Having lectured and co-authored papers and a text- book on the topic, Dr. Hadi Antoun of Paris, France, is an authority on guided bone regeneration (GBR) procedures. After introducing the creos xenoprotect resorbable collagen membrane into his practice, Dr. Antoun was kind enough to share his experiences with Nobel Biocare News.
A resorbable collagen membrane with outstanding handling properties and an extended barrier function, creos xenoprotect is a non-chemically cross-linked membrane for guided bone regeneration (GBR) and guided tissue regeneration (GTR) procedures.
What was your initial reaction, the first time that you used the creos xenoprotect membrane?
Dr. Hadi Antoun: That the membrane is easy to handle and, once moistened, does not stick to the site, so you can still change its position after placement.
Why is it so important to have a membrane that is easy to handle?
Antoun: During surgery we cannot afford to spend too much time adapting the membrane to the defect of each individual patient. We need a membrane that we can handle and cut easily, that does not stick to instruments and that can be adapted to the shape of the site after the biomaterial has been placed. Handling properties are important, but good handling alone is not enough.
What then have you found to be the other main advantages of creos xenoprotect?
Antoun: Its elasticity and high biocompatibility. Biocompatibility is fundamental, while the elasticity means it can be sutured or fixated with pins and then tightened without tearing. It also resorbs slowly, allowing time for the invasion of bone cells at the site, remodeling and bone regeneration.
In the case you are sharing with our readers online (see the link at the end of this article), you use a combination of xenograft substitute and autogenous bone. What benefits does this combination offer?
Antoun: The cells that survive transplantation in the autogenous graft provide osteogenic potential and growth factors that are released gradually. This compliments the bovine hydroxyapatite, which is a biomaterial that resorbs very slowly. It acts as a scaffold for bone regeneration, providing the augmented bone with stability.
You stated that in this particular case some remnants of the creos xenoprotect membrane could still be seen after six months. Were you surprised by this longevity?
Antoun: I was pleasantly surprised. Most resorbable membranes resorb after a few weeks or three to four months at most. The core principles of guided bone regeneration dictate that the longer we keep soft tissues and fibroblasts away from the bone area, the greater the opportunity for new bone to form. As such, a long degradation time like this provides a greater chance of success.
You chose to restore the case in question with a NobelProcera Titanium Abutment. Why did you opt for a NobelProcera individualized restoration?
Antoun: An individualized abutment with a scalloped contour, in a biocompatible material like titanium, is important for the attachment and adhesion of hemidesmosomes in the transmucosal part of the restoration. Bone preservation is very probably related to this barrier. Moreover, from an economical point of view, we don’t have to deal with any additional costs related to a metal cast.
Clinical case_creos xenoprotect_Dr Hadi Antoun
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Were you pleased with the results of this case? What was the patient’s reaction?
Antoun: Re-entry at six months was very satisfying. Bone augmentation covered all exposed threads, and the most interesting point was the bulky bone augmentation right up to the implant neck. There was more than 2 mm of newly formed bone on the buccal side.
What would you say to a clinician who is considering trying creos xenoprotect for the first time?
Antoun: I would recommend trying the membrane. The results are very encouraging and, provided that the basic principles of GBR are followed, complications seem very rare.
For me, the combination of autogenous and xenogeneic biomaterials with the membrane has worked well. The final trimming of the membrane can be done after the augmentation by stretching the membrane before fixating it. Tension-free soft tissue coverage is a key factor for successful bone augmentation.
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