Frequently Asked Questions (FAQ)

Blood from the defect may be used for mixing. Care should be taken to avoid contamination with salivary bacteria.

Geistlich Bio-Oss® is made from the mineral part of bovine bone. The strictly controlled manufacturing process ensures high quality and safety standards by:

• defined origin of the raw material
• country of origin: Australia (and for some countries also New Zealand) which is historically and currently free of BSE
• selected and certified slaughterhouses
• pre- and post-mortem health inspection for each individual animal
• extremity bone (according to WHO Guideline on tissue infectivity classified as tissues with no detected infectivity or infectious prions)
• effective inactivation methods with 15h treatment at high temperature and cleaning with strong alkaline solutions
• sterilization, double sterile packaging
• official controls by international authorities

The use of local antibiotics is generally unnecessary when utilizing Geistlich Bio-Oss®.

No. If Geistlich Bio-Oss® is autoclaved, moisture can collect in the particles due to the high porosity of the product, which can change the hydrophilic properties. Moreover, Geistlich Bio-Oss® is not approved for re-sterilization. Re-sterilization under any circumstances is not recommended.

A membrane should be used in conjunction with Geistlich Bio-Oss® as a barrier against the ingrowth of soft tissue¹. Native collagen membranes such as Geistlich Bio-Gide® also promote wound healing and increase therapeutic safety in the event of a postoperative wound dehiscence^2,3. Physicians should read the package insert prior to use.

References:

1. Gielkens PF, et al.: Clin Oral Implants Res 2008; 19(5) : 516-21.
2. Tal H, et al.: Clin Oral Implants Res 2008; 19(3): 295-302.
3. Becker J, et al.: Clin Oral Implants Res 2009; 20(7): 742-49.

Fundamentally, the use of small particles is recommended for small defects (up to 2 dental alveoli) and for augmenting autogenous grafts. The large particles are recommended for large defects (> 2 dental alveoli, sinus lifts), however, preferences can vary from dentist to dentist.

No. There are no other tips available.

No. The applicator tips are not available separately.

No. Discard and use a new Geistlich Bio-Oss Pen®.

No. If Geistlich Bio-Oss® is autoclaved, moisture can collect in the particles due to the high porosity of the product, which can change the hydrophilic properties. Moreover, Geistlich Bio-Oss® is not approved for re-sterilization. Re-sterilization under any circumstances is not recommended.

No, Geisltich does not recommend mixing autologous bone with the Geistlich Bio-Oss® granules within the syringe.

Depending on the size of the defect, between 1.5 to 4 cc of Geistlich Bio-Oss® granules are needed, 3cc on average. This is equivalent to two 1.5cc Geistlich Bio-Oss Pen® with large granules or three 1cc Geistlich Bio-Oss Pen® with small granules.

0.5 cc Geistlich Bio-Oss Pen®: ~0.5 ml
1.0 cc Geistlich Bio-Oss Pen®: ~1.0 ml
1.5 cc Geistlich Bio-Oss Pen®: ~1.5 ml

A membrane should be used in conjunction with Geistlich Bio-Oss® as a barrier against the ingrowth of soft tissue¹. Native collagen membranes such as Geistlich Bio-Gide® also promote wound healing and increase therapeutic safety in the event of a postoperative wound dehiscence^2,3. Clinicians should read the package insert prior to use.

References:

1. Gielkens PF, et al.: Clin Oral Implants Res 2008; 19: 516-21.
2. Tal H, et al.: Clin Oral Implants Res 2008; 19: 295-302.
3. Becker J, et al.: Clin Oral Implants Res 2009; 20(7): 742-49.

Fundamentally, the use of small particles is recommended for small defects (up to 2 dental alveoli) and for augmenting autogenous grafts. The large particles are recommended for large defects (> 2 dental alveoli, sinus lifts), however, preferences can vary from dentist to dentist.

The collagen in Geistlich Bio-Oss Collagen® does not function as a membrane. When space maintenance is required, it is recommended to use a membrane for optimal results¹.

References:

1. Perelmann-Karmon, et al.:  Int J Periodontics Restorative Dent 2012; 32(4): 459-65.

No. Geistlich Bio-Oss® Collagen is a mixture of 90% Geistlich Bio-Oss® spongiosa granules and 10% highly purified porcine collagen in a block form. Geistlich Bio-Oss® is a natural bone mineral of bovine origin. The collagen facilitates adaptation of the Geistlich Bio-Oss® to the defect site.

As Geistlich Bio-Oss Collagen® contains collagen, allergic and inflammatory tissue reactions cannot be excluded. These are, however, extremely rare.

Geistlich Bio-Oss® and Geistlich Bio-Oss Collagen® share the same indications. These products may be used interchangeably in the following procedures: 

• Augmentation or reconstructive treatment of the alveolar ridge.
• Filling of periodontal defects.
• Filling of defects after root resection, apicoectomy, and cystectomy.
• Filling of extraction sockets to enhance preservation of the alveolar ridge.
• Elevation of the maxillary sinus floor.
• Filling of periodontal defects in conjunction with products intended for Guided Tissue Regeneration(GTR) and Guided Bone Regeneration (GBR).
• Filling of peri-implant defects in conjunction with products intended for Guided BoneRegeneration (GBR).

Geistlich Bio-Oss Collagen® is recommended for reconstruction of bone defects in the following procedures:

• Augmentation/reconstruction of alveolar ridges.
• Filling of extraction sockets.
• Preparation of implant sites, filling of bone dehiscences, and sinus floor augmentations.
• Filling of periodontal bone defects, membrane support during guided bone regeneration (GBR) and guided tissue regeneration (GTR).

Geistlich Bio-Gide® is a membrane with a unique bilayer structure. It combines optimal bone formation with complication–free wound healing and predictable outcomes. A significant number of scientific publications and proven long-term clinical success support the safety and efficacy of Geistlich Bio-Gide®.

Geistlich Bio-Oss Collagen® and Geistlich Bio-Gide® are made of collagen, therefore allergic and inflammatory tissue reactions cannot be excluded. However, this is extremely rare.

