Among young dental practitioners, Dr. Bastian Wessing, who is in community practice at the Luisenhospital in Aachen, Germany, is one of the most experienced in the use of guided bone regeneration (GBR). He both writes and lectures on the topic, and has been kind enough to take time from his busy schedule to answer a few of our questions.
What was your initial reaction when you used the creos xenoprotect membrane for the first time?
Dr. Bastian Wessing: My first reaction was, “Wow, this membrane handles really well during surgery!” In the dry state it is clearly more rigid than other non-chemically cross-linked membranes that I tried before and slower in the rehydration so it can be shaped optimally to the defect size and geometry.
It also sticks less to the tissue when in contact with the gingiva in the dry state. After rehydration, however, it adapts well to the underlying surface as usually experienced when using other natural collagen membranes. In the wet state, it is also superior to trim as well as unfold when pleated. After rehydration, it is possible to stabilize particulate grafts by fixation of the membrane with the help, for instance, of titanium pins and “spanning” the membrane over the grafted site.
Especially for this use, we performed in vitro experiments like suture pull-out testing, which showed twice the values for the creos xenoprotect compared to a reference product, and even higher values than an ePTFE (expanded polytetrafluoroethylene) membrane.1
In approximately how many cases have you used creos xenoprotect so far?
Wessing: Because we were given the opportunity to use the membrane before general distribution by Nobel Biocare, we have used it in more than 300 treatment procedures.
What, in your opinion, are the attributes that make creos xenoprotect stand out?
Wessing: The outstanding attributes of creos xenoprotect are easy defect adaptation due to slow rehydration and rigid property in the dry state; low expansion rate after rehydration; high mechanical stability with respect to tensile and suture pull-out strength; and prolonged biodegradation.
In addition, high biocompatibility, good revascularization and a low dehiscence rate are all associated with this membrane.2 Our manuscript containing the first clinical data was accepted for publication in July 2014 in the International Journal of Periodontics and Restorative Dentistry.
Why are the handling characteristics of a membrane such as creos xenoprotect so important?
Wessing: GBR techniques are sensitive with respect to the surgeon’s experience level and not always so easy to perform as frequently described, thus a good-handling material helps to increase predictability of the entire treatment.
Are there any particular indications or procedures for which you feel creos xenoprotect is especially well suited?
Wessing: We use creos xenoprotect in our practice mainly in socket preservation, to cover the lateral bone window when performing sinus lift operations, and in lateral ridge augmentation using GBR.
For these indications, the membrane is superbly suitable according to our experience. For the sake of full disclosure, there are limitations in the field of vertical ridge augmentation, of course, as with all other collagen membranes.
What would you say to a clinician considering trying creos xenoprotect?
Wessing: This question is not so easy to answer. It depends on how much bone grafting experience this colleague has had.
I would tell a less-experienced colleague that he or she is getting an excellent, easy-to-handle product, which combines many good attributes for anyone beginning with bone augmentation membrane techniques.
However, I would also recommend increasing the difficulty level slowly, and underline the importance of acquainting oneself thoroughly with the topic and techniques.
I would advise a more experienced colleague to start with the familiar techniques of bone augmentation using this top-quality membrane, while explaining that creos xenoprotect stretches the limits of what collagen membranes can do.
In cases of open healing dehiscences, we observed something remarkable—spontaneous wound closure after 2–3 weeks, and without complete loss of the graft.
Frequently, spontaneous closure was also observed before the membrane was completely degraded, especially when we used the creos xenoprotect double-folded for a “socket-seal” of the extraction alveole combined with “socket-preservation.”