Published in November 1989

Physician and Surgeon specializing in Dentistry. Periodontist.
Piazza Repubblica 4, 09129 Cagliari, Italy.
tel ++39 070 498159, fax ++39 070 400164
web site

University of Sassari [Italy]
Post-graduate School of Dentistry and Dental Prosthesis, Prof. V. Tenti, Director.
Course in Periodontology
held by Prof. G. Petti


Key words:

Fibrin glue, Interpore 200, amniotic membrane, new attachment

The most ambitious goal in bone surgery, the creation of a new attachment, calls for suitable materials and special techniques. Only a rigorous in vivo experimental protocol and subsequent histological examinations can ensure success

Fig. 1 Cross section, from bottom to top: bone graft (blue), Tissucol layer (yellow), amniotic membrane (light blue) mucogingival flap (purple). The amniotic membrane inhibits apical migration of the epithelial attachment. Fig. 2 Graft of amniotic membrane B with fibrin glue A as a protection of the non-re-absorbable hydroxyapatite implant C. Direct contact between bone and root may lead to root re-absorption and anchylosis.

Basics of in vivo experimentation

Fig. 3 After preparing the receiving bed for the bone graft, the amniotic membrane B is glued to the root with fibrin glue A. Fig. 4 At this point, after gluing the amniotic membrane, the operation continues with the Interpore 200 bone implant (C)

Fig. 5 The implant is covered with the amniotic membrane B saturated with Tissucol (A') and the mucoperiosteal flap D is repositioned. Periodontal space E is protected by the amniotic membrane B placed between the bone implant C and the root, to which the membrane is attached with Tissucol (A'), which also has the function of biostimulating cells in the periodontal space. The amniotic membrane B' glued with fibrin glue A' onto the implant C and well fitted to the root inhibits apical migration of attachment D.

A = fibrin glue
B = amniotic membrane
C = Interpore 200 implant
D = mucoperiosteal flap
E = periodontal space with ligament
A' = fibrin glue
B' = amniotic membrane

By inhibiting direct contact between bone and root with the amniotic membrane and fibrin glue, reabsorption and consequent anchylosis is avoided. By avoiding contact between the periodontal space and gum, apical migration of the epithelial attachment is inhibited and, in the long run, this should lead to the formation of a short epithelial attachment. The amniotic membrane is then glued to the root In reality, the glue occupies the space between the root and the membrane and is thus invaded by cells which are capable of regenerating the periodontal ligament; we must not forget the biostimulating action and tissue regeneration performed by the fibrin glue and the trophoblastic inner surface of the amniotic membrane. Between the inner trophoblastic surface of the membrane (facing the root) and the outer epithelial surface (facing the bone graft) we find the basal membrane; this sandwich of tissues, especially owing to the presence of the basal membrane, represents a good barrier against tissue cell penetration.
Fig. 6 Amniotic membrane: the edges of the epithelial face curl inwards; this is important in distinguishing the epithelial surface from the trophblastic surface.
Materials and methods
The amniotic membrane
Fig. 7 Cross section of the amniotic membrane (Amniex Mastelli s.r.l.). Note the curling edges.
Interpore 200