Study

The use of permamem® as an occlusive barrier for alveolar ridge preservation

Original Title: THE USE OF A NON-ABSORBABLE MEMBRANE AS AN OCCLUSIVE BARRIER FOR ALVEOLAR RIDGE PRESERVATION: A ONE YEAR FOLLOW-UP PROSPECTIVE COHORT STUDY

Papi P, Di Murro B, Kubilius R, Tromba M, Carmine Passarelli P, D´Addona A and Pompa G. 2020. Antibiotics 9(3). pii: E110.

https://pubmed.ncbi.nlm.nih.gov/32138241/

Objective: Test the clinical efficacy of permamem® in alveolar ridge preservation
To obtain preliminary data and test the clinical effectiveness and efficacy of permamem® (d-PTFE membrane) in alveolar ridge preservation procedures with a flapless approach.

Methods:
Socket sealing with intentionally exposed permamem® without socket grafting
A traumatic extraction was performed in the premolar maxillary area of 15 patients, and permamem® was used to seal the alveolar cavity: no biomaterial was used to graft the socket and the membrane was left intentionally exposed and stabilized with sutures. The membrane was removed after four weeks and dental implants were placed four months after the procedure. After 4 months the ridge width and height and keratinized mucosa width were measured.

Results:
Stable bone ridge width and height after 4 months
After tooth extraction, healing was uneventful and membranes were removed non-surgically without anesthesia after four weeks. No bacterial infection was detected in any of the cases treated. The mean width of the alveolar cavity was 8.9 ± 1.1 mm immediately after tooth extraction, while four months later a mean reduction of 1.75 mm was experienced. A mean vertical reduction of 0.9 ± 0.42 mm on the buccal aspect and 0.6 ± 0.23 mm on the palatal aspect were recorded at implant placement.

Mean horizontal bone loss after four months was 1.75 mm, while a recent systematic review -Jambhekar et al. (2015) – reported a mean loss of 2.79 mm after the same interval for flapless extractions with spontaneous healing. Mean mid-buccal vertical height loss was 0.9 mm, compared to the median 1.74 mm loss reported by the above mentioned review for the studies with no intervention.

Successful implantation and good clinical results
High primary stability of dental implants installed: they reached all values of insertion torque greater than 35 Ncm, with also ISQ values > 65 at baseline and after one year of functional loading. Mean keratinized mucosa width value was 2.37 ± 0.89 mm at baseline, while four months later, an average of 3.5 ± 1.26 mm was measured.
As for peri-implant clinical and radiographic parameters, the mean probing pocket depths (PPD) values were 2.55 ± 0.65 mm after one year with no significant increase (p > 0.05) from PPD-baseline (2.25 ± 0.45 mm). Mean marginal bone loss (MBL) was 0.22 ± 0.13 mm, while bleeding on probing was negative on all implants.

Conclusion:
Effective alveolar ridge preservation

permamem® proved to be effective in alveolar ridge preservation, with the outcomes of the regeneration not affected by the complete exposure of this biomaterial.

Advantages of socket preservation with permamem®:
permamem® avoids the necessity of obtaining a primary closure, allowing complete exposure of the membrane, with no need for large flaps or vertical releasing incisions.
The antibacterial properties of the membrane lower the need for systemic antibiotic therapy. Only prophylactic antibiotics were prescribed in this study, with no need for full antibiotic coverage.
The absence of a graft material inside the socket shortens treatment times because there is no need to wait more than four months for surgical re-entry.

Piero Papi

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