Geistlich Combi-Kit Collagen is packed in a double blister. After the outer blister has been opened sterility can no longer be guaranteed. The product Geistlich Combi-Kit Collagen is registered for one time use only. It is not recommended to use the products separately.

Geistlich Combi-Kit Collagen is recommended for the reconstruction of the alveolar ridge, extraction socket management and augmentation of bone dehiscences.

Geistlich Bio-Gide® Perio and Geistlich Bio-Oss® Collagen are made of collagen, therefore allergic and inflammatory tissue reactions cannot be excluded. However, this is extremely rare.

The collagen in Geistlich Bio-Oss® Collagen does not function as a membrane. In guided bone regeneration (GBR) procedures, a membrane is indicated to obtain optimal results.¹

References:

1. Perelman-Karmon M, et al.: Int J Periodontics Restorative Dent 2013, 32(4): 459-65.

Perio-System Combi-Pack is packed in a double blister. After the outer blister has been opened, product sterility can no longer be guaranteed. The product Perio-System Combi-Pack is approved for single use only.

Geistlich Bio-Gide® can be used submerged or in an open healing situation¹ depending on the surgeon's preference. The advantages of the secondary intention healing of Geistlich Bio-Gide® include the ability to perform a flapless surgery and the preservation of the mucogingival line.

References:

1. Cardaropoli D, et al.: Int J Periodontics Restorative Dent 2012, 32(4): 421-30.

As Geistlich Bio-Gide® adheres very well to the defect, it is normally not necessary to utilize fixation screws or pins. However, fixation is possible if required.

No. Autoclaving or hot-air sterilization irreversibly destroys the collagen structure. The physical properties of the membrane are changed and the consistency of the product becomes like parchment paper. In addition the product is not approved for re-sterilization and therefore may not be used.

The bilayer structure of Geistlich BioGide® has a compact and porous surface. The compact layer of Geistlich Bio-Gide® exhibits higher cell occlusiveness than the rough, porous layer, preventing the downgrowth of epithelial cells. If the membrane is applied with the porous surface placed toward the soft tissue, integration of the bone cells may take place more slowly. However, it is not necessary to remove the membrane.

As Geistlich Bio-Gide® is made of collagen, allergic reactions and inflammatory tissue reactions cannot be excluded. However this is extremely rare.

Inflammation is a possible complication, which may occur with any surgery. However, biocompatibility of Geistlich Bio-Gide® has been verified in numerous studies.

Geistlich Bio-Gide® is a membrane with a unique bilayer structure. It combines optimal bone formation with complication-free wound healing and predictable outcomes. The native collagen of Geistlich Bio-Gide® leads to significantly less soft tissue dehiscences compared to artificially cross-linked membranes.¹ A significant number of scientific publications and proven long-term clinical success support the safety and efficacy of Geistlich Bio-Gide®.



References:

1. Tal H, et al.: Clin Oral Impl Res 2008; 19: 295-302.
2. Becker J, et al.: Clin Oral Impl Res 2009; 20(7): 742-49.
3. Schwarz F, et al.: Clin Oral Impl Res 2008; 19(4): 402-15.

Expert clinicians have estimated that a membrane used in Guided Bone Regeneration should maintain its barrier function until the provisional matrix and woven bone are present. Barrier duration is considered to be necessary for 7 to 14 days in most cases. Optimal barrier function now means that occlusiveness is maintained until the wound heals – a process which normally takes about 2 weeks.

Geistlich Bio-Gide® has proven to support bone regeneration on an equivalent level as membranes with a longer barrier function, with a reduction of complications during wound healing.^1-3

References:

1. Tal H, et al.: Clin Oral Implants Res 2008; 19(5): 295-302.
2. Becker J, et al.: Clin Oral Implants Res 2009; 20(7): 742-49.
3. Schwarz F, et al.: Clin Oral Implants Res 2008; 19(4): 402-15.

Alveolar bone regenerates best with a membrane designed for guided bone regeneration. The use of a membrane leads to increased bone as well as better quality bone compared to procedures that do not include a membrane.¹

References:

1. Schwarz F, et al.: Clin Oral Impl Res 2008; 19(4): 402-15.

Geistlich Bio-Gide® Compressed has a smoother surface, a firmer feel and is easier to cut compared to Geistlich Bio-Gide®. It offers an alternative handling for clinicians who prefer a firmer membrane. 

As Geistlich Bio-Gide® Compressed adheres very well to the defect, it is normally not necessary to stabilize with screws, pins or sutures. However, stabilization with screws, pins or sutures is possible due to its high tensile strength and may be indicated to avoid displacement due to shear loading or mobilization.

The smooth surface of Geistlich Bio-Gide® Compressed does not affect wound healing. It has the same clinical performance and biological properties as Geistlich Bio-Gide®. Various studies have shown that the Geistlich Bio-Gide® family of products supports excellent wound healing^1-3 and predictable bone regeneration⁴.

References:

1. Tal H, et al.: Clin. Oral Implants Res 2008; 19: 295-302. 
2. Zitzmann NU, et al.: Int J Oral Maxillofac Implants 1997; 12: 844-52. 
3. Becker J, et al.: Clin. Oral Implants Res 2009; 20(7): 742-93. 
4. Schwarz F, et al.: Clin Oral Implants Res. 2014, 25(9): 1010-15.

The bilayer structure of Geistlich Bio-Gide® Compressed has a compact, porous surface that exhibits higher cell occlusiveness than the rough, porous layer which prevents the downgrowth of epithelial cells. If the membrane is applied with the porous surface placed toward the soft-tissue, integration of the bone cells may take place more slowly, however the membrane does not need to be removed.

Geistlich Bio-Gide® Shape shares the same biological properties but is pre-cut to reduce preparation time, facilitate easier handling and specifically designed for non-intact extraction sockets.

Place the membrane without pre-wetting within the extraction socket. The long wing of the Geistlich Bio-Gide® Shape should be placed to cover the bony defect of the socket with the dense surface facing towards the soft-tissue and the rough side facing the defect. To close the extraction socket, both lateral wings of the Geistlich Bio-Gide® Shape membrane should be tucked underneath the mucosa, located mesially and distally of the socket. The upper wing should be tucked lingually/palatally in-between the soft-tissue and bone wall.

