Category: Uncategorized

CLINICAL CASE

1 – Baseline occlusal view: situation before removal of tooth #20.
2 – Tooth removal and extraction socket management with Gesitlich Bio-Oss® and Geistlich Bio-Gide®.
3 – Geistlich Fibro-Gide® was trimmed to the defect size, to augment the buccal and crestal soft-tissue area of the ridge.
4 – Geistlich Fibro-Gide® in place, augmenting buccal and crestal area of tooth #20 and buccal in the edentulous area tooth #21 to tooth #19.
5 – Immediate provisionalization of the implants.
6 – 3 weeks post-surgery: occlusal view of augmented area with created emergence profile.
7 – 3 weeks post-surgery: buccal view of augmented area with created emergence profile.
8 – Provisional reconstruction 6 weeks post-surgery.
9 – Final restoration 2.5 years post-surgery: soft-tissue thickness remains stable over time.

CLINICAL CASE

1 – Baseline buccal view: soft-tissue concavity at the dental implant site.
2 – Baseline occlusal view: volume deficiency on the buccal aspect.
3 – Adapting and trimming of Geistlich Fibro-Gide® to the defect size. Additional bevel cut performed for the area to be positioned close to the incision line.
4 – Position and fixation of Geistlich Fibro-Gide® to the buccal flap with horizontal mattress suture.
5 – Primary closure obtained by horizontal mattress and single interrupted sutures.
6 – 4 months follow-up: showing the healed soft-tissue after augmentation surgery.
7 – 4 months follow-up: provisional restoration. Notice volume recovery.
8 – Occlusal view before final restoration.
9 – 9 months follow-up: final restoration after soft-tissue augmentation surgery.

CLINICAL CASE

1 – Exposure of the alveolar ridge and buccal bone.
2 – Horizontal and vertical osteotomies of the distracted segment.
3 – The upward lift of the transported segment, achieving a height gain of 7 mm.
4 – Geistlich Bio-Oss® Block is trimmed in a dry state with a piezo surgical device to the required dimension and shaped to completely fit into the recipient site.
5 – The coronally shifted segment is fixed with miniplates and miniscrews and thus immobilizes also the biomaterial block.
6 – The coronally shifted segment is fixed with miniplates and miniscrews and thus immobilizes also the biomaterial block.
7 – Intra-operative situation following implants insertion 4 months after interpositional grafting.
8 – Periapical X-ray evaluation immediately after implant insertion.

CLINICAL CHALLENGE:

  • Insufficient alveolar ridge height for implant placement and proximity to the alveolar nerve
  • Autologous bone harvesting is associated with patient discomfort

AIM/APPROACH:

  • Interpositional grafting with Geistlich Bio-Oss® Block for vertical augmentation
  • Alveolar ridge volume preservation and minimizing patient morbidity

CLINICAL CASE

1 – Preoperative radiograph depicting the severe bony atrophy in the posterior mandible.
2 – Fixation of the pre-formed osteosynthesis plate with miniscrews.
3 – Augmentation with autologous bone harvested from the angular region of the mandible and mixed with Geistlich Bio-Oss®.
4 – The grafted site including the osteosynthesis plate is covered with Geistlich Bio-Gide® and the tensile collagen membrane is pinned down. Thus, the augmented site is accurately covered and stabilized.
5 – In order to obtain primary wound closure, a double-layered suturing technique is used by combining a horizontal internal mattress and a coronal single stitch technique.
6 – Implants are inserted 6 months after augmentation and the healing abutments are connected to the implants.
7 – Lateral view of the final prosthetic restoration 6 months after implant placement.
8 – Intraoral radiograph 15 months after augmentation procedure showing a stable bony situation.

