MKG Broschuere E.pdf En

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Therapy Concepts orOral & Maxilloacial Surgery

LEADING REGENERATION


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Geistlich a Company with Tradition

The history o the company Geistlich began in 1851 with the manuacturing o glues rom

bones. Later, bones and other animal tissues were processed to yield ower ertiliser and

highquality gelatine or oodstus. In the ollowing years, the company expanded into

the eld o pharmaceuticals and established a second plant in Wolhusen near Lucerne.

In 1983, a new business idea was stimulated by a report rom Proessor Philip Boyne

on the successul reconstruction o crushed jaws with cattle bone. This led to the birth

o Geistlich BioOss: a highly puried anorganic bone material with a high similarity to

human bone or eective bone regeneration.Thereater, a manuacturing process to ree the bone o organic constituents, while

maintaining its natural microstructure and anorganic composition, was developed and

patented. Already during the initial discovery and development phases there was close

cooperation with various experts and leading clinics. This laid the oundation or todays

sound scientic evidence base which presently consists o more than 600 publications.

In 1996, another undamental innovation rom Geistlich changed the market o bone and

tissue regeneration substantially through the introduction o Geistlich BioGide: the rst

natural and ully resorbable collagen membrane now replacing the nonresorbable ePTFE

membrane in a majority o indications. The natural composition o this membrane, which

is very similar to human collagen, proved to be a key parameter or its positive eect on

bone and sot tissue healing processes.

Nowadays, Geistlich BioOss

and Geistlich BioGide

have become a benchmark in dentalbone regeneration, conrmed by more than 20 years o clinical experience and an ever

increasing number o scientic publications. In addition, the range o applications are

continuously being expanded within the dental, maxilloacial, and orthopaedic elds.

With the brochure at hand we would like to oer you an overview on current treatment

methods or complex cases o bone regeneration in the oral and maxilloacial areas.

Your Geistlich Biomaterials Team


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Acknowledgments:

Geistlich Biomaterials wishes to thank Dr. Z. Krol, Pro. Dr. Dr. R. Sader and Pro. Dr. Dr. H.F. Zeilhoer Hightech

Research Center o CranioMaxilloacial Surgery, University Hospital Basel or kindly delivering the oblique view o the

cranioacial CT, visualized by volume rendering method, which appears on the cover and in the outlook.

We acknowledge all the authors o the Clinical Cases or their valuable contribution and eorts. Geistlich Biomaterials

thanks Blackwell Publishing Wiley InterScience, RC Libri, Quintessence Publishing, and Quintessenz Verlag or the

copyright permissions.


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Index

Scientic Background06 Bone and Bone Substitutes

06 Clinical Facts

07 Quality o Lie

08 High Therapy Saety with a Membrane

Clinical Cases10 Cawood Classication

12 Cawood Class IV

12 Dr. J.J. Aranda

13 Dr. K.H. Bormann, Pro. Dr. Dr. N.C. Gellrich

14 Pro. Dr. D. Buser, PD Dr. T. von Arx

15 Pro. Dr. C. Hmmerle

16 Dr. G. Iglhaut

17 Pro. Dr. C. Maiorana

18 Pro. Dr. I. Urban

19 Cawood Class V

19 Pro. Dr. M. Chiapasco

20 Dr. P. Felice MD/DDS, Pro. L. Checchi MD/DDS, Pro. M. Marchetti MD/DDS21 Dr. U. Grunder

22 Dr. M. Merli

23 Pro. Dr. A.R. Paranque

24 PD Dr. Dr. K.A. Schlegel

25 Pro. Dr. Dr. R. Schmelzeisen, Pro. Dr. Dr. R. Gutwald,

Dr. Dr. A. Stricker, Dr. M. Vogeler, Dr. S. Sauerbier

26 Pro. Dr. M. Simion, Dr. I. Rocchietta

27 Dr. M. Steigmann

28 Dr. S. Stbinger, Pro. Dr. Dr. R. Sader

29 Dr. T. Testori

30 Cawood Class VI30 Dr. Dr. C. Glatzer, Dr. O. Schwerdtner

31 Pro. Dr. Dr. T. Iizuka

32 PD Dr. Dr. C. Jaquiry, Dr. N. Gabutti, Pro. Dr. Dr. H.F. Zeilhoer

33 Univ.Pro. Dr. C. Krenkel, Dr. Dr. S. Enzinger

34 Pro. Dr. Dr. H. Terheyden

35 Dr. A. Triaca, Dr. Dr. R. Minoretti, Dr. D. Kraus

Product Range36 Geistlich BioGide / Geistlich BioOss

Outlook


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Bone and Bone SubstitutesBone is made up o several types o tissues. The primary part being the mineralized tissue that is composed mostly o

calcium hydroxylapatite and collagen I which gives it rigidity and a threedimensional trabecular structure. Other types o

tissue ound in bones include marrow, endosteum and periosteum, nerves, blood vessels and cartilage. Additionally, bone

tissue consists o living cells and various proteins embedded in the mineralised matrix that makes up the osseous tissue.

Bone grating procedures are oten needed to replace missing bone at one site with material rom another site. The bone

material may stem rom the patients own body autograt, rom human cadavers allograt, rom animal origin xenograt,

or rom synthetic material. Allograts and xenograts are principally unprocessed bone substitute mostly obtained rom

bone banks.

Geistlich BioOss, dierent rom all the above mentioned materials, is a highly puried xenogeneic bone substitute

completely void o organic tissue and solely made up o the mineral component o bovine bone.

Clinical FactsVolume Preservation:Presently, autogenous bone is irreplaceable in the treatment o large bony deects and is regarded as

the gold standard or bone augmentations. However, it has been scientically proven that autogenous bone grats show a

stronger resorption than a mixture o a slow resorbable bone substitute with autogenous bone.

Schlegel and coworkers claim that the augmented bone volume is preserved in the sinus cavity lled with a mixture o

Geistlich BioOss, while the height o a purely autogenous bone grat diminishes markedly.

Comparison o horizontal augmentation techniques shows lower resorption rates, i the autogenous block grat is covered

with Geistlich BioOss and Geistlich BioGide Fig. 1.36 Alternatively, using only these biomaterials or horizontal

augmentations is an eective treatment and avoids completely the harvest o autogenous bone.

Scientic Background

Resorption(%)

autog. block+

Geistlich Bio-Oss

peripherically 4

autog. block+

autog. chipsperipherically

+

Geistlich Bio-Gide 5

autog. block+

Geistlich Bio-Oss

cover 3

autog. block+

Geistlich Bio-Oss

cover

+


autog. block+

autog. chipsperipherically 3

Fig. 1: Resorption rate o the autogenous blockgrat in dierent augmentation techniques.

Garg AK. Knochen / Biologie, Gewinnung, Transplantation in der zahnrztlichen Implantologie. Berlin: Quintessenz 2006. Schlegel KA et al. Histologic ndings in sinus augmentation with autogenous bone chips versus a bovine bone substitute.