The membrane can be placed inside the alveolus for a less invasive surgical procedure but can also be placed outside, between the bone and the soft-tissue. The long wing of the Geistlich Bio-Gide® Shape should cover the bony defect of the socket, if present, with the dense surface facing towards the soft-tissue, and the rough side facing the defect.

Suturing of Geistlich Bio-Gide® Shape on top may be indicated to avoid its displacement due to shear loading or mobilization. 

Geistlich Bio-Gide® Shape is indicated for the treatment of non-intact extraction sockets. Geistlich Mucograft® Seal is recommended in extraction sockets with intact buccal bone walls.¹

Reference:

1. Geistlich Mucograft Seal Advisory Board Meeting Report, 2013. Data on file, Geistlich Pharma AG, Wolhusen, Switzerland.

As Geistlich Bio-Gide® Perio adheres very well to the defect, it is normally not necessary to utilize fixation screws or pins. However, fixation is possible if required.

No. Autoclaving or hot-air sterilization irreversibly destroys the collagen structure. The physical properties of the membrane are changed and the consistency of the product becomes like parchment paper. In addition the product is not approved for re-sterilization and therefore may not be used.

The bilayer structure of Geistlich BioGide® Perio has a compact and porous surface. The compact layer of Geistlich Bio-Gide® Perio exhibits higher cell occlusiveness than the rough, porous layer, preventing the downgrowth of epithelial cells. If the membrane is applied with the porous surface placed toward the soft tissue, integration of the bone cells may take place more slowly. However, it is not necessary to remove the membrane.

As Geistlich Bio-Gide® Perio is made of collagen, allergic and inflammatory tissue reactions cannot be excluded. However, this is extremely rare.

Inflammation is a possible complication, which may occur with any surgery. However, the biocompatibility of Geistlich Bio-Gide® Perio has been verified in clinical studies and the incidence of complications is low.

The surface of Geistlich Bio-Gide® Perio has been made firmer when dry to facilitate periodontal applications. Second, the outer blister pack of Geistlich Bio-Gide® Perio includes four sterile water repellent templates. These can be placed repeatedly in the region of the defect to allow customization of the template before trimming the membrane to the precise shape.

Geistlich Fibro-Gide® is intended to be used for soft-tissue regeneration at the alveolar ridge. Indications of Geistlich Fibro-Gide® are insufficient soft-tissue volume and recession defects.¹

1. Instructions for Use. Geistlich Fibro-Gide®. Geistlich Pharma AG, Wolhusen, Switzerland.

Geistlich Fibro-Gide® is a porous, resorbable and volume-stable porcine collagen matrix specifically designed for soft-tissue regeneration.¹ The matrix is made of reconstituted collagen and undergoes smart chemical cross-linking to improve volume stability of the device while maintaining its excellent biocompatibility.^1-3

1. Instructions for Use. Geistlich Fibro-Gide®. Geistlich Pharma AG, Wolhusen, Switzerland.
2. Thoma DS et al. J Clin Periodontol. 2016 Oct; 43(10): 874–85.
3. Thoma DS et al. Clin Oral Implants Res. 2015 Mar; 26(3): 263–70.

Animal models show gradual resorption and integration of Geistlich Fibro-Gide® into host tissue while maintaining volume stability.¹

1. Thoma DS. et al. Clin Oral Implants Res. 2012.

Geistlich Fibro-Gide® is an alternative to autologous connective tissue grafts (CTG) for soft tissue volume augmentation around dental implants and natural teeth.^1,2 Geistlich Fibro-Gide® obviously has the advantage of reducing patient morbidity since there is no additional harvest site. Furthermore, there is minimal risk of necrosis when using Geistlich Fibro-Gide® compared to CTG.³

1. Thoma DS et al. J Clin Periodontol 2016.
2. Zeltner M et al. J Clin Periodontol 2017.
3. Data on file. Geistlich Pharma AG, Wolhusen, Switzerland.

Geistlich Fibro-Gide® is ready to be applied in a dry or wet state to the defect and does not need pretreatment or conditioning before application. Geistlich Fibro-Gide® possesses excellent hydrophilic characteristics that lead to a rapid hydration of the collagen matrix (patient’s own blood and/or sterile saline).¹ When applied dry to the defect site, the matrix will hydrate easily by soaking up the patient’s own blood and/or sterile saline if applied to the matrix, very quickly.¹

1. Data on file. Geistlich Pharma AG, Wolhusen, Switzerland.

Geistlich Fibro-Gide® can be applied either in a dry or wet state subject to individual preference: pre-wetting can be done with blood and/or sterile saline.^1,2 Geistlich Fibro-Gide® can be cut and trimmed both in a dry or wet state, using scissors and/or a scalpel.^1,2 The scalpel is recommended for dry handling.^1,2 Using a scalpel will help to obtain smooth edges and tapers for improved wound adaptation and precise fit of the matrix.^1,2

1. Instructions for Use. Geistlich Pharma AG, Wolhusen, Switzerland.
2. Data on file. Geistlich Pharma AG, Wolhusen, Switzerland.

The device will gain approximately 25% in volume once wet. This increase in volume has to be taken into account when deciding to trim the matrix and determining its dimension prior to implatation.¹ A generous flap design is the key to full submersion of the matrix.

1. Data on file. Geistlich Pharma AG, Wolhusen, Switzerland.

Use your preferred flap design. A generous preparation of the flap and ensuring adequate blood supply is key to promoting successful healing by complete coverage of Geistlich Fibro-Gide® (submerged healing). Different surgical techniques, such as tunneling and/or envelope techniques are currently being clinically tested.

Clinical experience has shown that tension-free wound closure is a key factor in preventing dehiscence. In open flap procedures for augmentation at the alveolar ridge a horizontal mattress suture is recommended to stabilize the matrix (5.0-6.0).¹ In recession coverage, single sutures (7.0) have been used for stabilization.¹

1. Data on file. Geistlich Pharma AG, Wolhusen, Switzerland.

A tension-free closure of the flap is key to a successful and complication-free healing and avoidance of any dehiscences during the healing phase.

