Belleggia Fabrizio
Private Practice, Rome, Italy.
Clin Adv Periodontics. 2025 Jun;15(2):139-149. doi: 10.1002/cap.10298. Epub 2024 Jun 10.
Vertical ridge augmentation (VRA) requires long healing times for bone maturation. This case study deals with the intentional early removal of a titanium-reinforced dense polytetrafluoroethylene (TR-dPTFE) membrane that allowed for treatment times reduction and improvement of bone quality.
A TR-dPTFE membrane was used for VRA in the premolar region of the upper right maxilla. The defect was filled with a mix of particulate autogenous bone and porcine xenograft in a 1:1 ratio. After a 4-month uneventful healing period, the membrane was removed, and the thick keratinized palatal tissue was moved toward the buccal side via a pedicle flap. Implants insertion and healing abutments application were carried out 3 months later, when bone graft could have been revascularized and nourished by the periosteum.
The histologic evaluation of a bone sample harvested during implant bed preparation revealed a huge amount of mature newly formed bone even in the most coronal part. Two screw-retained crowns were delivered 2 months after implant insertion and the 3.5-year follow-up showed perfectly maintained hard and soft tissues.
Intentional early removal of TR-dPTFE membrane after a 4-month healing time, with simultaneous soft tissue augmentation via a buccally reposioned pedicle flap, allowed graft revascularization from the periosteum, and resulted in optimal quantity and quality of the regenerated bone. This process shortened the overall treatment times, taking only 9 months from VRA to prosthetic loading. Both augmented hard and soft tissues allowed for crestal bone maintenance around implants.
Titanium-reinforced dense polytetrafluoroethylene (TR-dPTFE) membranes, due to their closed structure, do not allow the passage of cells and vessels from the periosteum, and revascularization from the residual bone alone is not enough for proper graft maturation and long-term crestal bone maintenance. Early removal of TR-dPTFE membrane allows graft revascularization from the periosteum, and results in optimal quantity and quality of the regenerated bone. Increasing the thickness of the soft tissues, increasing the width of the keratinized mucosa, and repositioning the mucogingival line, via a free gingival graft or a pedicle flap, should be performed simultaneously in the membrane removal phase to reduce the number of surgical interventions, decrease patient morbidity, and shorten the total treatment time.
垂直骨嵴增高术（VRA）需要较长的愈合时间使骨成熟。本病例研究涉及有意早期移除钛增强致密聚四氟乙烯（TR-dPTFE）膜，这使得治疗时间缩短且骨质量得到改善。
在右上颌前磨牙区使用TR-dPTFE膜进行VRA。用1:1比例的自体颗粒骨和猪异种移植物混合物填充骨缺损。经过4个月的平稳愈合期后，移除膜，并通过带蒂瓣将厚的角化腭组织向颊侧移动。3个月后进行种植体植入和愈合基台安装，此时骨移植可能已通过骨膜重新血管化并获得营养。
在种植窝制备过程中采集的骨样本的组织学评估显示，即使在最冠方部分也有大量成熟的新形成骨。种植体植入2个月后戴入两颗螺丝固位冠，3.5年的随访显示软硬组织完美保持。
在4个月愈合时间后有意早期移除TR-dPTFE膜，同时通过颊侧复位带蒂瓣进行软组织增量，使移植物通过骨膜重新血管化，并导致再生骨的数量和质量达到最佳。这个过程缩短了总体治疗时间，从VRA到修复体加载仅需9个月。增加的软硬组织都有助于维持种植体周围的牙槽嵴骨。
钛增强致密聚四氟乙烯（TR-dPTFE）膜由于其封闭结构，不允许细胞和血管从骨膜通过，仅靠剩余骨的重新血管化不足以实现移植物的适当成熟和长期牙槽嵴骨维持。早期移除TR-dPTFE膜可使移植物通过骨膜重新血管化，并导致再生骨的数量和质量达到最佳。在膜移除阶段应同时通过游离龈瓣或带蒂瓣增加软组织厚度、增加角化黏膜宽度并重新定位膜龈线，以减少手术干预次数、降低患者发病率并缩短总治疗时间。
