Biological and clinical responses to dense and expanded PTFE membranes in alveolar ridge preservation: A prospective non-randomized cohort study with ex vivo analyses

Objectives: Nonresorbable polytetrafluoroethylene (PTFE) membranes, including dense (d-PTFE) and expanded (e-PTFE) types, are commonly utilized in alveolar ridge preservation (ARP). However, their differential effects on clinical healing remain unclear. This observational ex vivo and clinical study aimed to compare inflammatory and regenerative responses of cells adhering to retrieved d-PTFE and e-PTFE membranes and to link these responses to clinical outcomes. Materials and methods: Expanded and dense PTFE membranes, routinely retrieved from ARP-treated patients, were cultured ex vivo under inflammatory and regenerative conditions. We measured cell viability and cytokine levels (TGF-β and IL-6) using cell counting and ELISA. Clinical wound healing was assessed three weeks post-surgery, and bone preservation was evaluated radiographically three months post-ARP. Results: Cells adherent to d-PTFE showed higher viability, lower secretion of inflammatory cytokine IL-6, and higher levels of regenerative factor TGF-β compared to e-PTFE. Clinically, d-PTFE was associated with superior soft tissue healing scores and fewer inflammatory signs. Both membrane types effectively preserved bone, though e-PTFE demonstrated a trend toward better maintenance of crestal bone. Conclusion: d-PTFE membranes appear superior to e-PTFE in reducing early soft tissue inflammation and enhancing healing during ARP. However, both membranes are similarly effective at bone maintenance. Further studies with longer follow-up are warranted. Clinical relevance: The present findings highlight the translational potential of membrane selection in clinical practice, suggesting that clinicians can leverage each membrane’s unique biologic effects to meet specific treatment objectives.