Int J Oral Maxilloac Implants 2003 JanFeb;18(1):53-8. Maiorana C et al. Reduction o autogenous bone grat resorption by means o biooss coverage: a prospective study.

Int J Periodontics Restorative Dent 2005;25(1):19-25. Proussaes P et al. The use o ramus autogenous block grats or vertical alveolar ridge augmentation and implant placement: a pilot study.

Int J Oral Maxilloac Implants 2002 MarApr;17(2):238-48.

Proussaes P. Clinical and histologic evaluation o the use o mandibular tori as donor site or mandibular block autograts: report o three cases.Int J Periodontics Restorative Dent 2006 Feb;26(1):43-51. von Arx T & Buser D. Horizontal ridge augmentation using autogenous block grats and the guided bone regeneration technique with collagen membranes:

a clinical study with 42 patients. Clin Oral Implants Res 2006;17(4):359-66. Hmmerle CHF et al. Ridge augmentation by applying bioresorbable membranes and deproteinized bovine bone mineral: a report o twelve consecutive cases.

Clin Oral Implants Res 2008;19(1):19-25.


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Implant survival rates:In the past years, several clinical studies and metaanalysis have evaluated the implant survival rate

depending on the urnishing bony support in sinus lit procedures. The survival rate increases ater augmentation with

bone substitutes alone or in a mixture with autogenous particulate grats, as compared to sites augmented with autogenous

bone only Fig. 2a,b.810 Generally it has been shown that the implant survival in augmented bone is similar to the survival

rate in sites where an augmentation was not needed.

Therapeutic Flexibility:Autogenous bone resorption narrows the therapeutic time window or implant placement.

The slowresorbing matrix structure o Geistlich BioOss increases the stability o the grat and prevents premature

resorption o the newly ormed bone. The augmented volume is preserved over a prolonged period and so extends

the therapeutic window.

Quality o LieNumerous clinical studies report rom 18% up to 50% o patients with diminished sensitivity

ater bone harvesting rom the chin. Joshi et al. state 20% and 25% o donor site morbidity

ater bone harvesting rom the ramus and the iliac crest, respectively.

The addition o a bone substitute may render the access o a second surgical site unnecessary,

which, in turn, increases the quality o lie.

Wallace SS & Froum SJ. Eect o maxillary sinus augmentation on the survival o endosseous dental implants.

A systematic review. Ann Periodontol 2003;(1):328-43. Aghaloo TL & Moy PK. Which hard tissue augmentation techniques are the most successul in urnishing bony support or implant placement?

Int J Oral Maxilloac Implants 2007;22Suppl:49-70.

Del Fabbro M et al. Systematic review o survival rates or implants placed in the grated maxillary sinus.Int J Periodontics Restorative Dent 2004 Dec;24(6):565-77. von Arx T et al. Neurosensory disturbances ollowing bone harvesting in the symphysis: a prospective clinical study. Clin Oral Implants Res 2005;16(4):432-9. Raghoebar GM et al. Morbidity o chin bone harvesting. Clin Oral Implants Res 2001 Oct;12(5):503-7. Misch CE. Implant dentistry. Dent Today 2002 Nov;21(11):62.Joshi A & Kostakis GC. An investigation o postoperative morbidity ollowing iliac crest grat harvesting. Br Dent J 2004 Feb 14;196(3):167-71; discussion 155.

Fig. 2b: The implant survival rate is signicantly higher inaugmentations with biomaterials compared to those withautogenous bone only.

. . .

bone substituteautogenous bone autogenous bone+ bone substitute

Implantsurvivalrate(%)

Fig. 2a: Implant survival rates in external sinus oor elevationdier with augmentation materials 5128 implants, ollowup12102 months.

*Note: the 22 reerenced studies with xenogeneic materialswere conducted with Geistlich BioOss.

100

95

90

85

80

75

70

65

Implantsurvivalrate(%)

88.0 92.0 93.3 95.6

synthetic iliac crest autogenous allogeneic xenogeneic* n=190) (n=1845) (n=2904) (n=189) (n=443)

0

81.0


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High Therapy Saety with a MembraneThe use o a membrane or the regeneration o bone and sot tissue is the essential component o the Guided Bone

Regeneration GBR and Guided Tissue Regeneration GTR concept. The membrane perorms several important unctions

and orms a basis or predictable clinical results. An optimal barrier unction, stabilisation o the augmentate, and supportive

properties or excellent wound healing are all crucial prerequisites or high therapy saety and an optimal outcome in the

aesthetic zones.

More bone:Recent animal experiments and clinical studies have analysed the new bone ormation with and without

the use o a membrane. Gielkens et al. conclude that bone ormation is signicantly higher in the presence o Geistlich

BioGide, than in its absence, a nding also reected in the clinical trial results o Wallace and coauthors.

Higher bone density: Kim et al. show in the dog model that the combination o Geistlich BioOss and Geistlich BioGide

leads to signicantly higher bone density in GBR procedures than Geistlich BioOss alone compare Figure 3.

Less Resorption:In horizontal augmentations, scientic evidence demonstrates that the autogenous block undergoes

less resorption, when combining Geistlich BioOss with Geistlich BioGide compared to the same treatment without

Geistlich BioGide von Arx 2006, Maiorana 2005.

Enhanced Wound Healing: Vascularization is critically important in the early phases o successul wound healing. Thereore,

the requirements proposed or an adequate barrier in GBR/GTR are, among others, tissue integration, nutrient transer

and biocompatibility.,

Clinical studies comparing dierent membranes conclude that the resorbable collagen membrane Geistlich BioGide

shows a lower incidence o wound dehiscencies., In case o a dehiscence the wound heals uneventully.

Bonedensity()

weeks weeks

Control

Geistlich Bio-Oss

Geistlich Bio-Oss and Geistlich Bio-Gide

.

.

.

.

Fig. 3: Bone density measured by dental CT postoperatively 100% is intact adjacent alveolar bone.The extraction socket sites were treated with i Geistlich BioOss, ii Geistlich BioOss andGeistlich BioGide, or iii neither Geistlich BioOss nor Geistlich BioGide control.

Gielkens PF et al. Vivosorb, BioGide, and GoreTex as barrier membranes in rat mandibular deects: an evaluation by microradiography and microCT.

Clin Oral Implants Res 2008;19(5):516-21. Wallace SS et al. Sinus augmentation utilizing anorganic bovine bone BioOss with absorbable and nonabsorbable membranes placed over the lateral window:

histomorphometric and clinical analyses. Int J Periodontics Restorative Dent 2005;25(6):551-9. Kim M et al. Eect o bone mineral with or without collagen membrane in ridge dehiscence deects ollowing premolar extraction. In Vivo 2008 MarApr;22(2):231-6. Lakey LA et al. Angiogenesis: Implications or tissue repair. In: Davies JE, ed. Bone Engineering. Toronto: Em Squared Incorporated 2000;137-142.

Hardwick R et al. Membrane design criteria or guided bone regeneration o the alveolar ridge. In: Buser D, et al. Guided bone regeneration in implant dentistry.Hong Kong: Quintessence 1994;101-136. Tal H et al. Longterm biodegradation o crosslinked and noncrosslinked collagen barriers in human guided bone regeneration.