After surgical treatment with Geistlich Fibro-Gide®, post-surgical management that typically follows procedures involving connective tissue grafts has been reported to be effective. Please use your clinical judgment based on the individual profile of the patient and the details of the surgery.

Geistlich Mucograft^® = Compact and spongy layer
Geistlich Fibro-Gide^® = Porous layer

Geistlich Mucograft® = Reconstituted collagen: No cross-linking
Geistlich Fibro-Gide® = Reconstituted collagen: Smart cross-linking

Geistlich Mucograft® = Reduced volume stability
Geistlich Fibro-Gide^® = Good volume stability 

Geistlich Mucograft® = Open-healing & submerged healing
Geistlich Fibro-Gide^® = Submerged healing only 

Geistlich Mucograft^® Treatment Option:

• Gain of keratinized tissue
• Socket Seal
• Vestibuloplasty
• Recession Coverage

Geistlich Fibro-Gide® Treatment Option:

• Soft-tissue volume augmentation around dental implants and natural teeth, and under pontics
• Recession Coverage

Clinical studies have shown a physiological increase in thickness when using CTG as the gold standard of 0.35 to 3.2 mm.^1-3 Clinical studies have shown that treatment with Geistlich Fibro-Gide® results in an increase of 1-2 mm of thickness^4,5 which is equivalent to results obtained with CTG4. Geistlich Fibro-Gide® is provided with a thickness of 6 mm which gives freedom to the surgeon to trim it to the desired size and to use the collagen matrix for thickening of tissues under pontics where more volume might be required. For lateral soft-tissue augmentation, it is recommended to reduce the thickness of Geistlich Fibro-Gide® in order to achieve a tension-free, primary wound closure.

1. Eghbali A et al. Clin Implant Dent Relat Res. 2016.
2. Thoma DS et al. Periodontol 2000. 2014.
3. De Bruyckere T et al. J Clin Periodontol. 2015.
4. Thoma DS et al. J Clin Periodontol 2016.
5. Chappuis V et al. Manuscript in preparation.

Geistlich Fibro-Gide® was designed for and performs best with primary wound closure. Clinical observation suggests that under circumstances where the wound dehiscence led to limited exposure of Geistlich Fibro-Gide®, uneventful healing and successful outcomes were nonetheless achieved.

After treatment with Geistlich Mucograft®, please follow the same postsurgical management that is usually applied with connective tissue grafts or free gingival grafts.

It depends on the indication:
1. Gain of Keratinized Tissue: Open healing is recommended when Geistlich Mucograft® is used to increase the width of keratinized tissue. The innovative design of Geistlich Mucograft® allows excellent healing in open healing situations¹.
2. Recession Coverage: Geistlich Mucograft® should remain completely submerged under the flap to avoid premature resorption of the collagen.^2-4 Direct blood supply is important.

References:

1. Sanz M, et al.: J Clin Periodontol 2009; 36(10): 868-76.
2. McGuire MK & Scheyer ET: J Periodontol 2010; 81(8): 1108-17.
3. Cardaropoli D, et al.: J Periodontol 2012; 83(3): 321-28.
4. Rotundo R & Pini-Prato G: Int J Periodontics Restorative Dent 2012; 32(4): 413-19.

It depends on the indication:
1. Gain of keratinized tissue: Geistlich Mucograft® should be applied on a periosteal bed^1,2 as direct blood supply is important. In open healing, the blood is supplied through the edges of the device from the surrounding tissue and from the periosteum.
2. Recession Coverage: Geistlich Mucograft® can be used partially or completely over bone.^3-5 Blood is supplied through the edges of the device from the surrounding tissue and from the flap completely covering the matrix.

References:

1. Sanz M, et al.: J Clin Periodontol 2009; 36(10): 868-76.
2. Lorenzo R, et al.: Clin Oral Impl Res 2012; 23(3): 316-24.
3. McGuire MK & Scheyer ET : J Periodontol 2010; 81(8): 1108-17.
4. Cardaropoli D, et al.: J Periodontol 2012; 83(3): 321-28.
5. Rotundo R & Pini-Prato G: Int J Periodontics Restorative Dent 2012; 32(4): 413-19.

In the majority of the clinical cases reported and in all the studies performed with Geistlich Mucograft®, one matrix layer was used. Presently, clinical data is not available to prove that several layers of the device outperform a single layer of Geistlich Mucograft®.

The compact structure should face outward, away from underlying bone, with the spongeous structure facing the bone or soft-tissue wound bed. No clinical or comparative data is available regarding the performance of Geistlich Mucograft^® when placed with the compact structure facing the bone or soft-tissue wound bed.


Published data shows different suturing techniques with Geistlich Mucograft®: non-resorbable^1,2 and resorbable³, 0-5^1,2 and 0-6⁴. There is no clinical evidence showing a benefit of one type of suture over another one when suturing Geistlich Mucograft®.

References:

1. Sanz M, et al.: J Clin Periodontol 2009; 36(10): 868-76.
2. Herford AS, et al.: J Oral Maxillofac Surg 2010; 68(7): 1463-70.
3. Cardaropoli D, et al.: J Periodontol 2012; 83(3): 321-28.
4. McGuire MK & Scheyer ET : J Periodontol 2010; 81(8): 1108-17.

No. Geistlich Mucograft® has limited elongation properties and should always be sutured tension-free.

Our measurements indicate that there is no additional swelling of the matrix following hydration (90 minute period examined)¹.

References:

1. Data on file, Geistlich Pharma AG, Wolhusen, Switzerland

Geistlich recommends handling and applying the material dry, as it is easy to trim and pre-suture.

Geistlich Mucograft® is ready to be applied directly to the defect and does not need treatment or hydration prior to application. Due to its excellent hydrophilicity, the matrix will hydrate quickly with the patient’s blood after placement in the defect.

Geistlich Mucograft® can be used as an alternative to both a free gingival graft or a connective tissue graft (CTG) for increasing keratinized tissue^1-3. Geistlich Mucograft® is also an alternative to CTG for use in recession coverage procedures^4-6.