CLINICAL CHALLENGE:

  • Severely atrophied alveolar ridge with insufficient bone volume for implant placement
  • ­­­­High complication rates and patient discomfort associated with large augmentations when using autologous bone grafts

AIM/APPROACH:

  • 3-dimensional augmentation of alveolar ridge by the fence technique for implant placement
  • At the same time reducing complication rates and patient discomfort

CLINICAL CASE

1 – Occlusal view of the ridge after flap elevation.
2 – Longitudinal split of the alveolar crest by use of piezo-surgical instruments.
3 – Two implants are placed in the expanded crest.
4 – The split around the implants is filled with a mixture (1:1) of autologous bone chips from the retromolar area and Geistlich Bio-Oss®.
5 – The augmented ridge is covered with a Geistlich Bio-Gide® membrane before closure of the soft tissue.
6 – Buccal view of the final situation.
7 – Occlusal view of the prosthetic outcome.
8 – X-ray findings 6 months after implant placement.

CLINICAL CHALLENGE:

  • Insufficient alveolar ridge width for implant placement
  • Autologous bone is subject to resorption and may lead to loss of volume

AIM/APPROACH:

  • Ridge Split procedure in combination with Geistlich Bio-Oss® and Geistlich Bio-Gide® for horizontal augmentation
  • Preservation of the alveolar ridge volume

CLINICAL CASE

1 – 3D reconstruction from CBCT images showing horizontal maxillary atrophy at the two-teeth gap.
2 – Intraoperative view of the atrophied anterior maxillary site. Tenting screws are placed to support the collagen membrane.
3 – Application of a mixture (1:1) of autologous bone chips from the retromolar area and Geistlich Bio-Oss®.
4 – Coverage with a double layer of collagen membrane Geistlich Bio-Gide®.
5 – Tension-free, primary wound closure by mattress and single interrupted sutures.
6 – Situation at re-opening after 6 months showing vital bone and reconstructed ridge contour.
7 – Guided implant placement in regenerated bone with stent (additional implant placement at position 22).
8 – Final prosthetic restoration.

CLINICAL CHALLENGE:

  • Insufficient alveolar ridge width for implant placement
  • Donor site morbidity after autologous bone block harvesting and resorption of autologous bone

AIM/APPROACH:

  • Horizontal alveolar ridge augmentation with Geistlich Bio-Oss® and Geistlich Bio-Gide®
  • Minimizing autologous bone harvesting and resorption protection

CLINICAL CASE

1 – Patient with missing teeth 3, 4 and 5 in combination with horizontal and vertical atrophy. Situation incompatible with ideal and prosthetically guided implant insertion.
2 – Initial CBCT showing vertical and horizontal bone deficit.
3 – 3-D model obtained from CBCT with the corresponding Yxoss CBR® design.
4 – Final titanium scaffold ready for use.
5 – Exposure of the bone defect with full thickness flap.
6 – Fixation of Yxoss CBR® filled with a mix of autologous bone chips and Geistlich Bio-Oss® using two titanium screws.
7 – Coverage with a Geistlich Bio-Gide® membrane.
8 – Tension-free hermetic suture of the flap.
9 – After 8 months, the adequate rooting of the bone graft is assessed by CBCT and the insertion of the implants is planned in a prosthetically guided manner.
10 – 8 months after the GBR the scaffold is removed and two endosseous implants are inserted.
11 – Radiography with three elements supported by implants.
12 – Final prosthetic reconstruction 3 months after implant placement, without the need of a temporary interim solution.

CLINICAL CASE

1 – Initial clinical situation showing an extended horizontal and vertical bone gap at former positions of teeth 3 and 4 which were extracted 8 weeks earlier.
2 – CBCT showing a deficient vestibular contour and the corresponding bone defect. 3-D design of Yxoss CBR® derived from the patient’s anatomy.
3 – Surgical situation with horizontal and vertical bone defect.
4 – After testing the adaptation of Yxoss CBR® to the defect, it is filled with a graft consisting of 30% autologous particulate bone and 70% granules of Geistlich Bio-Oss®.
5 – Yxoss CBR® fixed with titanium screws.
6 – Adaptation of Geistlich Bio-Gide® over the structure. Complete, tension-free wound closure will follow.
7 – Sites at the day of the procedure after sutures placed. Tunnel between #23,24 and partial thickness flap raised between #23,22.
8 – Radiographic situation after 6 months of healing, before reopening.
9 – Insertion of two implants (Straumann® BLT). The resonance frequency measurement shows ISQ values of 70-75.
10 – Insertion of the healing abutments and adaptation of the flap.
11 – Soft tissue maturation 12 weeks after implant insertion.
12 – Clinical situation after prosthetic finalization, 18 months after surgery. X-ray shows stability of marginal bone levels.