Clin Oral Implants Res 2008;19(3):295-302. Zitzmann NU et al. Resorbable versus nonresorbable membranes in combination with BioOss or guided bone regeneration.

Int J Oral Maxilloac Implants 1997;12(6):844-52.


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Reliable Barrier Function and Biocompatibility: Alteration o natural collagen structures by crosslinking reduces the

enzymatic degradation rate at the cost o decreased biocompatibility, as seen in Figure 5 adapted rom Rothamel 2005.

The literature does not report a dierence in bone ormation in relation to the duration o the barrier unction. Due to

the natural bilayer structure and its similarity to human collagen, Geistlich BioGide leads to optimal bone ormation

as well as excellent wound healing. Native collagen is resorbed enzymatically through an irritationree process and

consequently shows signicant less dehiscences than crosslinked collagen.

Duration oBiodegra

dation

Biocompatibility, tissueintegration,

vascularization

Geistlich BioGide

Crosslinked membranes

Nonresorbable membranesFig. 5: Geistlich BioGide oers the optimalbarrier unction while providing the highest

level o biocompatibility based on Rothamel2005.

AT EL ML IL AT EL ML IL AT EL ML IL

Fig. 4: Immunohistochemical stainings 2 weeks ater implant. Complete transmembraneous vascularization with Geistlich Bio

Gide

a. Angiogenesis merely reached the external layer o the respective membrane bodies o b BioMend Extend and cTutoDent original magnication 20x. AT: adjacent tissue; EL: external layer; ML: middle layer; IL: internal layer. Arrows indicatethe ormation o blood vessels in the respective layers.

a b c

Schwarz F et al. Angiogenesis pattern o native and crosslinked collagen membranes: an immunohistochemical study in the rat.Clin Oral Implants Res 2006;17(4):403-9. Schwarz F et al. Immunohistochemical characterization o guided bone regeneration at a dehiscencetype deect using dierent barrier membranes:

an experimental study in dogs. Clin Oral Implants Res 2008 Apr;19(4):402-15. Rothamel D et al. Biodegradation o dierently crosslinked collagen membranes: an experimental study in the rat. Clin Oral Implants Res 2005 Jun;16(3):369-78. Becker J. Interview: Is a long barrier unction necessary?. Geistlich News 2007;2:28-29.

Predictable Outcome:The use o a membrane to cover the lateral window in sinus lit has been correlated with a higher

implant survival rate in a systematic review and metaanalysis. Thus, a more predictable outcome can be expected due to

consistently better bone ormation obtained using a membrane.

As seen rom the below immunohistochemical evaluations in a rat model, Geistlich BioGide shows a homogeneous angi

ogenesis pattern and transmembraneous vascularisation ater two weeks Fig. 4. Other collagen membranes tested do

not vascularise until 4 to weeks, some not even ater 24 weeks.,


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Clinical Cases

Cawood ClassicationIn 1988, Cawood and Howell established a classication o edentulous jaws that has been generally accepted over the

years. Such a classication serves to simpliy description o the residual ridge and thereby aid selection o the appropriate

surgical and prosthodontic technique.

Arising rom their morphological studies o edentulous jaws, Cawood and Howell concluded that i basal bone does not

change shape signicantly unless subjected to harmul local eects and ii alveolar bone changes shape signicantly

ollowing a predictable pattern.

The most commonly observed changes in shape o the alveolar process are summarised or the mandible Fig. a,b

and or the maxilla Figure 7a,b.

Cawood JI & Howell RA. A classication o the edentulous jaws. Int J Oral Maxilloac Surg 1988 Aug;17(4):232-6.

Posterior Mandible

Fig. b: Classication o posterior mandible. Basal bone and alveolar bone in blue and white, respectively.

Anterior Mandible

Fig. a: Classication o anterior mandible. Basal bone and alveolar bone in blue and white, respectively.


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Descriptive classications o the alveolar bone changes derived rom the composite diagrams:

Class I dentate

Class II immediately postextraction

Class III wellrounded ridge orm, adequate in height and width

Class IV knieedge ridge orm, adequate in height and inadequate in width

Class V at ridge orm, inadequate in height and width

Class VI depressed ridge orm, with some basalar loss evident

Although this classication was originally based on the observations o edentulous jaws, it can also be used to describe

deects in partially edentulous jaws, taking into account that the transitions between classes are gradual.

The clinical cases presented subsequently show dierent therapy concepts in partially or ully edentulous jaws or oral and

maxilloacial deects belonging to Cawood Class IV, V, or VI.

Anterior Maxilla

Posterior Maxilla

Fig. 7a: Classication o anterior maxilla. Basal bone and alveolar bone in blue and white, respectively.

Fig. 7b: Classication o posterior maxilla. Alveolar bone in blue.


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1 CT-scan images o the recipi

ent area.

2 Intrasurgical view o the reci

pient area. Note the severehorizontal ridge resorption.

6 Two layers o Geistlich BioGide, xed with tacks, coverthe recipient area. This provides protection against a potential sot tissue enestration and also rom an eventualresorption o the grats.

3 Intrasurgical view o the do

nor site lled with GeistlichBioOss. A single ap waselevated including receptorand donor areas.

4 Autogenous bone grat placed

and xed in its correct position at the recipient area.

5 Geistlich BioOss covers theblock in order to achieve asot contour o the gratedarea. This avoids potentialcomplications during thehealing process and the collapse o the membrane.

7 Reentry surgery ater months, demonstrating optimal bone regeneration.

8 Panoramic Xray ater imimplant placement.

Cawood Class IV

ConclusionWithin the available treatment modalities or the regeneration o posterior mandibular areas, autogenous bone block grats

rom the mandibular symphysis remain as one o most popular procedures perormed by the dental community as this

surgical technique oers an easy access and enough grat material or adequate augmentation. The biomaterials, Geistlich

BioOss


may help the surgeon to obtain optimal regeneration results, avoiding potential sot andhard tissue complications during the healing process in both donor and receptor areas.

GBR with Block GratingDr. Juan Jos Aranda; Madrid

Therapy Concept

Jaw Dentition Region Augmentation

Upper Jaw Partially Edentulous Anterior Horizontal

Lower Jaw Fully Edentulous Posterior Vertical

Material

> Autogenous bone block chin

> Geistlich BioOss

> Geistlich BioGide xed with tacks

Aim

> Horizontal ridge augmentation: a GBR procedure is perormed with an autogenous bone block grat

harvested rom the chin area utilizing Geistlich BioOss and Geistlich BioGide.


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Cawood Class IV

ConclusionThe combination o autogenous bone grats harvested rom the alveolar zygomatic buttress with autogenous bone chips

is suited or reconstruction o bony alveolar crest deects in the anterior maxillary region. Bone harvesting was perormed

with the piezoelectric device Mectron Medical Technology, which avoids trauma to the mucosal membrane o the

maxillary sinus.