References:

1. Sanz M, et al.: J Clin Periodontol 2009; 36(10): 868-76.
2. Lorenzo R, et al.: Clin. Oral Impl. Res 2012; 23(3): 316-24.
3. Nevins M, et al.: Int J Periodontics Restorative Dent 2011; 31(4): 367-73.
4. McGuire MK & Scheyer ET : J Periodontol 2010; 81(8): 1108-17.
5. Cardaropoli D, et al.: J Periodontol 2012; 83(3): 321-28.
6. Rotundo R & Pini-Prato G: Int J Periodontics Restorative Dent 2012; 32(4): 413-19.

The collagen in Geistlich Mucograft® is methodically replaced by newly formed soft-tissue. The matrix is rapidly vascularized and colonized by soft-tissue cells. This leads to a good integration of the matrix without any signs of foreign body reaction^1,2.

References:

1. Rocchietta I, et al.: Int J Periodontics Restorative Dent 2012; 32(1): e34-40.
2. Ghanaati S, et al.: Biomed Mater 2011; 6(1): 015010.

Geistlich Mucograft® consists of porcine collagen and is specifically designed for soft-tissue regeneration. The matrix is comprised of a compact structure that provides stability while allowing open healing, paired with a spongy structure that supports blood clot stabilization and ingrowth of soft-tissue cells.

Geistlich Mucograft® is a unique collagen matrix designed specifically for soft-tissue regeneration as an alternative to autogenous soft-tissue grafts.

 

Geistlich Mucograft® Seal should be sutured using non-resorbable sutures; tissue adhesives should not be used¹. The close adaptation of the device to the soft-tissue borders can be accomplished by single-interrupted, double-interrupted or cross-stitch suturing.

The finest possible suture material comfortably used by the surgeon should be selected: for single-interrupted suturing, a 5.0 or 6.0 suture size is recommended; for cross-stitch suturing, a 5.0 suture size is appropriate¹.

References:

1. Geistlich Mucograft Seal Advisory Board Meeting Report, 2013. Data on file Geistlich Pharma AG, Wolhusen, Switzerland.

No. Geistlich Mucograft^® Seal has limited elongation properties and should always be sutured tension-free.

The compact macro-structure should face outward, away from underlying bone, with the spongeous micro-structure facing the bone or soft-tissue wound bed. Geistlich Mucograft® Seal spongeous micro-structure is grooved for easier differentiation of the two sides. The grooved spongeous micro-structure should face the bone.

Our measurements indicate that the matrix does not expand further following hydration (90-minute period examined)¹.

 
References:

1. Data on file, Geistlich Pharma AG, Wolhusen, Switzerland

Geistlich Biomaterials recommends the handling and application of Geistlich Mucograft® Seal be done in a dry state.  The matrix is easy to trim and easy to pre-suture.

Geistlich Mucograft® Seal is ready to be applied and does not need pre-treatment or hydration before application. Due to its excellent hydrophilicity, the matrix will hydrate quickly following placement into the site with the patient’s blood.

The collagen of Geistlich Mucograft® will be replaced by newly formed soft-tissue. The matrix is rapidly vascularized and colonized by soft-tissue cells^1,2. This leads to a good integration of the matrix without any signs of foreign body reaction^3,4.

References:

1. Rocchietta I, et al.: Int J Periodontics Restorative Dent 2012; 32(1): e34-40.
2. Ghanaati S, et al.: Biomed Mater 2011 Feb; 6(1): 015010.
3. Nevins M, et al.: Int J Periodontics Restorative Dent 2011; 31(4): 367-73.
4. Camelo M, et al.: Int J Periodontics Restorative Dent 2012; 32(2): 167-73.

 

Geistlich Mucograft^® Seal consists of porcine collagen and is specifically designed for soft-tissue regeneration. The matrix is built up of a compact macro-structure that gives stability while allowing open healing, and a spongy micro-structure that supports blood clot stabilization and ingrowth of soft-tissue cells.

 

Geistlich Mucograft® Seal  is a unique collagen matrix designed specifically for soft-tissue regeneration in extraction sockets for ridge preservation

Geistlich Mucograft® Seal needs the support of Geistlich Bio-Oss Collagen® underneath for good healing of both the soft and the hard-tissues in order to preserve the ridge volume. After 8 weeks, the soft-tissues are healed but the mixture of the blood clot, Geistlich Bio-Oss Collagen® and the newly forming bone is still soft. Nevertheless, the implant can be drilled carefully into the socket and the remaining Geistlich Bio-Oss Collagen® will support the volume preservation of the ridge.    

 

The hydrophilic properties of Geistlich Mucograft® Seal result in a rapid moistening of the device with either saline or blood.

 

The resorption time of every biomaterial including Geistlich Mucograft® Seal depends on multiple factors: defect size, metabolism and general health of the patient, among other variables. In order to determine an average resorption time of Geistlich Mucograft® Seal in humans, biopsies of the healing soft-tissues would be needed following tooth extraction at different time points. This procedure is not ethically possible to conduct and thus the average resorption time cannot be measured. However, single histologic evaluations indicate that after 8 weeks Geistlich Mucograft® Seal is completely integrated into the newly formed soft-tissue. 

 

Geistlich Mucograft® Seal is specifically designed for soft-tissue regeneration¹. The collagen of Geistlich Mucograft® Seal is specially processed to support immediate blood clot stabilization. This leads to early vascularization^1,3, facilitates soft-tissue cell ingrowth² and excellent integration of the collagen matrix with surrounding tissues^2,3.  In contrast to other collagen products on the market, Geistlich Mucograft® and Geistlich Mucograft® Seal have been scientifically documented with proven clinical benefits.
References:

1. Biocompatibility according to ISO 10993-12001. Data on file Geistlich PharmaAG, Wolhusen, Switzerland.
2. Ghanaati S, et al.:  Biomed Mater 2011; 6(1): 015010.
3. Roccietta I, et al.: Int J Periodontics Restorative Dent 2012; 32(1): e34-40.

Geistlich vallomix^™ is the first conveniently co-packed xenogeneic / allogeneic validated bone substitute¹. Geistlich vallomix^™ contains individually packaged Geistlich Bio-Oss® granules and vallos^™ granules or fibers. Together, these products offer the opportunity to achieve optimal consistency and performance in demanding clinical situations.

