Advice for soft tissue allografts please.

Sun, 08/30/2009 - 07:19 — Anonymous

I am looking for any advice, tips, etc. for soft tissue allografts (ie. Alloderm, etc). I have no problem laying a flap and sticking in Alloderm, but I do not feel comfortable harvesting connective tissue from the palate.
Does anyone have any tricks, tips, etc. for gaining better results with Alloderm? My results have been fair so far, but I know they can be better from what I have seen in presentations and lectures. Any help is appreciated.

Comments

Sun, 09/06/2009 - 06:39 — OrthoKing

Soft tissue allografts: Very unpredictable

I am more of an implantologist then a soft tissue expert.

My first bit of advice is refer to a periodontist. They are best suited to treat soft tissue defects. That being said, alloderm is very unpredictable. I dont think you get the same results as with connective tissue. From the articles I read long term it doesnt hold up.

I would be curious to get a periodontist view on this.

Tue, 09/08/2009 - 05:23 — Ti Doc

Not happy with soft tissue allografts

Good ole connective is the best. Always works. Only limitation is how much you can get in one shot.

I have tried all of the soft tissue allografts and none work as well as CT. Plus, CT is free! I have never had a patient complain about the palatal harvest site.

Sat, 10/03/2009 - 23:32 — mbgumydr1

Not happy with soft tissue grafts

Yes, alloderm is most periodontists least favorite choice for augmenting soft tissue (except Pat Allen who can grow anything anywhere). The alloderm preparation and techniques is sensitive so careful prep and suture is important, as well as overdoing the amount of tissue that is put in place because it has about 50% retraction during healing. Ct offers the best solution for ridge augment or root coverage. I would suggest a CE course to assure good sx. technique and management in case of bleeding issues or post op problems like tissue sloughing. You could refer to your periodontist and ask if you can sit in during the procedure. Books are great but time consuming. I do think autogenous is best.

Sun, 10/04/2009 - 10:04 — N Shumaker DDS MS

Alloderm use is situational

I agree with most comments above. Even Pat Allen said (when I saw him speak) he still uses CT for "tough" areas. I think for 1-3 tooth defects CT is the best choice. When you get into large, multitooth (miller class 1/2) defects Alloderm becomes an option. This is due to the limited volume of CT available from the palate. Options become either staged CT grafts over time, or a large graft with alloderm with the caviat that you will return to cover those areas not successful with alloderm using CT at a later date. The literature supports that alloderm has less recurrent recession in multi-tooth defects compared to single tooth defects. Regardless my experience has been similar to Harris's in the long term....rebound recession occurs with alloderm over time. The increase in KG with CT vs Alloderm is a whole other issue....