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The Amnion-Chorion membrane is an ideal barrier membrane for many dental applications.
Why Amniotic Membranes?
The amniotic membrane is the natural layer surrounding the fetus in the womb. The membrane is essentially composed of two main layers: the amnion – the layers closest to the fetus, and the chorion – the layers closest to the mother. Together these layers provide a protective barrier adept at remodeling to accommodate the growing fetus. This protective feature makes amniotic membranes ideal for homologous use as a barrier in a variety of applications. Amniotic membranes have been used for decades in varied fields such as ophthalmology, reconstructive surgery, and burn treatment. The DCI Donor amnion-chorion membrane is a minimally manipulated, dehydrated, non-viable cellular amnion-chorion membrane.
Key Benefits of Amnion Chorion Membranes
Brief Instrument Guidance for Amnion Chorion Membranes
Because amnion-chorion membranes are incredibly adhesive when hydrate, Use dry instruments when the membrane is dry and wetted instruments once membrane is wet/hydrated, as this will prevent the membrane from sticking to the holding instrument. A common technique for placing amnion-chorion membranes is a 2-instrument method: dry instrument (e.g. plier/forcep) to place and anchor, and a wet instrument (e.g. periosteal elevator) to hydrate and tuck the membrane.
Amniotic Membranes Procurement, Processing and Safety
DCI Donor Services Tissue Bank is a non-profit, industry-leading allograft provider setting the standard in tissue quality and safety. Our dedicated team of professionals provide an extraordinary commitment to science, health and hope serving to link the gift of donation to saving and enhancing patient lives. This uncompromising, patient-centered focus generates allografts ideally suited for optimal results in a variety of surgical applications.
DCI Donor Services Tissue Bank’s amniotic membrane allografts are regulated as a human cell, tissue-based product (HCT/P) under section 361 of the Public Health Service Act. Tissue is procured through voluntary donation from scheduled Caesarean procedures of full-term healthy births. Maternal donors are screened per FDA and AATB guidelines for a panel of infectious diseases at an FDA registered and CLIA Certified laboratory and against established medical-social risk factors. Once received, the membrane is minimally processed to preserve the native structure of the tissue, dehydrated, and terminally sterilized with gamma irradiation with sterility assurance level (SAL) 10-6 to ensure recipient safety. A final quality control review is conducted by dedicated quality associates to ensure only grafts meeting the highest quality and safety standards are released for distribution.
DCI Donor Services Tissue Bank is registered with the FDA, certified by the AATB and licensed
1. Ashraf H, Font K, Powell C, and Schurr M. Antimicrobial Activity of an Amnion-Chorion Membrane to Oral Microbes. International Journal of Dentistry, 2019. 2019: p. 7 (Amnion-chorion membrane (ACM) was proven to be as bactericidal as paper discs inoculated with tetracycline at its minimum bactericidal concentration. The ACM bactericidal property may be beneficial in the early wound healing process.)
2. Clin Adv Periodontics. 2020 Dec 31. doi: 10.1002/cap.10144. Amnion-Chorion Membrane in Open-Wound Approach for Localized Horizontal Ridge Augmentation: A Case Series Report Shan-Huey Yu et al.
|Questions and Answers|
There are many different suturing techniques and we cannot recommend one over the other. However, in socket preservation procedures, it seems as if many clinicians seem to prefer a reverse figure eight type of suture technique. The reverse technique refers to the movement of the suture needle from inside the socket to the outside. This aids in membrane retention. In terms of suture material, PTFE Suture (3.0 or 4.0) is mostly used due to the monofilament nature, which eliminates bacterial wicking. However, PTFE sutures are non-resorbable. PGCL Sutures are an absorbable monofilament suture that could also be used as alternative to PTFE.
There are now several amnion-chorion membranes that are marketed in dentistry and that are each processed by highly-respected and regulated US-based Tissue Banks. In general, although there are slight differences in processing, all the amnion-chorion membranes are processed in a substantially similar manner, as they must be minimally manipulated according to FDA guidelines. Briefly, the membranes are deepithelialized (outermost amnion layer is removed), and the remaining amnion/chorion is dehydrated, cleansed/rinsed, sterilized and packaged.
Apparently, the main difference between some of the membranes is what layers are removed during processing (i.e. there are several underlying layers in both amnion and chorion). Some processors remove the "spongy" layer from the amnion, while others retain it (keeping it more minimally manipulated). Other processors claim to have a "thicker" membrane due to the inclusion of the Trophoblast layer part of the Chorion (the trophoblast is the innermost layer of the Chorion and the least exposed to maternal fluids). We are not aware of any studies that compare the clinical results from the various membranes, and there is no clinical evidence whatsoever of the superiority of one brand of membrane over any other. As mentioned, all the membranes are minimally processed according to strict FDA and AATB guidelines, and all are equally effective when used with proper protocols.
In terms of this amnion-chorion membrane, it is processed by DCI Donor Services Tissue Bank, a non-profit, industry-leading allograft provider setting the standard in tissue quality and safety. The membrane is deepithelialized, as noted above. Deepithelialized mainly refers to the outermost amnion layer that is exposed to maternal fluids, and is generally the most impacted with blood clots. In the process of removing the blood clots from the membrane, the Epithelium layer dis-attaches, thereby exposing the Basement membrane of the amnion (the first layer of collagen). Regarding the Trophoblast layer, the layer is left intact during the DCI Donor processing of the membranes. Additional, DCI Donor does not separate the amnion and chorion layers during processing, preserving the spongy layer, and just cleanses the tissue in order to maintain as much of the native tissue as possible. Separation of layers during processing is thought to adversely impact retention of the native growth factors.
Amnion-chorion membranes generally resorb in 8 to 12 weeks. If the membranes are left exposed, this absorption profile will obviously differ, but given the many factors that could impact an exposed membrane, it is not possible to give a precise resorption profile for an exposed membrane. However, amnion-chorion membranes have proven to behave exceptionally well even under exposure.
No there is no orientation. This particular amnion-chorion membrane, as well as all others we have seen in dentistry, do NOT have any orientation, as they are deepithelialized. They can be placed up or down, folded, and/or layered, without any concern.
If the membrane is exposed to the oral environment, then for 3 days post-op please instruction the patient to avoid overly aggressive rinsing, swishing with any solution to avoid dislodgement of the membrane.
After 3 days, gentle rinsing with tap water is recommended for the next 7 days.
The patient should not use any oral rinses 10 days post-op. This includes antiseptics; chlorhexidine (Peridex®), chlorhexidine without alcohol, and other common oral rinses. Oral rinses are can adversely impact the health of gingival cells, and chlorhexidine specifically may adversely impact the membrane. After one week the patient may begin using an oral rinse for plaque control.
After 10 days post-operatively, the patient may begin using an oral rinse for plaque control.
video for amnion
This is an excellent video which goes over the various use cases for amnion-chorion membranes.