Besides a minimal morbidity, the zygomatic buttress donor site supplies good quality bone with a natural convex shape

ideally suited or the anterior alveolar process region. The combination o cortical bone external layer covering the

autogenous bone chips internal lling provides an excellent basis or successul osseointegration o dental implants.

This avoids the need or later secondary corrective sot tissue augmentation with brous tissue grats to reconstitute thevestibular projection. Geistlich BioGide protects the bone grat, avours wound healing, and adds additional saety to

a predictable outcome.

Combining Cortical and Particulate BoneDr. KaiHendrik Bormann, Pro. Dr. Dr. NilsClaudius Gellrich; Hannover

1 Bony deect in the anterior

region.

2 A cortical bone transplant is

gained rom the alveolar zygomatic buttress region.

3 The bone grat is harvested

without harming the Schneiderian membrane.

4 The thin cortical bone grat

in place with transosseousscrew xation.

5 Ater lling the gap under thealveolar zygomatic buttesswith autogenous bone chips,Geistlich BioGide is placed

over the augmented deect.

6 Sot tissue situation ater 4weeks.

7 Situation at reopening beore implant insertion, 12weeks ater augmentation.

8 Fixation screws are removedand the dental implant is inserted.

Therapy Concept




Material> Autogenous bone transplant and chips alveolar zygomatic buttress

> Geistlich BioGide

Aim> Horizontal ridge augmentation: to achieve an excellent aesthetical outcome with an alveolar zygomatic buttress bone

transplant in combination with autogenous bone chips covered with Geistlich BioGide.


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ConclusionThe technique is appropriate or patients with severe horizontal bone atrophy and provides a successul ridge augmentation

with high predictability.

Covering the autogenous block grat with Geistlich BioOss and Geistlich BioGide signicantly reduces autogenous

bone block resorption.

The resorbable membrane, Geistlich BioGide, shows an easy handling and simplies the surgical method. The stability o

the membrane can be urther improved using the doublelayer technique.

Cawood Class IV

GBR with Block GratingPro. Dr. Daniel Buser, PD Dr. Thomas von Arx; Bern*

1 Thin ridge situation in the

posterior mandible.

2 The bone cortex is perorated

with a small round bur to induce bleeding rom the marrow cavity.

3 Bone grat rom the retromo

lar area xed with a titaniumscrew.

4 Coverage with Geistlich Bio

Oss.

5 The collagen membrane,Geistlich BioGide , is applied using the doublelayertechnique.

6 Primary wound closure is accomplished with single interrupted sutures.

7 Optimal bony support or implant placement ater approx. months.

8 Stable periimplant bone level18 months postoperatively.

Therapy Concept




Material

> Autogenous bone block retromolar area posterior to the augmentation

> Geistlich BioOss

> Geistlich BioGide doublelayer technique

Aim> Horizontal ridge augmentation: using Geistlich BioOss and Geistlich BioGide to cover the

autogenous bone block or minimizing resorption o the bone grat.

* von Arx T & Buser D. Horizontal ridge augmentation using autogenous block grats and the guided bone regeneration technique with collagen membranes:

a clinical study with 42 patients. Clin Oral Implants Res 2006;17(4):359-66.


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Cawood Class IV

ConclusionThis method appears suitable or successul horizontal ridge augmentation, prior to implant placement, in the indications

o single tooth gaps, multiple tooth gaps, and edentulous distal extension situations. The combination o Geistlich

BioOss and Geistlich BioGide appears to be an eective treatment option or horizontal ridge augmentation and

avoids harvesting o autogenous bone.

The barrier unction o the resorbable collagen membrane Geistlich BioGide seems to be adequate or the desired bone

regeneration in these indications.

GBR with BiomaterialsPro. Dr. Christoph Hmmerle; Zurich*

1 Buccal view o the deect

sites.

2 Augmentation with Geistlich

BioOss granules and Geistlich BioOss SpongiosaBlocks.

3 The resorbable Geistlich Bio

Gide membrane coveringthe right side o the augmented area.

4 The entire area covered with

Geistlich BioGide.

5 Suitable bone support or implant insertion 9-10 monthspostoperatively.

6 Ater placement o the implants, no remaining bonedeects were present.

7 Occlusal view o the deectclosure.

8 Final outcome ater insertiono the xed partial denture.

Therapy Concept




Material

> Geistlich BioOss Spongiosa Block

> Geistlich BioOss

> Geistlich BioGide

Aim> Horizontal ridge augmentation: GBR using biomaterials as sole substitute or alveolar bone augmentation

to avoid autogenous bone grat harvesting.

* Hmmerle CHF, Jung RE, Yaman D, Lang NP. Ridge augmentation by applying bioresorbable membranes and deproteinized bovine bone mineral:

a report o twelve consecutive cases. Clin Oral Implants Res 2008;19(1):9-25.


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ConclusionThe crest splitting technique allows the placement o implants in anatomic situations with insufcient ridge thickness, by

moving the external cortical plate o the maxilla in a labial direction. This technique allows immediate implant placement,

despite a large ridge augmentation.

The gap resulting rom the crest splitting is lled with autogenous particulate boneand Geistlich BioOss ratio 1:1, which

allows a predictable bone volume preservation. Due to the good adhesion o Geistlich BioGide to the deect, the

particulate bone grat is kept in situ during the regeneration process.

Cawood Class IV

Crest SplittingDr. Gerhard Iglhaut; Memmingen

1 Occlusal view o the ridge a

ter ap elevation.

2 Longitudinal split o the alve

olar crest.

3 Two implants are placed in

the expanded crest.

4 The split around the implants

is lled with a mixture oautogenous bone chips andGeistlich BioOss.

5 The augmented ridge is covered with a Geistlich BioGidemembrane beore closure othe sot tissue.

6 Lingual view o the nal situation.

7 Occlusal view o the prosthetic outcome.

8 Xray ndings 6 months aterimplant placement.

Therapy Concept




Material

> Autogenous bone chips retromolar

> Geistlich BioOss

> Geistlich BioGide

Aim

> Horizontal ridge augmentation: the crest splitting procedure in combination with Geistlich BioOss and

Geistlich BioGide is used to increase ridge width.


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Cawood Class IV

1 Preoperative panoramic ra

diograph showing partiallyedentulous ridge at teeth 32,31, 41.

2 Bone resorption and ridge

width reduction can be seenin the edentulous area.

3 Bone harvesting rom chin. 4 Onlay grat xation and

Geistlich BioOss contouringand covering.

5 Sot tissue healing monthsater surgery.

6 Occlusal view showing complete preservation o thegrat volume ater months.

7 Dental implants in place. 8 Postoperative panoramic radiograph.

ConclusionOptimal horizontal augmentation can be achieved in partially edentulous areas by contouring the autogenous bone block

with Geistlich BioOss.

Geistlich BioOss can be placed over grated areas, taking advantage o its osteocondutive properties and compensating

or the natural bone resorption that always occurs. Geistlich BioOss provided a spacemaking eect that allowed better

healing with osteogenic cell colonization and adequate volume o the grated area. Further, it appeared to avour good

blood supply and resulted in relatively dense bone within months.

