Home / Dental Professionals / FAQ

Frequently Asked Questions (FAQ)

Dental Products

Geistlich Bio-Oss®
1
Do I have to use venous blood or can I use blood from the defect?
Blood from the defect may be used for mixing. Care should be taken to avoid contamination with salivary bacteria.
2
Is Geistlich Bio-Oss® safe (transmission of diseases such as Bovine Spongiform Encepholapathy (BSE)?

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
3
Should Geistlich Bio-Oss® be mixed with antibiotics?
The use of local antibiotics is generally unnecessary when utilizing Geistlich Bio-Oss®.
4
Can Geistlich Bio-Oss® be re-sterilized?
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.
5
Can Geistlich Bio-Oss® also be used without membrane?
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 dehiscence2,3. 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.
6
When do you use the large Geistlich Bio-Oss® particles (1-2 mm) and when do you use the small particles (0.25-1 mm)?
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.
Geistlich Bio-Oss Pen®
1
Are other applicator tips (forms, length, diameter) available?
No. There are no other tips available.
2
Can separate applicator tips be ordered?
No. The applicator tips are not available separately.
3
If the applicator tip is contaminated (e.g. has fallen on the floor) can it be re-used?
No. Discard and use a new Geistlich Bio-Oss Pen®.
4
Can the Geistlich Bio-Oss Pen® be re-sterilized?
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.
5
Can the Geistlich Bio-Oss® granules be mixed with autologous bone in the Geistlich Bio-Oss Pen®?
No, Geisltich does not recommend mixing autologous bone with the Geistlich Bio-Oss® granules within the syringe.
6
How many Geistlich Bio-Oss Pen® delivery systems are needed for a sinus floor elevation?
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.
7
How much saline or blood is needed to moisten the Geistlich Bio-Oss Pen®?
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
8
Can Geistlich Bio-Oss Pen® also be used without membrane?
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 dehiscence2,3. 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.
9
When do you use the large Geistlich Bio-Oss Pen® particles (1-2 mm) and when do you use the small (0.25-1 mm)?
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.
Geistlich Bio-Oss Collagen®
1
Do I need a membrane when using Geistlich Bio-Oss® Collagen?
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.
2
Is Geistlich Bio-Oss® Collagen a collagen plug?
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.
3
Is it possible to have an allergic reaction to Geistlich Bio-Oss® Collagen?
As Geistlich Bio-Oss Collagen® contains collagen, allergic and inflammatory tissue reactions cannot be excluded. These are, however, extremely rare.
4
When can I use Geistlich Bio-Oss® and when Geistlich Bio-Oss®Collagen?

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).

5
What are the recommended indications for Geistlich Bio-Oss® Collagen?

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 Combi-Kit Collagen
1
How does Geistlich Bio-Gide® differ from other collagen membranes?
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®.
2
Is it possible to have an allergic reaction to Geistlich Bio-Oss® Collagen and 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.
3
Can I use Geistlich Combi-Kit products separately?
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.
4
What are the recommended indications for Geistlich Combi-Kit Collagen?
Geistlich Combi-Kit Collagen is recommended for the reconstruction of the alveolar ridge, extraction socket management and augmentation of bone dehiscences.
Perio-System Combi-Pack
1
Is it possible to have an allergic reaction to Geistlich Bio-Gide® Perio or Geistlich Bio-Oss® Collagen?
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.
2
Why do I need Geistlich Bio-Gide® Perio when using Geistlich Bio-Oss® Collagen?
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.
3
Can you use Perio-System Combi-Pack products separately?
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®
1
How can Geistlich Bio-Gide® be used in extraction socket management for open healing?
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.
2
Does the membrane have to be fixed?
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.
3
Can Geistlich Bio-Gide® be re-sterilized?
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.
4
What happens if the membrane is applied with the rough surface towards the soft tissue?
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.
5
Is it possible to have an allergic reaction to Geistlich Bio-Gide®?
As Geistlich Bio-Gide® is made of collagen, allergic reactions and inflammatory tissue reactions cannot be excluded. However this is extremely rare.
6
Have inflammatory reactions been associated with Geistlich Bio-Gide®?
Inflammation is a possible complication, which may occur with any surgery. However, biocompatibility of Geistlich Bio-Gide® has been verified in numerous studies.
7
How does Geistlich Bio-Gide® differ from other collagen membranes?

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.
8
How long should a membrane function as a barrier in Guided Bone Regeneration?

