Application of Biodegradable Magnesium Membrane Shield Technique for Immediate Dentoalveolar Bone Regeneration

Abstract

For the first time, the clinical application of the first CE registered magnesium membrane is reported. Due to the material characteristics of magnesium metal, new treatment methodologies become possible. This has led to the development of a new technique: the magnesium membrane shield technique, used to rebuild the buccal or palatal walls of compromised extraction sockets. Four clinical cases are reported, demonstrating the handling options of this new technique for providing a successful regenerative outcome. Using the technique, immediate implant placement is possible with a provisional implant in the aesthetic zone. It can also be used for rebuilding both the buccal and palatal walls simultaneously. For instances where additional mechanical support is required, the membrane can be bent into a double layer, which additionally provides a rounder edge for interfacing with the soft tissue. In all reported clinical cases, there was a good bone tissue regeneration and soft tissue healing. In some instances, the new bone had formed a thick cortical bone visible in cone beam computed tomography (CBCT) radiographs of the regenerated sites, which is known to be remodeled in the post treatment period. Overall, the magnesium membrane shield technique is presented as an alternative treatment option for compromised extraction sockets.

Keywords: NOVAMag membrane; resorbable metal; ridge preservation; socket preservation.

Figure 1

For the magnesium shield technique, the magnesium membrane is first cut to shape using the NOVAMag^® scissors (A). The rim of the membrane is then flattened using the NOVAMag^® sculpture (B) and bent into shape (C). In a compromised extraction socket (D), the membrane is either place as a single layer or bent into a double layer, before being positioned to rebuild either the buccal or palatal wall. The membrane is held in position by the periosteum and the defect space is filled with the graft material. A collagen membrane is placed on the top of the ridge (E). Using the technique, it is also possible to immediately place implants with a provisional restoration (F). Once implanted, the magnesium membrane will begin to degrade, transforming into magnesium salts that maintain the soft tissue barrier, and hydrogen gas will be released that provides a tenting of the soft tissue, which also extends the barrier effect, since cells cannot cross the gas cavity (G). After the magnesium metal has transformed into magnesium salts, no more gas is released, and the soft tissue returns into position over the newly formed bone and magnesium salts (H). After the critical healing period, the magnesium membrane is completely resorbed (I).

Figure 2

(A) Alveolar socket following atraumatic extraction and curettage. Severe bone loss of both buccal and palatal plates. (B) Buccal and palatial plates were created using the magnesium membrane shield technique. (C) Application of allograft. (D) Four months post operatively there was an excellent regeneration of bone defect, including fully regenerated cortical and palatal plates. The implant was stable and there was a good healing of the soft tissues. Black arrows are used to indicate the position of the magnesium membrane.

Figure 3

(A) Lateral volumetric cone beam computed tomography (CBCT) shows significant loss of buccal and palatal bone mass around tooth 24. (B) Coronal CBCT slice of the same area of tooth 24 revealing missed buccal and palatal bone and associated apical radiolucency. (C) The coronal CBCT section shows the implant in the area of tooth 24 and the obtained completely regenerated cortical and palatal plates.

Figure 4

(A) Alveolar socket following atraumatic extraction and curettage. Severe bone loss of buccal plate. (B) Buccal plate was created using the magnesium membrane shield technique. (C) Application of allograft together with magnesium membrane. The black arrow indicates the position of the magnesium membrane.

Figure 5

(A) Coronal CBCT section shows tooth 25 with vertical root fracture and destroyed buccal bony wall and intact palatine. (B) The coronal CBCT section shows the placed implant in the region of tooth 25 and the complete regeneration of the cortical wall.

Figure 6

(A,B) Alveolar socket following atraumatic extraction. Severe bone loss of buccal plate. (C) Buccal plate was created using the magnesium membrane double layer technique. (D) Application of allograft. (E) closing sutures and immediate provision. (F) four months postoperatively there was an excellent regeneration of bone defect, including fully regenerated cortical and palatal plates. The implant was stable and there was a good healing of the soft tissues. Black arrows are used to indicate the position of the magnesium membrane.

Figure 7

(A) Panoramic CBCT section shows bone loss around tooth 21. (B) Sagittal CBCT section of the area around tooth 21 shows extensive buccal bone loss. (C) A sagittal CBCT section shows the implant placed at site 21 with a restored cortical buccal plate. (D) Panoramic CBCT section shows bone formation around the implant in area 21.

Figure 8

(A,B) Alveolar socket following atraumatic extraction and curettage. Severe bone loss on buccal wall. (C) Buccal wall was created using the magnesium membrane shield technique. (D) Application of allograft. (E) Closing sutures and immediate provision. (F) Four months post operatively there was a regeneration of bone defect, including fully regenerated cortical bone. The implant was stable and there was a good healing of the soft tissues. The black arrow indicates the position of the magnesium membrane.

Figure 9

(A) Panoramic CBCT section shows associated apical radiolucency of tooth 15. (B) Coronal CBCT section shows tooth 15 with vertical root fracture and destroyed buccal bony wall and intact palatine. (C) Panoramic CBCT section shows bone formation around the implant in area 15. The coronal CBCT section shows the implant placed in the region of tooth 15.