Block ContouringPro. Dr. Carlo Maiorana; Milan*

Therapy Concept




Material> Autogenous bone blocks chin

> Geistlich BioOss

* Maiorana C & Simion M. Advanced Techniques or Bone Regeneration with BioOss and BioGide. RC libri 2005;34-37.

Aim

> Horizontal ridge augmentation: smoothing the surace o the autogenous bone block with Geistlich BioOss

to avoid sot tissue ingrowth and bone resorption.


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ConclusionThe combination o particulate autogenous bone and Geistlich BioOss allows a minimal invasive horizontal ridge

augmentation. This procedure avoids harvesting o an autogenous bone block and its related morbidity o the donor site.

The grat is urther protected with Geistlich BioGide. The barrier unction o the bioresorbable collagen membrane gives

the needed protection or optimal GBR and sot tissue healing. The xation o the membrane is mandatory in this case,

as it is vital to prevent micromovements o the grat.

Cawood Class IV

GBR with Particulate GratingPro. Dr. Istvan Urban; Budapest

1 Preclinical situation. 2 Knieedge ridge in the poste

rior mandible.

3 Mixture o autogenous parti

culate bone and GeistlichBioOss is placed onto theresidual ridge.

4 The grat is urther protected

with Geistlich BioGide.

5 Titanium pins are used to xthe collagen membrane.

6 Clinical situation ater twoweeks o healing.

7 Excellent incorporation o thegrat at reentry 7 monthsater rst surgery. The ridgewidth is approximately 10 mm

and thereore sufcient orimplant placement.

8 Implant insertion.

Therapy Concept




Material

> Autogenous bone chips oblique ridge o the retromolar area

> Geistlich BioOss

> Geistlich BioGide xed with titanium pins

Aim

> Horizontal ridge augmentation: minimal invasive augmentation procedure to obtain sufcient bone with a mixture o

autogenous bone and Geistlich BioOss covered with a Geistlich BioGide membrane.


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Cawood Class V

ConclusionBoth edentulous upper jaw sites are vertically augmented with a sinuslit procedure. On the let site an autogenous block

grat compensates additionally the severe vertical atrophy.

To prevent bone resorption and to preserve the augmented volume, Geistlich BioOss is used in the sinus lit in combination

with autogenous bone and to cover the lateral window in the sinus lit. Furthermore, beore sot tissue closure the

collagen membrane, Geistlich BioGide, is placed on the entire deect to protect it and to avour an optimal aesthetic

outcome.

Sinus Lit and Block GratingPro. Dr. Matteo Chiapasco; Milan

1 Preoperative radiograph sho

wing a partially edentulousmaxilla on both sides with anassociated vertical atrophy,more severe on the let side.

2 Sinus grating with a mixture

o Geistlich BioOss and autogenous bone associatedwith vertical onlay grating othe atrophic let maxilla.

3 Coverage and contouring o

the grat and the autogenousbone in the lateral enestration with Geistlich BioOss.

4 The lateral window and the

autogenous bone block arecovered with Geistlich BioGide.

5 Radiographic control atersurgery sinus grating withsimultaneous implant placement on the right side hasbeen perormed during thesame session.

6 Clinical situation ater sottissue closure.

7 Prosthetic rehabilitation outcome right side.

8 Clinical situation ater completion o prosthetic rehabilitation let side.

Therapy Concept




Material

> Autogenous bone block and chips let ramus

> Geistlich BioOss

> Geistlich BioGide

Aim

> Vertical ridge augmentation: reduction o autogenous bone grat resorption by covering the augmented site with

Geistlich BioOss and Geistlich BioGide.


20/4020

Cawood Class V

ConclusionThe sandwich osteotomy procedure in the posterior mandible yields an optimal vertical gain, which allows adequate bone

or implant placement, in patients with a minimum o 5 mm o bone above the mandibular canal.

Filling the recipient site with Geistlich BioOss Spongiosa Block avoids a second intervention or collection o autogenous

bone. Thus, the use o an inorganic cancellous bone block simplies the inlay surgery or both, dentist and patient.

Geistlich BioGide covers the distracted segment and the substitute bone grat and enhances wound healing without

complications.

Interpositional Bone GratingDr. Pietro Felice* MD/DDS, Pro. Luigi Checchi MD/DDS,Pro. Claudio Marchetti MD/DDS; Bologna

1 Exposure o the alveolar ridge

and buccal bone.

2 Horizontal and vertical oste

otomies o the distractedsegment.

3 The upward lit o the trans

ported segment, obtaining aheight dimension gain o 7mm.

4 Geistlich BioOss Spongiosa

Block is trimmed to the adequate dimension and shapeto be completely tted in therecipient site.

5 The distracted segment andthe biomaterial block arexed with miniplates and miniscrews.

6 A resorbable bilayer collagenmembrane Geistlich BioGide is used to cover the gratmaterial.

7 Intraoperative situation ollowing implants insertion, 4months ater the reconstruction.

8 Periapical xray evaluationimmediately ater implant insertion.

Therapy Concept




Material

> Osteosynthesis plates

> Geistlich BioOss Spongiosa Block

> Geistlich BioGide

* Felice P et al. Vertical ridge augmentation o the atrophic posterior mandible with interpositional block grats: bone rom the iliac crest versus bovine

anorganic bone. Eur J Oral Implant 2008 Sept (in press).

Aim

> Vertical ridge augmentation: gain o sufcient ridge height with a sandwich osteotomy lled with Geistlich BioOss

Spongiosa Block and covered with Geistlich BioGide.


21/4021

Cawood Class V

1 The vertical bony deect is vi

sible ater ap elevation.

2 The autogenous bone grat is

used or stabilising the heighto the membrane.

3 The 3dimensional volume is

created by using GeistlichBioOss Collagen, and covered by a titaniumreinorcedePTFE membrane.

4 Geistlich BioGide is placed

over the nonresorbable ePTFE membrane or betterwound healing.

5 The ePTFE membrane is

removed and the implant isinserted months postoperatively.

6 Closure o the sot tissue a

ter implant placement.

7 months ater implant place

ment the sot tissue healsuneventully and the verticaland horizontal ridge dimension is regained.

8 Optimal outcome in the aes

thetic relevant zone.

ConclusionThis method is appropriate or augmentations in the anterior region to allow implant placement and to ensure a good

aesthetic result. The autogenous bone grat is used or supporting the titaniumreinorced ePTFE membrane, which

denes the appropriate ridge height. The horizontal and vertical volume is created by using Geistlich BioOss Collagen.

The use o Geistlich BioGide over the nonresorbable membrane avours the healing o the sot tissue and minimises the

incidence o wound dehiscence.

Horizontal/Vertical AugmentationDr. Ueli Grunder; ZurichZollikon

Therapy Concept




Material

> Autogenous bone block spina nasalis

> Geistlich BioOss Collagen

> Titaniumreinorced ePTFE membrane> Geistlich BioGide

Aim

> Horizontal and vertical ridge augmentation: adequate bone volume as a support or sot tissue

to obtain an optimal aesthetic result.