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.
9
Why is a membrane necessary?
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
1
What is the difference between the two collagen membranes Geistlich Bio-Gide® Compressed and Geistlich Bio-Gide®?
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. 
2
Does Geistlich Bio-Gide® Compressed need to be stabilized?
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.
3
Does the smoother surface of the collagen membrane Geistlich Bio-Gide® Compressed (compared to Geistlich Bio-Gide®) affect wound healing?
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 healing1-3 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.
4
What happens if the membrane is applied upside down (dense surface facing the bone, porous surface facing the soft-tissue)?
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
1
What is the difference between Geistlich Bio-Gide® Shape and Geistlich Bio-Gide®?
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.
2
How should Geistlich Bio-Gide® Shape be placed?
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.
3
Should Geistlich Bio-Gide® Shape be placed inside or outside the alveolus?
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.
4
Can Geistlich Bio-Gide® Shape be sutured?
Suturing of Geistlich Bio-Gide® Shape on top may be indicated to avoid its displacement due to shear loading or mobilization. 
5
When should Geistlich Bio-Gide® Shape be used versus Geistlich Mucograft® Seal?

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.
Geistlich Bio-Gide® Perio
1
Does the membrane have to be secured with fixation screws or pins?
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.
2
Can Geistlich Bio-Gide® Perio be re-sterilized?
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.
3
What happens if the membrane is applied with the rough surface towards the soft tissue?
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.
4
Is it possible to have an allergic reaction to Geistlich Bio-Gide® Perio?
As Geistlich Bio-Gide® Perio is made of collagen, allergic and inflammatory tissue reactions cannot be excluded. However, this is extremely rare.
5
Have inflammatory reactions been associated with Geistlich Bio-Gide® Perio?
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.
6
What is the difference between Geistlich Bio-Gide® Perio and Geistlich Bio-Gide®?
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®
1
What are the indications for Geistlich Fibro-Gide®?

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.
2
What is Geistlich Fibro-Gide® made of?

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.
3
Is Geistlich Fibro-Gide® resorbable?

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.
4
Is Geistlich Fibro-Gide® an alternative to free gingival graft (FGG) or to connective tissue grafts (CTG)?

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.
5
Does Geistlich Fibro-Gide® need pre-treatment?

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.
6
Is it easier to apply/handle Geistlich Fibro-Gide® in a dry or wet state?

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.
7
Does Geistlich Fibro-Gide® increase its volume after hydration?

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.
8
Which flap design is recommended when using Geistlich Fibro-Gide®?
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.
9
What suture technique should be used with Geistlich Fibro-Gide®?

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.
10
How should the flap be closed with Geistlich Fibro-Gide® underneath?
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.
11
Are antibiotics needed after treatment with Geistlich Fibro-Gide®?
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.
12
What is the difference between Geistlich Mucograft® and Geistlich Fibro-Gide®?

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
13
How much thickness of Geistlich Fibro-Gide® is required in order to obtain a thickening of the soft-tissue comparable to when connective tissue graft (CTG) is used?

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 thickness4,5 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.
14
How does Geistlich Fibro-Gide® perform is exposed in the oral cavity?
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.
Geistlich Mucograft®
1
Are antibiotics needed after treatment with Geistlich Mucograft®?
After treatment with Geistlich Mucograft®, please follow the same postsurgical management that is usually applied with connective tissue grafts or free gingival grafts.
2
Should Geistlich Mucograft® be used submerged or in open healing situations?
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.
3
Should Geistlich Mucograft® be placed directly over the bone or over the periosteum?
It depends on the indication:
1. Gain of keratinized tissue: Geistlich Mucograft® should be applied on a periosteal bed1,2 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.
4
How many layers of Geistlich Mucograft® should be used?
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®.
5
Which side of Geistlich Mucograft® should face the bone?
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.

6
What suture should be used with Geistlich Mucograft®?
Published data shows different suturing techniques with Geistlich Mucograft®: non-resorbable1,2 and resorbable3, 0-51,2 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.
7
Can Geistlich Mucograft® be stretched?
No. Geistlich Mucograft® has limited elongation properties and should always be sutured tension-free.
8
Does Geistlich Mucograft® swell after placement?
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
9
Should Geistlich Mucograft® be handled/applied wet or dry?
Geistlich recommends handling and applying the material dry, as it is easy to trim and pre-suture.
10
Does Geistlich Mucograft® need to be treated prior to application to the defect?
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.
11
Is Geistlich Mucograft® an alternative for free gingival graft (FGG) or for connective tissue graft (CTG)?
Geistlich Mucograft® can be used as an alternative to both a free gingival graft or a connective tissue graft (CTG) for increasing keratinized tissue1-3. Geistlich Mucograft® is also an alternative to CTG for use in recession coverage procedures4-6.

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.
12
Is Geistlich Mucograft® resorbable?
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 reaction1,2.

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.
13
What is Geistlich Mucograft® made of?
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.
14
What is Geistlich Mucograft®?
Geistlich Mucograft® is a unique collagen matrix designed specifically for soft-tissue regeneration as an alternative to autogenous soft-tissue grafts.
Geistlich Mucograft® Seal
1
What suture should be used with Geistlich Mucograft® Seal?
 

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.
2
Can Geistlich Mucograft® Seal be stretched?

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

3
Which side of Geistlich Mucograft® Seal should face the bone?

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.

4
Does Geistlich Mucograft® Seal expand after placement?

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
5
Should Geistlich Mucograft® Seal be handled/applied wet or dry?

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.

