I see new regenerative techniques appearing that would allow horizontal and vertical regeneration, deliberately leaving exposed membranes.
We started with PTFE membranes, now we’re at “occlusive titanium membranes” or something like that.
It seems that this bogey soft tissue management scares a lot of people and I honestly don’t understand why. There are not many concepts that you need to know. I explain them in my course, eight hours to know EVERYTHING YOU NEED in the field of soft tissue management.
In the end it’s all about knowing how to design the cut, how to release the flaps and how to suture. Three things.
It’s not so difficult, there is no need to find risky alternative ways without scientific support and shoot them in people’s mouths.
Don’t get me wrong, I’m not a conservative in my job; on the contrary, I try to innovate all the time and bring constant improvements to procedures in order to simplify and make them even simpler. Consider that it takes me less than 4 hours of agenda from scratch to the end to complete a full arch rehabilitation of two stratified zirconium arches. I cut every step mercilessly, I automate and delegate until death while maintaining absolute control of quality but…
…I find it risky to challenge biology in clinical and non-experimental settings, without the vigilance of ethics committees and the scientific community!!!
Today I want to contribute to the cause of “complying with established protocols” and talk to you about the third step in soft tissue management for bone regeneration: THE SUTURE.
If you want to avoid the dreaded EXPOSURE you can’t suture the way you want. You HAVE TO suture this way:
- Start with the mesial vertical incision. Simple interrupted sutures, that’s easy.
- Suture the whole cut with horizontal mattress sutures inserting the needle at least 4 mm from the cut.
- Close the edges of the flaps with Simple interrupted sutures between the mattress sutures.
I’ll insert a video at the end to give you some practical information.
So these will be the healings at 15 days. It’s hard to imagine that you can see something exposed here… don’t you think?!?!
Of course this will happen only if you properly release the flaps, but I can’t explain it all at once!!!!!
Now I’ll leave you to the video.