22/4022

ConclusionThis technique is relatively simple and can provide excellent GBR results in partially endentulous patients. The osteosyn

thesis plates can be rapidly shaped and customized to any possible situation providing a rigid scaold to protect the bone

grat. The resorbable Geistlich BioGide is preerred over nonresorbable membranes in order to minimize postoperative

complications.

Cawood Class V

Vertical AugmentationDr. Mauro Merli; Rimini

1 Radiological ndings showing

the deect prior to the intervention.

2 Immediate implant insertion

beore vertical ridge augmentation.

3 Titanium osteosynthesis

plates are opportunely bentand xed with screws on thedeect.

4 The resorbable barrier Geist

lich BioGide is placed overosteosynthesis plates lledwith the particulate autogenous bone grat.

5 Xray displaying the situationimmediately ater augmentation.

6 Tissues during the healingphase o the grat just beoreimplant exposure.

7 Exposure o the regeneratedarea with the plates still insitu 9 months ater implantinsertion.

8 The implants are completelysurrounded by bone.

Therapy Concept




Material

> Autogenous bone chips ramus


> Geistlich BioGide

Aim> Vertical ridge augmentation: grat stability is achieved using osteosynthesis microplates.

GBR is perormed with autogenous bone grat and a resorbable barrier membrane, Geistlich BioGide.


23/4023

Cawood Class V

1 Computed Tomography beore

augmentation.

2 The drawing shows the stron

gly resorbed alveolar bone.Autogenous bone blocks inbuccal and palatal sides createa 3 wall cavity, which is lledwith a mixture o GeistlichBioOss and autogenousbone chips ratio 3:1.

5 CT showing the situation months ater bony augmentation.

4 3dimentional CT showing the

augmented deect rom thelet prole.

3 CT showing the augmented

deect.

6 Geistlich BioOss lls thesinus cavity and the gaps between the autogenous boneblock grats.

7 months postbone grating,implants are inserted.

8 Xray ndings ater implantplacement.

ConclusionMaxillary sinus augmentation with Geistlich BioOss, combined with autogenous bone block grats is a possible method

or creating adequate bone height and width beore implant insertion. In cases o severe atrophy autogenous block grats

in the buccal and in the palatal sides create a 3wall cavity or reconstruction o the alveolar crest. The created cavity can

be easily lled with Geistlich BioOss and autogenous bone chips.

The Geistlich BioOss material not only serves as a scaold or blood clot ormation, but also preserves the augmented

volume due to its slow rate o conversion to autogenous bone remodeling.

Alveolar Reconstruction and Sinus LitPro. Dr. Armand R. Paranque; Paris

Therapy Concept




Material> Autogenous bone blocks and chips ramus and chin

> Geistlich BioOss

Aim

> Horizontal and vertical ridge augmentation: alveolar crest reconstruction associated with maxillary sinus lit.


24/4024

Cawood Class V

1 Preoperative panoramic radio

graph.

2 Clinical situation in the right

maxilla ater implant placement.

3 The site augmentated with

Geistlich BioOss is stabilised with a titanium mesh.

4 Geistlich BioOss lls the

lateral enestration o the sinus.

5 Situation in the let upper jawater lateral window preparation.

6 Geistlich BioOss lls thesinus cavity and covers thedeect around the implants.A titanium mesh stabilises the

retromolar augmentation.

7 Radiographic ndings months ater augmentation.

8 Final outcome months atersurgery right side.

ConclusionThe combination o sinus lit with horizontal and vertical augmentation using particulate bone substitute allows implant

insertion in a onestage procedure.

Geistlich BioOss is used to ll the sinus cavity and or augmentation o the ridge deect. The use o particulate bone

substitute, which is stabilised with a titanium mesh, avoids completely the harvesting o autogenous bone and the risk o

morbidity o the donor site.

Sinus Lit and Bone Substitute GratingPD Dr. Dr. Karl Andreas Schlegel; Erlangen

Therapy Concept




Material > Geistlich BioOss stabilised with a titanium mesh

Aim

> Horizontal and vertical ridge augmentation: Geistlich BioOss used in sinus elevation and in

horizontal augmentation, supported by a titanium mesh.


25/4025

Cawood Class V

1 Panoramic Xray o the initial

situation.

2 Bone marrow approx. 60 ml

is harvested with a needlerom the pelvis dorsal orventral. The bone marrowaspirate is concentrated in acentriuge to 37 ml in approx. 15 minutes.

3 Geistlich BioOss is mixed

with the bone marrow concentrate and with autologousthrombin.

4 The mixture is lled into the

sinus oor deect throughthe lateral enestration andinto the extraction socket.

5 The lateral enestration and

augmentation sites are covered by a Geistlich BioGide.

6 Implant placement at reentry

only 3 months ater sinus lit.

7 Final situation with the pro

sthetic supply on both sites.

8 Panoramic Xray ater implant

insertion.

ConclusionThe sinus model demonstrates that the combination o Harvest BMAC Bone Marrow Aspirate Concentrate with

Geistlich BioOss and Geistlich BioGide accelerates the tissue regeneration. Histological analysis conrms the presence

o mature bone with a high percentage o lamellar bone, already ater 3 months.

The concentrated bone marrow aspirate delivers growth actors and mononuclear cells including mesenchymal stem cells

specically targeted to the deect. This allows the immediate presence o the complex physiological system needed or

tissue regeneration. Thereore, the addition o Harvest BMAC to Geistlich BioOss may be a successul technique or a

broad range o clinical indications.

The Harvest BMAC in combination with Geistlich BioOss


is currently being tested in a prospectivemulticenter study.

Sinus Lit with Harvest BMACTM

Pro. Dr. Dr. Rainer Schmelzeisen*, Pro. Dr. Dr. Ral Gutwald,Dr. Dr. Andris Stricker, Dr. Michael Vogeler, Dr. Sebastian Sauerbier; Freiburg*FRCS London

Therapy Concept




Material

> Harvest BMACTM Bone Marrow Aspirate Concentrate

> Geistlich BioOss

> Geistlich BioGide

Aim

> Vertical ridge augmentation: acceleration o the tissue regeneration process to obtain mature bone in a short

period o time ater augmentation.


26/4026

ConclusionSuccessul vertical ridge augmentation can be achieved in partially edentulous lower jaws by covering a mixture o

particulate Geistlich BioOss and autogenous bone chips with a titaniumreinorced ePTFE membrane.

Histologic observations conrm a positive osteoconductivity o Geistlich BioOss in close contact with the newly ormed

bone.*

Geistlich BioOss undergoes very slow resorption and substitution with new bone remodelling, which is expected to be

advantageous or the longterm stability o regenerated bone.

Cawood Class V

Vertical AugmentationPro. Dr. Massimo Simion, Dr. Isabella Rocchietta; Milan

1 Intraoral view o the deect in

the posterior right mandible.

2 Two tenting screws are in

serted to support the overlying membrane and the particulated grat.

3 Augmentation with Geistlich

BioOss and autogenousbone 1:1 and covering with atitanium reinorced ePTFEmembrane.