6
Does Geistlich Mucograft® Seal require pre-treatment?

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.

7
Is Geistlich Mucograft® Seal resorbable?

The collagen of Geistlich Mucograft® will be replaced by newly formed soft-tissue. The matrix is rapidly vascularized and colonized by soft-tissue cells1,2. This leads to a good integration of the matrix without any signs of foreign body reaction3,4.

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.
8
What is Geistlich Mucograft® Seal made of?
 

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.

 
9
What is Geistlich Mucograft® Seal?
Geistlich Mucograft® Seal  is a unique collagen matrix designed specifically for soft-tissue regeneration in extraction sockets for ridge preservation

10
Why should I use Geistlich Bio-Oss Collagen® with Geistlich Mucograft® Seal, if I plan to place an implant after 8-10 weeks?
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.    
11
Does Geistlich Mucograft® Seal absorb blood and saline equally well?
 

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

 
12
How long is the resorption time for Geistlich Mucograft® Seal?

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. 

 
13
What’s the difference between collagen sponges made by other manufacturers and Geistlich Mucograft® Seal?

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 vascularization1,3, facilitates soft-tissue cell ingrowth2 and excellent integration of the collagen matrix with surrounding tissues2,3.  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™ & Geistlich vallomix™f
1
What is Geistlich vallomix™?

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)
2
What are the main benefits of Geistlich vallomix™?

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 worldwide2,3, 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.
3
What is the difference between vallos™ and vallos™f?

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)
4
How does vallos™ or vallos™f differ from other allografts?

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)
5
Can vallos™ and vallos™f be purchased separately from Geistlich vallomix™?

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 performance1-14 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).
6
Why combine a demineralized allograft with Geistlich Bio-Oss®?

Demineralized allografts offer the potential of osteoinductivity1-3 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).
7
What makes vallos™ and vallos™f validated allografts?

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).
8
How is osteoinductive potential tested?

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 studies1-2.

References:

  1. Compiled DCI Osteoinductivity Validation Summary_2020. (data on file)
  2. Han et al., 2003, J Orthop Res 21_648-654
9
What clinical evidence is available for combining allogeneic and xenogeneic bone?

The combination of allogeneic and xenogeneic bone has been well documented and widely used in clinical practice for many years1-2. 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.
10
Should Geistlich vallomix™ be mixed or layered?

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

11
Do Geistlich vallomix™ and Geistlich vallomix™f require preparation prior to use?

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.

12
Can Geistlich vallomix™ replace the combination of demineralized and mineralized allografts?

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
RPM™ Reinforced PTFE Mesh
1
Why and how was RPM™ developed?

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.

2
What type of material is RPM™?
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.
3
What is the shelf life of RPM™?
The expiration date of the material is 4 years from the date of manufacture.
4
When should I use a regular Ti-reinforced PTFE membrane and when should I use RPM™?

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.

5
Do I have to use Geistlich Bio-Gide® with RPM™?

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 healing2, 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

6
If I use Geistlich Bio-Gide® on top of RPM™, do I still need to achieve tension-free primary closure?

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.

7
How long should the bone graft heal before re-entry to place implants?

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.

8
How should I fixate RPM™?

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™.

9
Can RPM™ only be used for vertical ridge augmentation?

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.

10
How do I manage exposure?

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

11
Should I trim RPM™ before use? How do I trim the material?

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.

12
Should I over-augment the graft in anticipation of graft resorption?

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.

13
Is there any published clinical data on RPM™?

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.

14
What is the uniqueness of RPM™ over PTFE membranes?
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.
15
What is the purpose of the mandibular SKUs?

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

16
I am currently using titanium meshes, what is the benefit of RPM™?

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.

Dental Therapeutic Area

Extraction Socket Management
1
Can Geistlich Mucograft® Seal be used in extraction socket management for open healing? How?
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.
2
Why should I use Geistlich Bio-Oss® Collagen with Geistlich Mucograft® Seal, if I plan to place an implant after 8-10 weeks?

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.

3
At what time point does the literature recommend re-entry or implant placement in extraction sockets?
  • 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.
4
Can Geistlich Bio-Oss® and Geistlich Bio-Oss Collagen® be used in an extraction socket if inflammation is present at the time of placement?
It is not recommended to use Geistlich Bio-Oss® and Geistlich Bio-Oss® Collagen in case of infected sites (see package insert).
5
I treat extraction sockets. If I use your products - when can I expect bone?
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
6
Is it possible to regenerate bundle bone with Geistlich biomaterials?
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.
7
What is bundle bone?
It is a tooth-related structure that resorbs after tooth extraction. The buccal bone wall of the socket is very thin1-3 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.
8
Can Geistlich Bio-Gide® be used in extraction socket management for open healing? How?
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.
9
Which Geistlich biomaterials do you recommend for the treatment of extraction sockets?
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 alone1,2.

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.
Soft-Tissue Regeneration
1
Why do I need keratinized tissue?
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.

Find your local expert in over 90 regions