CLINICAL CASE

1 – Large horizontal and vertical bone defect in region 5-12; deficit emerging from many years of wearing mucosa-supported dentures.
2 – 3-D design including 3-D model, grafting volume, Yxoss CBR® and implants.
3 – 3-D Design including 3-D model and Yxoss CBR®.
4 – Initial clinical situation before opening of the soft tissue.
5 – Presentation of bony situs with a full-thickness flap (ridge incision).
6 – Titanium scaffold filled with 100% Geistlich Bio-Oss® and placed onto bone defect. Fixation performed with 4 mini-screws in the buccal area.
7 – Soft tissue situation after 6 months of healing.
8 – Careful separation of Yxoss CBR® into two parts at predetermined breaking points (Easy Removal Design®). Pilot drill performed through built-in holes according to backward planning principle.
9 – 4 implants placed in positions 5, 7, 10 and 12 to support the prosthesis. Bleeding out of the bone shows a good vascularization.
10 – Panoramic X-ray 6 months after the augmentation. In the meantime, 4 additional implants have been placed in the lower jaw.

CLINICAL CASE

1 – Radiographic image showing the vertical bone deficit in the left mandible.
2 – Clinical situation before opening the area.
3 – Incision for the creation of a poncho flap.
4 – Starting in the retromolar area the incision is directed toward the distal region of tooth 23.
5 – Cortical bone is removed with the trephine, crushed and mixed with Geistlich Bio-Oss® (50:50).
6 – Successive application of Geistlich Bio-Gide®.
7 – Dehiscence after 1.5 months. The soft tissue was de-epithelialized and a free gingival graft was sutured to protect the exposition. Dehiscence may occur but usually heals spontaneously after appropriate cleaning.
8 – After 6 months, the ridge incision is applied to access the 3-D titanium scaffold.
9 – Buccal view of the regenerated bone. Even though there was dehiscence, the bone was regenerated satisfactorily.
10 – Four implants are inserted and the soft tissue is healed showing the contour provided by the good adaptation of the provisional prosthesis.
11 – Clinical situation after the final prosthesis and the soft tissue frenum removal.
12 – Radiographic situation.

CLINICAL CASE

1 – Clinical situation in the posterior maxilla depicting a large buccal defect in the edentulous area.
2 – Fixation of the autologous block from the symphysis.
3 – Contouring of the grafted site with Geistlich Bio-Oss®.
4 – The augmented area is covered with the collagen membrane Geistlich Bio-Gide®.
5 – Primary wound closure is accomplished with single interrupted sutures.
6 – Clinical aspect of the augmented ridge with no signs of block resorption.
7 – Implant placement 3 months post augmentation.
8 – Long-term follow-up showing stable peri-implant bone level 3 years after implant placement.

CLINICAL CASE

1 – The preoperative radiograph displays the vertical bone defect in the left mandible and thus, insufficient vertical bone volume to allow implant placement.
2 – Yxoss CBR® is planned based on the preoperative CBCT data.
3 – Opening the defect site using the ridge incision technique. The titanium scaffold fits the bone defect precisely during the augmentation procedure.
4 – The titanium scaffold is filled with 50% autologous bone and 50% Geistlich Bio-Oss®. Fixation is performed with one titanium screw in vestibulolingual direction.
5 – A collagen membrane (Geistlich Bio-Gide®) is used to provide an additional barrier for bone regeneration.
6 – Stable soft tissue situation after 6 months with no complications during the healing period. After reopening, bone is regenerated to the contour defined by the titanium scaffold.
7 – The bone is completely regenerated in the correct three-dimensional orientation. This is also visible in the respective CBCT. Implant placement is now possible.
8 – Two implants were placed with good primary stability. The vertical bone regeneration is also visible in the CBCT data.
9 – Postoperative panoramic radiograph after implant placement.
10 – Clinical situation 3 months post implant insertion.
11 – Final prosthetic reconstruction 6 months post implant insertion and 16 months post regenerative surgery.
12 – Final prosthetic reconstruction 16 months post regenerative surgery.