4 The ePTFE membrane is

shaped to adapt to the deect. The membrane is secured bucally by two xationscrews.

5 Primary wound closure. 6 Panoramic X-ray o the augmented sites.

7 Ater months o uneventulhealing, the screws and themembrane are removed.

8 Three titanium implants areplaced.

Therapy Concept




Material

> Autogenous bone chips maxillary tuberosity

> Geistlich BioOss

> Titaniumreinorced ePTFE membrane xed with screws

* Simion M et al. Vertical ridge augmentation by expandedpolytetrauoroethylene membrane and a combination o intraoral autogenous bone grat and

deproteinized anorganic bovine bone Bio Oss. Clin Oral Implants Res 2007 Oct;18(5):620-9.

Aim> Vertical ridge augmentation: combination o a mixture o Geistlich BioOss and autogenous bone chips 1:1

with a titaniumreinorced ePTFE membrane or longterm successul GBR.


27/40


28/40


29/4029

Cawood Class V

ConclusionThanks to the CT diagnostic, the complexity o the sinus cavity can be revealed and an appropriate surgical procedure can

be planned.

In sinuses with multiple septa, careul attention should be payed in membrane elevation in order to preserve its integrity.

The Schneiderian membrane can be successully protected or repaired in case o peroration with Geistlich BioGide.

With Geistlich BioOss, a predictable implant outcome can be achieved even without the use o autogenous bone.

Sinus Lit AugmentationDr. Tiziano Testori; Como

1 Computed tomography show

ing the complexity o the sinus anatomy.

2 Orthopantomograph o the

initial situation.

3 Antrostomy with membrane

elevation displaying the multiple septa.

4 The Schneiderian membrane

is protected with GeistlichBioGide.

5 The antrum is lled with

large particles o GeistlichBioOss.

6 Geistlich BioOss complete

ly lls the antrum up to thevestibular cortical wall.

7 Placement o two Geistlich

BioGide membranes doublelayer technique to coverthe antrostomy.

8 Post-op orthopantomograph

showing the sinus lift proce-dure.

Therapy Concept




Material> Geistlich BioOss

> Geistlich BioGide

Aim> Vertical ridge augmentation: reconstructive surgery with a sinus lit augmentation with multiple septa.


30/4030

Cawood Class VI

ConclusionLe Fort I osteotomies allow the repositioning o the maxilla in an aesthetic as well as a unctional context. The resulting

acial contours lead to a juvenilisation o the prole, which cannot be achieved by using maxilliary sinus grating.

The coverage o the autogenous bone grat by Geistlich BioGide reduces the autogenous bone resorption, and ensures

the bony bridging o the osteotomy gap.

Le Fort I OsteotomyDr. Dr. Corvin Glatzer, Dr. Oliver Schwerdtner; Berlin

1 Preoperative situation: Typi

cal Class III malocclusion.

2 Buccal view with an extreme

ly atrophied alveolar ridge.

3 Le Fort I osteotomy and xa

tion with osteosynthesisplates.

4 Contouring with autologous

bone chips.

5 The deect is covered with aresorbable collagen membrane Geistlich BioGide.

6 Situation months ater surgery.

7 Osteosynthesis plates areremoved at the stage o reentry.

8 Successul Le Fort I osteotomyoutcome leading to a pleasantprole.

Therapy Concept




Material

> Autogenous bone chips harvested intraorally


> Geistlich BioGide

Aim

> Vertical ridge augmentation: oral unctionality restored with the Le Fort I osteotomy.


31/4031

Cawood Class VI

ConclusionThe autogenous bone grat allows ull reconstruction o a severely atrophied alveolar ridge in both the upper and the lower

jaw with recovery o oral unction. The bone blocks are urther contoured with autogenous bone chips to ll the remaining

gaps and even out the labial alveolar ridge.

Due to multiple layers o Geistlich BioGide covering the deect, the bony augmentation is strongly stabilized, which

enhances a proper GBR.

GBR with Block GratingPro. Dr. Dr. Tateyuki Iizuka; Bern

1 Preoperative xray reveals

strong resorption o the maxilla and the mandible letside.

2 Situation ater exposure o

the maxillary alveolar ridge.

3 Autogenous bone block grats

are xed and contoured withautogenous bone chips.

4 The maxillary grat is covered

completely with several layers o Geistlich BioGide.

5 Autogenous bone block inplace mandible.

6 Contouring o the mandibular grat with autogenousbone chips.

7 Resorbable collagen membranes Geistlich BioGideare placed over the augmented site beore suture.

8 Radiography, 3 months atersurgery.

Therapy Concept




Material> Autogenous bone blocks and chips calvaria

> Geistlich BioGide

Aim> Horizontal and vertical ridge augmentation: reconstruction o extremely atrophied maxilla and mandible

to restore oral unction.


32/4032

ConclusionThis method is suitable and sae or bilateral sinus elevation and simultaneous lateral ridge augmentation in cases where

large volumes o hard tissue > cc are required.

Bilateral sinus elevation by using biomaterial alone is possible under the conditions o: i undamaged Schneiderian

membrane, and ii relatively low volume o hard tissue required 3 cc or successul implant installation.

In severe atrophy cases however, the combination o autologous bone harvested rom the iliac crest and Geistlich BioOss

provides: i sufcient volume o regenerative material by simultaneous reduction in the need or autologous bone, ii

sufcient stability by introducing a slow resorbable biomaterial, and iii sufcient amount o potentially osteogenic cells.

Sinus Lit and Block GratingPD Dr. Dr. Claude Jaquiry, Dr. Nicolas Gabutti,Pro. Dr. Dr. HansFlorian Zeilhoer; Basel

2 The bony window is removed

PiezoSurgery and theSchneiderian membrane issuccessully elevated. A Geistlich BioGide is placed toprotect the mucosa and to acilitate introduction o autologous bone and biomaterial.

3 Autologous blocks harvested

rom the iliac crest are placedin multilayer technique. Gapsbetween the blocks are lledup using a 1:1 mixture oGeistlich BioOss and cancellous bone.

4 The bony window is replaced

and additional blocks or lateral augmentation are xedby titanium screws.

5 The augmented area is covered by a Geistlich BioGidemembrane in order to prevent invasion o brous tissue.

6 CTscan sagittal section othe right upper jaw 9 monthsater augmentation showingconsolidated hard tissuewithin the newly createdridge.

7 The vertical dimension > 10mm allows successul implant installation 4.2 mm diameter and 12 mm length.

8 Clinical view ater xed prosthetic rehabilitation.

Therapy Concept




Material

> Autogenous bone blocks and chips iliac crest

> Geistlich BioOss

> Geistlich BioGide

1 Partially edentulous maxilla

showing severe atrophy oposterior ridge. Residual vertical bone 1 mm does notallow simultaneous implantinstallation.

Aim> Horizontal and vertical ridge augmentation: successul vertical and lateral ridge augmentation in a severe atrophy case.

Cawood Class VI


33/4033

Cawood Class VI

1a Clinical situation beore sur

gery.