References:

1. Compiled DCI Osteoinductivity Validation Summary_2020. (data on file)

The combination of a validated allograft with osteoinductive potential¹ and a volume preserving xenogeneic bone substitute can provide significant advantages in regenerative procedures, enabling the possibility of reduced time between tissue regeneration and implant placement. Geistlich vallomix™ simplifies combining a high quality demineralized cortical allograft, vallos™ with Geistlich Bio-Oss®, the leading xenogeneic bone substitute for regenerative dentistry worldwide^2,3, with more than 35 years of scientific validation.

References:

1. Compiled DCI Osteoinductivity Validation Summary_2020. (data on file)
2. iData Research Inc., US Dental Bone Graft Substitutes and other Biomaterials Market, 2015.
3. iData Inc., European Dental Bone Graft Substitutes and other Biomaterials Market, 2015.

vallos™ is an allogeneic bone in the form of granules, whereas vallos™f is an allogeneic bone in the form of fibers (shavings from cortical bone). vallos™f shows putty-like handling properties and can be easily molded by the clinician into a desirable shape for application to the defect site. vallos™f has also demonstrated 4-times higher osteoinductive potential compared to vallos™.¹ Both vallos™ and vallos™f can be mixed with Geistlich Bio-Oss® in a dry or hydrated state.

References:

1. Compiled DCI Osteoinductivity Validation Summary_2020. (data on file)

vallos™ and vallos™f are demineralized cortical freeze-dried allografts that offer osteoinductive potential and new vital bone formation after 18-20 weeks.¹ Our allograft supplier meets the highest quality standards, is a federally certified organ procurement organization, and remains in control of all processes, from donor screening to all steps of allograft processing, to provide a state-of-the-art product. To counterbalance heterogeneity between different donors, every donor lot for vallos™ is tested to ensure osteoinductive potential. Moreover, adding Geistlich Bio-Oss® offers the potential for more consistent and predictable clinical outcomes.

References:

1. Robert A Wood & Brian L Mealey: J Periodontol. 2012 Mar;83(3):329-36. (Clinical Study)

These allografts are not sold separately, today. Geistlich vallomix™ and Geistlich vallomix™f were designed to be conveniently co-packed, bringing together the verified osteoinductivity of vallos™¹ with the volume stability of Geistlich Bio-Oss®.^3-8 Together, these products bring the opportunity for optimal consistency and performance^1-14 in demanding clinical situations.

References:

1. Compiled DCI Osteoinductivity Validation Summary_2020. (data on file)
2. Robert A Wood & Brian L Mealey: J Periodontol. 2012 Mar;83(3):329-36. (Clinical Study).
3. Piattelli M et al.: Int J Oral Maxillofac Implants 1999; 14 (6), 835-40. (Clinical Study).
4. Sartori S et al.: Clin Oral Implants Res 2003; 14 (3), 369-72. (Clinical Study).
5. Maiorana C et al.: Int J Periodontics Restorative Dent 2005; 25 (1), 19-25. (Clinical Study).
6. Orsini G et al.: Oral Dis 2007; 13 (6), 586-93. (Clinical Study).
7. Lindgren C et al.: Int J Oral Maxillofac Implants 2009; 24 (6), 1093-100. (Clinical Study).
8. Mordenfeld A et al.: Clin Oral Implants Res 2010; 21 (9), 961-70. (Clinical Study).
9. Serrano CA et al.: Implant Dent. 2018 Aug; 27(4):467-473. (Clinical Study).
10. NCBI Pubmed, Month Year, Search term “Bio-Oss” (1208 hits) (Market research).
11. Berglundh T & Lindhe J: Clin Oral Implants Res 1997; 8 (2), 117-24. (Preclincal Study).
12. Weibrich G et al.: Mund Kiefer Gesichtschir 2000; 4 (3), 148-52. (Preclincal Study).
13. Degidi M et al.: Oral Dis 2006; 12 (5), 469-75. (Clinical Study).
14. Galindo-Moreno P et al.: Clin Oral Implants Res 2010; 21 (2), 221-7. (Clinical Study).

Demineralized allografts offer the potential of osteoinductivity^1-3 as compared to mineralized allografts. While offering new bone formation capacity, demineralized bone matrices are subject to volume resorption during the healing process.⁴ Geistlich Bio-Oss® has shown to consistently maintain grafted bone volume over time.^5-10 Thus, the demineralized vallos™ and Geistlich Bio-Oss® complement each other to obtain a bone graft that has osteoinductive potential while maintaining its volume.

References:

1. Glowacki, J., S. Zhou, and S. Mizuno, J Craniofac Surg, 2009. 20 Suppl 1: p. 634-8
2. Glowacki, J Oral Maxillofac Surg . 2015 Dec;73(12 Suppl):S126-31. doi: 10.1016/j.joms.2015.04.009.
3. Urist, Marshall R. (1965). Science 12:150 (698): 893–899.
4. Serrano CA et al.: Implant Dent. 2018 Aug; 27(4):467-473. (Clinical Study).
5. Piattelli M et al.: Int J Oral Maxillofac Implants 1999; 14 (6), 835-40. (Clinical Study).
6. Sartori S et al.: Clin Oral Implants Res 2003; 14 (3), 369-72. (Clinical Study).
7. Maiorana C et al.: Int J Periodontics Restorative Dent 2005; 25 (1), 19-25. (Clinical Study).
8. Orsini G et al.: Oral Dis 2007; 13 (6), 586-93. (Clinical Study).
9. Lindgren C et al.: Int J Oral Maxillofac Implants 2009; 24 (6), 1093-100. (Clinical Study).
10. Mordenfeld A et al.: Clin Oral Implants Res 2010; 21 (9), 961-70. (Clinical Study).

Numerous studies show that allografts demonstrate a high degree of heterogeneity that is associated with inter-donor variability.^1-2 Inclusive of the state-of-the-art quality control and donor safety assessments, vallos™ and vallos™f are both tested for every donor lot on its osteoinductive potential. This offers the opportunity to obtain more predictable clinical outcomes³. This ensures that each lot has been processed, tested, and validated for osteoinductive potential, reducing lot-to-lot variability.

