Guide for using Cytoflex Resorb

Cytoflex® Resorb® is a microporous membrane made of synthetic, bioresorbable polyglycolide (PGA), polylactide (PLA) and D, L-lactide /glycolide (PLGA) copolymers. PGA, PLA and PLGA are all biocompatible; these materials have been well-documented and widely used in implantable devices for medical and dental applications.

Membrane Handling

The membrane should be handled using only powder-free gloves and/or with sterile atraumatic forceps. Hold the membrane gently and cut the membrane to the desired configuration with sharp scissors.
After trimming, there should be no sharp corners or rough edges which may cause tissue irritation and/or protrusion.
To enhance space-making capabilities, the membrane may be curved over the fingertip or a sterile instrument handle to create a dome shape. This curving action may be used to soften the membrane matrix if needed.

Membrane Placement

The side with the distinct diamond pattern embossing (large grating) should face the gingival tissue. The smoother side should face the bony defect or bone graft site.

info

In the inner package, the layer facing the dentist should face the gingival tissue.

To enhance stability and provide adequate protection of the space over the bony defect, the membrane should be trimmed to extend 2-3mm beyond the defect margins and remain at least 1 mm from adjacent, uninvolved teeth; avoid using unnecessarily large membranes.
The use of a non-resorbable monofilament suture is recommended. Loss of tensile strength during the initial 2-week healing period can lead to premature membrane exposure. If additional stability is desired, the membrane may be stabilized with sutures. The use of bone tacks or bone screws to stabilize resorbable membranes has not been studied and is not recommended by the manufacturer.
Adequate flap release must be accomplished in order to achieve a tension-free primary closure. A double layer closure with a deep layer of horizontal mattress sutures followed by a standard wound closure with interrupted sutures is recommended.
Avoid overlapping or folding the barrier membrane during the procedure.

tip

Incidence of surgical complications is related to the severity of the bone defect. Cases requiring sophisticated technique should only be undertaken by surgeons with appropriate training and experience. Special considerations should be taken for patients including those with a medical history of smoking, diabetes, immune diseases, systemic diseases, need for prophylactic antibiotics, head/neck radiation therapy, and chemotherapy. Patients with a limited amount and width of keratinized mucosa or thin biotype are prone to soft tissue complications.

Site Re-entry

Cytoflex® Resorb® maintains barrier function for up to 2 months and resorbs within 6 months.
After membrane placement, the treated area should remain covered for approximately 4 to 6 months.
Remnants of the barrier matrix with a liquefied and/or granular appearance, usually within the soft tissue flap, may be present at the time of re-entry. These remnants will resorb and disappear. No special measures need to be taken.

Mitigation of Soft Tissue Complications

Soft tissue complications including membrane exposure, dehiscence, and acute infection/ abscess, may adversely affect the bone regeneration outcome. According to the literature, the rate of developing soft tissue complications varies widely from 0% to 45% with a weighted complication rate of 16.8%. There are no significant differences in the complication rates among types of membranes. Complications were reported as early as 1 week and as late as months following the operation.

note

Soft tissue dehiscence refers to the phenomena of membrane or implant perforated oral mucosa during the follow-up period. This is considered a minor complication, since the site typically shows gradual improvement with chlorhexidine application.

Membrane exposure occurs when a primarily closed membrane becomes unintentionally exposed. Minor exposure without infection may be treated with systemic antibiotic or with addition of chlorhexidine mouth rinse. Large exposure involving the exposure of underlying graft may necessitate complete removal of the graft and membrane and a repeat augmentation procedure.