How often do you deal with such complex cases as vertical and horizontal bone defects?
Prof. Temmerman: Working both in university and in a private practice I encounter many cases with vertical and horizontal defects, with a higher percentage for the horizontal defects. If we look at recent statistics, for example, only in the esthetic region about 90% of the implants are placed with a bone augmentation procedure. Most of the vertical defects I see are instead due to peri-implantitis or the typical posterior mandibular resorption. Definitely, those vertical augmentations are quite complex procedures and patient selection is very important.
Do you use different approaches depending on the case and its complexity?
Prof. Temmerman: I think we've been using any kind of approach at our university and department for the last ten years (laughs)! We started with bone blocks from the chin and ramus area. We tried also to split the crest, but we were not too convinced. And then of course GBR procedures. In the last period I also observed a certain revival towards non-resorbable membranes. Dense polytetrafluoroethylene membranes (d-PTFE) seem to work better than the expanded polytetrafluoroethylene (e-PTFE) membranes. And even autologous bone blocks, split in half are re-introduced at our department.
Is your research also focused on bone augmentation procedure?
Prof. Temmerman: It is. Working at university gives me the opportunity to do a lot of research. For example, in the last four to five years we have tried to combine the protocols and surgical strategies of other universities and private practices to develop a GBR protocol to enhance the outcomes. And this is necessary as we have seen, in a recently submitted study, that the outcomes of GBR procedures might vary depending on the used technique. In this study we performed re-entry procedures after five months and we were stunned by the fact that the bony dehiscence at the implant shoulder was only resolved in 20% of the cases. So, optimization of GBR procedures is necessary.
And what about customized treatment?
Prof. Temmerman: The development of customized treatments has been of enormous benefit and a great improvement for those who like me perform many procedures for bone augmentation. The use of non-resorbable membranes commits clinicians to a three-dimensional bending and cut. The surgery is already complicated in itself and what takes more time is the preparation of the membrane, there is no room for errors.
Customized devices, on the other hand, fit perfectly to the defect shape without having to go through a long and difficult pre-preparation process. This is the reason why customized treatments have caught my attention.
Is that also the reason why you tried Yxoss CBR®?
Prof. Temmerman: Yes, absolutely. I was impressed by the way the mesh fits the defect and very pleased to be able to do the fixation with just one to two screws.
What would you suggest to people who decide to use Yxoss CBR® for the first time?
Prof. Temmerman: At the moment I have used about six, seven Yxoss CBR® meshes. Handling is quite easy, and the duration of surgery is much reduced. Don't forget, however, that the surgery remains complicated. So, I would suggest starting with small horizontal defects and then move to larger defects and finally use the mesh for vertical defects. Also, before using Yxoss CBR®, it is essential for the clinician to have knowledge on flap design, soft tissue management and tension free closure. So, basic surgical skills remain of utmost importance.