permamem® is an exceptionally thin, non-resorbable and biocompatible membrane. It is composed of biologically inert, high-density polytetrafluoroethylene (PTFE), which acts as an efficient barrier against bacterial and cellular penetration, and can therefore be used for open healing in certain indications. In addition, an easy removal of the membrane is enabled as no adjacent tissue grows into it. permamem® maintains its structural characteristics both during the initial implantation and over the whole healing time 1, 2.
OPEN HEALING IN SOCKET AND RIDGE PRESERVATION
Since permamem® can be used for open healing in socket- and ridge preservation, primary wound closure is omitted and the soft tissue contours are maintained 3, 4. The missing flap closure avoids displacement of the mucogingival line thus preserving the attached gingiva. Likewise, the aesthetic outcome is improved as the non-surgical removal of the membrane after the healing time omits the need for big surgical incisions. After removal of permamem®, the primary healing process and the re-epithelialization of the regenerated soft tissue is completed within about one month.
permamem® shows good handling properties thanks to its thin character (thickness ~ 0.08 mm). The rounded edges of the membrane avoid traumatization of the soft tissue. The membrane can be cut to the desired shape and size with a pair of scissors or a scalpel while maintaining sterility. 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.
permamem® should always be immobilized at the recipient site by pins, screws or sutures. For socket and ridge preservation, permamem® can be sutured to the periosteum or a periosteal flap to achieve a tight adaptation of the membrane to the recipient site.
permamem® should be removed in accordance with the indication. For extraction socket regeneration procedures, the membrane can be removed after three to four weeks. In case of larger bone defects and augmentations with bone substitute material, the membrane can usually be removed after approximately six months. The blue color allows for easy recovery of the membrane. In open healing procedures, permamem® may easily be removed after the desired healing time in a non-surgical way with a pair of tweezers. If primary closure is obtained during membrane placement, opening of the surgical site will be required to remove the membrane. If permamem® becomes exposed because of a flap dehiscence, the membrane does not necessarily need to be removed immediately and may be left in place as it provides a barrier against bacterial penetration.
Management of soft tissue dehiscence
In case of a flap dehiscence, permamem® does not necessarily need to be removed immediately and may be left in place as the membrane provides a barrier against bacterial penetration protecting the underlying bone from bacterial colonization. The membrane can be left in place if a) no swelling and/or infection is present and b) if the margins of the membrane are still covered by the flap. The patient should be enrolled in a continuous recall to monitor the exposure (weekly control) and should be instructed to rinse with antiseptic mouthwash (0.2% Chlorhexidine) every eight hours.
permamem® is provided in the following dimensions:
15 x 20 mm
20 x 30 mm
30 x 40 mm
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permamem® is made of high-density polytetrafluoroethylene (PTFE), which is a non-resorbable, biologically inert and biocompatible material. The membrane fulfills the requirements of biocompatibility according to EN ISO 10993 and EN ISO 7405. The membrane comes into contact with bone and soft tissue and is categorized as a medical device Class IIb for continuous use for more than 30 days according to Directive 3/42/EEC.
Due to its inertness and denseness, adjacent soft tissue will only attach superficially and will not grow into or over the membrane. Therefore, a non-surgical removal of the membrane is possible in open healing procedures. Similarly, in case of a secondary exposure, i.e. a flap dehiscence, there will be no re-epithelialization over the membrane.
Thanks to its unique structure permamem® prevents bacterial biofilm formation on the exposed outer membrane surface when permamem® is used for open healing (or got secondarily exposed due to a flap dehiscence). Thus, during membrane removal the risk for contamination of the augmented area by accumulated plaque is reduced and in addition, the retrieval of the membrane is facilitated.
For the regeneration of bone defects outside the ridge contour, permamem® may be preferentially used because of its higher form stability. In socket and ridge preservation permamem® can be left exposed to the oral cavity as it acts as an efficient barrier against bacterial and cellular penetration thanks to its dense structure. Due to its synthetic character, permamem® is the membrane of choice for the treatment of patients with dietary or religious conflicts.
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Gergely Z et al. 2019 Rehabilitation of vertical ridge defects with a tent-pole approach utilizing a new generation high-density polytetrafluoroethylene membrane. Proof of concept and volumetric evaluation. /Case report of 7 cases/. Poster Osteology Barcelona
Palkovics, D., Bolya-Orosz, F., Pinter, C., Molnar, B., & Windisch, P. (2022). Reconstruction of vertical alveolar ridge deficiencies utilizing a high-density polytetrafluoroethylene membrane /clinical impact of flap dehiscence on treatment outcomes: case series/. BMC oral health, 22(1), 490. https://doi.org/10.1186/s12903-022-02513-7
Papi, P., Di Murro, B., Tromba, M., Passarelli, P. C., D’Addona, A., & Pompa, G. (2020). The Use of a Non-Absorbable Membrane as an Occlusive Barrier for Alveolar Ridge Preservation: A One Year Follow-Up Prospective Cohort Study. Antibiotics (Basel, Switzerland), 9(3), 110. https://doi.org/10.3390/antibiotics9030110
Zafiropoulos, G. G., Kačarević, Z. P., Qasim, S. S. B., & Trajkovski, B. (2020). Open-Healing Socket Preservation with a Novel Dense Polytetrafluoroethylene (dPTFE) Membrane: A Retrospective Clinical Study. Medicina (Kaunas, Lithuania), 56(5), 216. https://doi.org/10.3390/medicina56050216