References:

1. Urist, Marshall R. (1965). Science 12:150 (698): 893–899.
2. Schwartz et al., J Periodontol. 1996 Sep;67(9):918-26. doi: 10.1902/jop.1996.67.9.918
3. Serrano CA et al.: Implant Dent. 2018 Aug; 27(4):467-473. (Clinical Study).

Osteoinductive potential is assessed in vitro with the alkaline phosphatase activity (ALP) testing method on every donor lot for vallos™ and vallos™f. ALP is a commonly used indicator for bone formation processes in the synthesis of hydroxyapatite. The acceptance criteria for vallos™ and vallos™f are based on a measurement according to an osteoinductivity index, above which a donor lot can be considered osteoinductive positive based on the in vitro and in vivo (heterotopic bone formation) correlation studies^1-2.

References:

1. Compiled DCI Osteoinductivity Validation Summary_2020. (data on file)
2. Han et al., 2003, J Orthop Res 21_648-654

The combination of allogeneic and xenogeneic bone has been well documented and widely used in clinical practice for many years^1-2. Studies specific to Geistlich vallomix™ are in preparation.

References:

1. Serrano CA et al.: Implant Dent. 2018 Aug; 27(4):467-473. (Clinical Study).
2. Landi L. et al., Int J Periodontics Restorative Dent. 2000 Dec;20(6):574-83. PMID: 11203594.

Geistlich vallomix™ can be mixed, layered, or adjusted based on the clinical needs of the patient, providing flexibility for a range of therapeutic areas.

It is recommended to hydrate and mix Geistlich Bio-Oss® along with the vallos™ or vallos™f component. According to the package insert, vallos™ should be hydrated a minimum of 30 minutes. When preparing vallos™f gently mix for 30-60 seconds until completely hydrated. It is recommended that all freeze-dried allografts be hydrated in Ringer’s solution, normal saline, or other normal physiologic solution containing antibiotics of the clinicians’s preference. The decision to hydrate freeze-dried bone should be based upon the clinician’s preference. Please see the Package Insert for more information.

Clinician preference dictates which choice in biomaterials should be used. Geistlich vallomix™ embodies a combination of demineralized and mineralized bone material and can be considered a suitable replacement of demineralized and mineralized allograft material. Geistlich Bio-Oss® provides the mineralized component of Geistlich vallomix™ which has been attributed to beneficial volume stability over mineralized allografts¹.

References:

1. Lee et al., Int J Oral Maxillofac Implants. 2009 ; 24 :609-615

After many years of using both e-PTFE and d-PTFE membranes, Dr. Istvan Urban felt that for larger bone augmentations it was oftentimes challenging to achieve adequate vascularization of the outer sections of the graft due to the distance from the native bone. Dr. Urban began experimenting with perforating d-PTFE membranes, with the notion that the periosteum may be a source of angiogenesis and cell migration that can communicate with the graft. As a result, he was able to achieve clinically more vascularized augmented bone after the healing period.

RPM™ is made of two layers of d-PTFE mesh with Grade I titanium. d-PTFE is a dense, biologically inert and biocompatible material, with a grade I titanium frame in between. Grade I titanium is the softest and most ductile grade of commercially pure titanium. It does not have memory and can be easily bent and folded into new shapes.

The expiration date of the material is 4 years from the date of manufacture.

RPM™ and Ti-reinforced PTFE membranes like Cytoplast™ are indicated for the treatment of alveolar bone defects. The rationale behind RPM™ is that the combination of macro-perforations and coverage with Geistlich Bio-Gide® will lead to better vascularization of the outer sections of the augmented bone. According to Osteogenics, Dr. Istvan Urban has been almost exclusively using RPM™ since it has been made available.

Although it is possible to use RPM™ alone, Geistlich Bio-Gide® provides additional protection of the graft from potential bacterial or soft tissue infiltration. Geistlich Bio-Gide^® also increases tissue tolerance by providing a “buffer” for the soft tissue from the potentially sharp folds and edges of the RPM™. Geistlich Bio-Gide® enhances soft tissue cell migration and early re-epithelialization, which may minimize tissue dehiscence and improve healing. The additional layer of collagen membrane may also provide coverage for graft particles that are not completely protected and stabilized by RPM™

PTFE membranes have a long-standing history as barrier membranes for volume stabilization and are highly biocompatible¹. Collagen membranes, such as Geistlich Bio-Gide®, have been shown to be beneficial for uneventful soft tissue healing^{2, 3} in GBR procedures resulting in protection against soft tissue ingrowth and lowered complication rates².

References
1. Urban et al. Int J Periodontics Restorative Dent 2013
2. Becker et al. Clin Oral Implants Res. 2009
3. Tal et al. Clin Oral Implants Res. 2008

Yes. Tension-free primary closure is still crucial to clinical success when performing ridge augmentation procedures using RPM™ and Geistlich Bio-Gide®. Because of the macro-perforations of the RPM™, early tissue dehiscence may lead to bacterial infection through the mesh. Even though Geistlich Bio-Gide® provides additional barrier coverage, it can resorb prematurely in the event of exposure and not offer protection from bacteria.

Generally, for large augmentations (>6mm) it is recommended for the clinician to wait at least 9 months for the bone to mature enough prior to implant placement.

Either a screw or pin/tacking system could be used to fixate RPM™. Fixation through the titanium frame and/or the areas of macro perforations should be avoided. Geistlich Bio-Gide® does not need to be fixated over RPM™.

Even though RPM was designed for challenging GBR procedures like vertical ridge augmentation, it can certainly be used for horizontal augmentation, as well.

It has been shown that Geistlich Bio-Gide® is perfectly suited for horizontal GBR (i.e. Sausage Technique), however there are clinicians that prefer a more form-stable barrier for large augmentations. RPM™ in combination with Geistlich Bio-Gide® provides a perfect solution to that.

