, whereas in contrast to collagen can be left exposed during socket and ridge preservation procedures, however requires removal after healing. On the other hand, NOVAMag® membrane is produced from pure magnesium metal. Due to the inherent properties of magnesium metal, the membrane is mechanically strong yet degradable. Thus, a second surgical intervention for removal is not necessary.
collprotect® membrane is an allrounder that can be used for all common regenerative dental surgical procedures but because of its shorter barrier function in comparison to Jason® membrane, it is the membrane of choice for the regeneration of smaller to middle-size defects, as well as periodontal defects. On the contrary, the naturally long barrier function of Jason® membrane is especially beneficial for the regeneration of larger defects or in more extended augmentative procedures. Moreover, application of the very thin Jason® membrane is preferred in patients with a thin biotype, especially where tension-free closure of the flap tends to be difficult.
Although permamem® can be used in the same indications as resorbable (collagen) barrier membranes, due to the distinctive material properties, permamem® may be preferred in some indications, e.g. for the regeneration of bone defects outside the ridge contour, because of its higher form stability. Compared to collagen membranes, permamem® has superior space-maintaining properties and capacity for cell occlusion. In socket and ridge preservation permamem® can be left exposed for open healing as it acts as an efficient barrier against bacterial and cellular penetration thanks to its dense structure. For augmentation outside the ridge contour or generally when a space-maintaining membrane is required, the synthetic NOVAMag® membrane can also be a suitable choice.
The exposure of native collagen membranes should be avoided since fast occurring bacterial resorption significantly reduces the barrier function of the membrane. Due to its low thickness, Jason® membrane is particularly prone to premature (bacterial) degradation in case of exposure. In situations of incomplete or unstable wound closure due to insufficient flap mobilization, covering of the membrane with collafleece® may protect the healing area and promote a fast secondary healing and wound closure. If open healing in socket or ridge preservation is intended, the use of a non-resorbable membrane such as permamem® is recommended.
Placement of a collagen fleece (e.g. collafleece®) prior to the application of bone grafting materials can protect the Schneiderian membrane from damage, especially when working with granules. If a minor perforation of the Schneiderian membrane has occurred, a collagen membrane (e.g. collprotect® membrane or Jason® membrane) may be used to cover the perforation1.
All botiss membranes can be positioned with either side facing towards the bone defect and soft tissue, respectively. Although Jason® membrane exhibits one rough and one slightly smoother surface microscopically, corresponding to the inner and outer surface of the natural pericardium, the membrane may be placed facing whichever way around without affecting the clinical outcome. Since the stability of the membrane depends on the architecture of the collagen fibers rather than the outer and inner surfaces, the membrane can be placed in either direction.
collprotect® membrane and Jason® membrane can be applied dry or after hydration in sterile saline solution or patient blood. Nevertheless, cutting the membranes is easier in a dry state. For better adhesion, the membrane can be wetted shortly prior application but in many cases it is placed in dry condition and without fixation. Placement of a dry membrane gives stability and allows easy filling and contouring of the defect while in the meantime the membrane starts to hydrate and can easily be folded over the defect. In many cases, Jason® membrane and collprotect® membrane may be used without fixation but the immobilization with sutures, pins and screws is also possible. Furthermore, fixation of the membranes can also help to prevent dislocation/migration of bone substitute particles.
permamem® does not require hydration prior to use. To ensure membrane stability and protection of the bone grafting material, permamem® should be placed in such a way that the membrane extends three to four millimeters beyond the edges of the bone defect. A minimum distance of one millimeter to the adjacent teeth should be maintained. It is recommended to fix permamem® by sutures, screws or pins. Additionally, in open healing procedures (i.e. socket/ridge preservation), the membrane may also be passively immobilized by sutures. It is also recommended to immobilize the NOVAMag® membrane on both sides of the defect (orally and buccally) with screws or sutures to avoid micromovements. Please find more handling tips on the NOVAMag® surgical guide.
The collagen membranes from botiss (Jason® membrane, collprotect® membrane) and also NOVAMag® membrane are completely resorbed by the body. Therefore, a surgical removal is not required. Nevertheless, permamem® is made of non-resorbable high-density PTFE and should be removed in accordance with the indication after healing.
1 Cuadrado-González L, Jiménez-Garrudo A, Brizuela-Velasco A, Pérez-Pevida E, Chávarri-Prado D, Diéguez-Pereira M, Pacho-Martínez JM (2018) J Oral Implantol. Aug;44(4):301-304.