2a Augmented site ater 14

weeks o distraction procedure.

3a Implant insertion and tem

porary bridge 4 months ater rst surgery.

4a Final prosthodontic rehabi

litation with xed bridge inthe lower jaw 9 months ater rst surgery.

1b Xray corresponding to picture 1a.




ConclusionThe endodistraction device, looking like a dental implant, is positioned in the centre o the bone and, when escalated,

creates a distraction chamber, which lls up with callus ormation and later original bone.

Compared to conventional devices with plates, the main advantages are: no tilting tendency to the lingual side and no

second operation or device removal.

Using the endodistraction technique bone, gums, and the rehabilitation o the aesthetics o ace and lips are gained within

one operation.

DistractionUniv.Pro. Dr. Christian Krenkel, Dr. Dr. Simon Enzinger; Salzburg

Therapy Concept




Material > EndoDistractor Krenkel

Aim

> Vertical ridge augmentation: ull reconstruction o the alveolar bone and recovery o oral unctionality.


34/4034

Cawood Class VI

ConclusionInterpositional bone grat procedures i.e., Le Fort I osteotomy in the maxilla and sandwich osteotomy in the mandible

provide several advantages to edentulous patients with moderate to severe bone loss ater periodontitis: i sagittal and

vertical movement o the ridges with compensation o the bone loss, ii conservation o the xed gingival tissues on top

o the ridge, iii less resorption than with onlay grats, iv good wound healing o the bony deect.

The good biological prerequisites or regeneration in the osteotomy gaps interpositional grating allow clinical use o

bone substitute materials such as Geistlich BioOss.

Le Fort I and Sandwich OsteotomiesPro. Dr. Dr. Hendrik Terheyden; Kassel*

1 Preoperative radiologic n

dings showing strong boneresorption in mandible andmaxilla.

2 The gap let ater osteotomy

was lled with iliac crest andGeistlich BioOss 1:3.

3 The deect in the maxilla was

covered with Geistlich BioGide.

4 Filling o the mandibular

sandwich osteotomy witha mixture o particulate iliaccrest and Geistlich BioOss1:3.

5 Ater 4 months implants wereplaced.

6 Situation in the maxilla aterimplant insertion.

7 Optimal outcome with xedprosthetic supply.

8 Panoramic Xray ater implant placement.

Therapy Concept




Material

> Autogenous bone blocks and chips iliac crest

> Geistlich BioOss

> Geistlich BioGide

* Terheyden H et al. Interpositionsosteoplastik des zahnlosen Ober und Unterkieers Eine therapeutische Alternative bei Knochenverlust durch aggres

sive Parodontitis. Implantologie 2007;15(3):297-304.

Aim> Horizontal and vertical ridge augmentation: use o Geistlich BioOss and Geistlich BioGide or reconstruction

o extremely atrophied ridges in edentulous patients.


35/4035

Cawood Class VI

ConclusionOne therapy concept or vertical ridge augmentation o a partially endentulous ridge in an aesthetically relevant region is

the combination o distraction osteogenesis ollowed by an autogenous bone grating.

The prerequisite or using distraction osteogenesis is a minimum o 6 to 7 mm o bone height above the vital structures.

In the distraction phase, the two pieces o bone undergo gradual incremental separation and new bone lls in the deect.

Due to the additional bone grating ater distraction, a good aesthetic outcome is ensured. Implant placement is carried

out in a third stage.

Distraction and Block GratingDr.Albino Triaca, Dr. Dr. Roger Minoretti; Zurich & Dr. Dan Kraus; Lugano

1 Preoperative clinical situation. 2 Raising the mucoperiosteal

ap, ater a vestibular incision, and perorming the osteotomy.

3 Fixation o the crane distrac

tor MDOC, Orthognathicswith screws.

4 Situation at the end o the

distraction procedure 0.250.5 mm per day.

5 The distractor is removed atthe end o the distraction retention period, which lasts 3months.

6 Autogenous bone blocks andchips are use or urther augmentation and xed withscrews and a titanium mesh.

7 Ater months, the titaniummesh and screws are removed. Additionally the attachedgingiva is broadened with apalatal sot tissue grat.

8 Situation ater implant placement and healing.

Therapy Concept




Material

> Distractor MDOC, Orthognathics

> Autogenous bone blocks and chips iliac crest, stabilised with a titanium mesh

> Osteosynthesis screws

Aim> Vertical ridge augmentation: the distraction procedure and an iliac crest bone grat used or excellent

outcome in the aesthetically relevant zone.


36/4036

Product Range

Resorption(%)

Less

resorption!

autog. block+

Geistlich Bio-Oss

peripherically 4

autog. block+

autog. chipsperipherically

+Geistlich Bio-Gide 5

autog. block+

Geistlich Bio-Oss

cover 3

autog. block+

Geistlich Bio-Oss

cover+


autog. block+

autog. chipsperipherically 3

Comparison o horizontalaugmentation techniquesshows lower resorption

rates, i the autogenousblock grat is coveredwith Geistlich BioOssand Geistlich BioGide.

Geistlich BioGide PerioSystem CombiPack

Geistlich BioOss Geistlich BioOss Collagen

Geistlich BioGide and Geistlich BioOss:

your successul regeneration team


37/4037

Geistlich BioGide Geistlich BioOss

Geistlich Bio-Gide

resorbable, bilayer membrane25 x 25 mm

Geistlich Bio-Oss

spongiosa granules0.251 mm; 0.25 g, 0.5 g, 2 g

Geistlich Bio-Gide

resorbable, bilayer membrane30 x 40 mm

Geistlich Bio-Oss

spongiosa granules12 mm; 0.5 g, 2 g

Geistlich Bio-Gide Perioresorbable, bilayer membrane16 x 22 mm, sterile templates

Geistlich Bio-Oss Collagenspongiosa granules + 10% collagen100 mg approx. 0.20.3 cm

250 mg approx. 0.50.6 cm

Perio-System Combi-Pack

Geistlich BioOss

Collagen 100 mg+ Geistlich BioGide Perio 16 x 22 mm,sterile templates

Geistlich Bio-Oss Spongiosa Block

1 block1 x 1 x 2 cm approx. 2 cm


38/4038

Oral and maxilloacial surgery oers a plurality o therapy concepts or regeneration o sot and hard tissues. A broad

variety o surgical approaches within the alveolar ridge augmentation therapies has been presented in this brochure.

As a pioneer in bone and sot tissue regenerative processes, Geistlich Biomaterials is committed to scientic research in

better solutions and new areas o regeneration. With this goal, Geistlich Biomaterials together with leading international

surgeons conduct several clinical studies, ocusing on a broad spectrum o oral and maxilloacial indications, namely:

cranial deects, orbital oor, rhinoplasty, palatal and alveolar clet, orthognathics, genioplasty.

We are looking orward to presenting you our results and discussing with you new indications or using biomaterials in

cranial and maxilloacial surgery.

Outlook

Cranial Defects

Orbital Floor

Rhinoplasty

Palatal Cleft

Orthognathics

Genioplasty

Alveolar Cleft


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