Exposure without purulence – Weekly monitoring and cleaning with chlorhexidine gel and gentle brushing. If exposure occurs before 2 months post-operatively, the mesh should stay in place 6-8 weeks before removal. If exposure occurs after 2 months post-operatively, monitor until full graft maturation if possible⁴

Exposure with purulence – Antibiotics can be prescribed at the practitioner’s discretion and the mesh and all non-incorporated graft particles and granulomatous tissue should be removed. If exposure occurs before 2 months post-operatively, all of the graft may be compromised and require removal. If exposure occurs after 2 months post-operatively, there may be some consolidated regenerated tissue underneath the infected or granulomatous areas⁴

Please note that the above guidelines describe the management of exposed conventional titanium-reinforced D-PTFE membranes. Exposed RPM™ may be more prone to infection due to the presence of macro perforations.

Reference 
4. Gallo et al. J Oral Maxillofacial Implants 2019

Some customization and adjustment to the size/shape of the material is often necessary to ensure placement without contacting adjacent teeth or other anatomical structures.

Trimming can be done with surgical scissors. Care should be taken during cutting to avoid delamination of the material. Cutting through the areas of macro perforations or titanium frame may weaken the material.

Obtaining tension-free primary closure is crucial to the healing process and success of the graft. Over augmentation can make flap management and primary closure difficult. The clinician should use sound judgment to ensure that an adequate amount of graft is applied without significantly interfering with the clinician’s ability to close the tissue.

Since RPM™ is a new product that was launched in 2019, there is no published research at this time. Dr. Istvan Urban has been using the product exclusively for 2 years (as of 2020) and is currently working on a clinical case series to be published in the near future.

The unique circular perforations of RPM™ allow for direct contact between the bone graft and periosteum, favoring naturally occurring vascularization and infiltration of osteogenic cells into the bone graft.

The mandible SKUs were designed with perforations only on the buccal side of the mesh. This allows perfusion of blood and osteogenic cells to the buccal aspects of the graft. The non-perforated lingual side allows easier removal from the lingual aspect, as there is no tissue infiltration

Have you ever seen non-vital or non-incorporated bone graft when you remove the membrane due to lack of vascularity in the outer sections of the bone graft? The perforations of RPM allow dual vascularization (from bone and periosteum) to increase the vitality of the bone graft.

Yes. Geistlich Mucograft® Seal is an alternative to autogenous soft-tissue graft for soft-tissue regeneration. Geistlich Mucograft® Seal does not require pre-hydration or washing. It should be handled and applied in a dry state. Before applying Geistlich Mucograft® Seal, adjacent soft-tissue margins should be de-epithelialized. This allows epithelial cells to freely migrate from the soft-tissue borders into the matrix.

Geistlich Mucograft® Seal needs the support of Geistlich Bio-Oss Collagen® underneath for good healing of both the soft and the hard-tissues in order to preserve the ridge volume. After 8 weeks, the soft-tissues are healed but the mixture of the blood clot, Geistlich Bio-Oss Collagen® and the newly forming bone is still soft. Nevertheless, the implant can be drilled carefully into the socket and the remaining Geistlich Bio-Oss Collagen® will support the volume preservation of the ridge.

• Type 1: simultaneous to extraction (immediate)
• Type 2: 4-8 weeks after extraction (early implantation)
• Type 3: 12-16 weeks after extraction (delayed implantation)
• Type 4: more than 16 weeks after extraction (late implantation)¹

References:

1. Chen S, Buser D: ITI Treatment Guide Vol 3.

It is not recommended to use Geistlich Bio-Oss® and Geistlich Bio-Oss® Collagen in case of infected sites (see package insert).

After 4-6 months the socket will be regenerated with hard tissue.¹

References:

1. Cardaropoli D, et al.: Int J Periodont Rest Dent 2012; 32(4) : 421-430

Regardless of the therapeutic approach, bundle bone resorbs following tooth loss or extraction. The bundle bone cannot be regenerated; however, Geistlich Bio-Oss® or Geistlich Bio-Oss Collagen® effectively substitute its function in supporting soft-tissue and compensate for buccal bone loss.^1,2

References:

1. Araujo M, et al.: Int J Periodont Rest Dent 2008; 28(2):123-135.
2. Fickl S, et al.: Journal Clin Periodontol 2008; 35:356-363.

It is a tooth-related structure that resorbs after tooth extraction. The buccal bone wall of the socket is very thin^1-3 and consists largely of bundle bone.

References:

1. Huynh-Ba G, et al.: Clin Oral Implants Res 2010; 21(1): 37-42.
2. Januario AL, et al.: Clin Oral Implants Res 2011; 22(10): 1168-71.
3. Araujo MG, Lindhe J: Journal Clin Periodontol 2005; 32(2): 212-18.

Geistlich Bio-Gide® can be submerged or used in an open healing situation¹ depending on the surgeon's preference. The advantages of the secondary intention healing of Geistlich Bio-Gide® are the ability to perform a flapless surgery and the preservation of the mucogingival line.

References:

1. Cardaropoli D, et al.: Int J Periodontics Restorative Dent 2012; 32(4) :421-30.

Geistlich Bio-Oss® OR Geistlich Bio-Oss Collagen® PAIRED WITH Geistlich Bio-Gide® are recommended for bone regeneration in the management of extraction sockets with defects that have intact bony walls. When Geistlich Bio-Oss® and Geistlich Bio-Gide® are used in combination, more bone is regenerated compared to extraction sites where a bone substitute material was used alone^1,2.

References:

1. Perelman-Karmon M, et al.: Int J Periodontics Restorative Dent 2012; 32(4): 459-65.
2. Geistlich Mucograft Seal Advisory Board Meeting Report, 2013. Data on file, Geistlich Pharma AG, Wolhusen, Switzerland.

Investigators still cannot agree on the importance of the presence of keratinized tissue. Various studies have shown, however, that lack of keratinized tissue around implants is associated with the following:

• Gingival recession over a period of five years¹
• Soft-tissue attachment loss²
• Increased plaque accumulation lingually¹
• Inflammation of the soft tissue²
• More frequent bleeding¹

References:

1. Schrott AR, et al.: Clin Oral implants Res 2009; 20(10): 1170-17.
2. Chung DMT, et al.: J Periodontol 2006; 77(8): 1410-20.