CLINICAL CASE

1 – Pre-operative assessment demonstrating significant bone loss, prior to vertical ridge augmentation.
2 – Labial view of the posterior mandibular defect site. Cortical bone was perforated to increase the blood supply.
3 – RPM™ was secured on the lingual side prior to applying a 1:1 mixture of autogenous bone and Geistlich Bio-Oss®.
4 – RPM™ was secured over the bone graft with titanium pins and screws.
5 – Geistlich Bio-Gide® is placed on top of RPM™ to prevent early soft tissue ingrowth while allowing for graft vascularization.
6 – Labial view of the soft tissue 9 months after the vertical bone augmentation.
7 – RPM™ exposed at 9 months, following flap elevation.
8 – Labial view of the regenerated surgical site at 9 months demonstrates well vascularized bone.
9 – Occlusal view of the regenerated surgical site at 9 months demonstrates well vascularized bone.
10 – Implant placement in the newly regenerated bone.
Geistlich Fibro-Gide® (15x20x6mm) was placed on top of two implants, to increase soft tissue thickness.
12 – Periapical x-ray 1 year post-operatively, demonstrates implant stability and mature bone formation following vertical bone augmentation and soft tissue thickening.

CLINICAL CASE

Initial situation, patient presented with radiographic and clinically traditional signs of peri-implantitis, including bleeding on probing, suppuration, radiographic progressive bone loss and clinical pathologic probing depths.
Mechanical debridement was achieved using titanium scalers, an ultrasonic device with an implant protective cap and titanium brushes to remove all of the visible contaminants of the implant surface. Citric acid was then placed on shreds of a non-woven gauze and applied to the surface for approx. 1min. Copious irrigation was done using saline solution and the surface was ablated using the Er:YAG laser at 20pps/50mj.
After the surface was prepped and no signs of residual granulation tissue was noted, the defect was grafted with Geistlich Bio-Oss®. Attention was given towards not augmenting beyond the bony envelope.
A protective Geistlich Bio-Gide® membrane was placed over Geistlich Bio-Oss®.
Geistlich Fibro-Gide® was placed over Geistlich Bio-Gide® to enhance soft-tissue volume and quality. Geistlich Fibro-Gide® was trimmed and adapted to the defect site ensuring a tension free closure.
Geistlich Fibro-Gide® was place on the top of the bone graft to enhance soft-tissue thickness. Geistlich Fibro-Gide® is porous. We can observe the rapid penetration of blood through the matrix.
Closure with a tension-free flap was achieved by releasing incisions and secured using 4-0 chromic gut sutures.
1.5 year post-operative photo and radiograph show the healing of the soft-tissues with no signs of peri-implantitis and adequate tissue thickening. Radiographic bone levels have maintained stable over the course of the year.

CLINICAL CASE

Pre-operative condition: Note that the gingival recession of 3-4 mm is evident as is the cervical root abrasions. The interdental papillae completely fills the embrasure space.
Incision design showing the sulcular incisions with horizontal incisions across the interdental regions ending with a remote oblique vertical releasing incision distal to the first bicuspid tooth.
Geistlich Fibro-Gide® is trimmed in a dry state to 10 x 15 x 6mm. The corners were trimmed for better adaptation and the matrix was then hydrated in sterile saline solution.
The interdental papillae were de-epithelialized and Geistlich Fibro-Gide®was placed over the exposed roots extending onto the bone. Geistlich Fibro-Gide® was not secured with sutures.
Internal periosteal releasing incision was made to allow tension-free coronal advancement of the buccal flap to completely cover Geistlich Fibro-Gide®.The flap was secured with 5-0 Monocryl® sutures.
1-week post-operative visit: the healing looks good and sutures are intact. There was a small soft-tissue dehiscence at the buccal margin of the canine tooth.
Healing progressed well at 2 months post-operatively and the dehiscence defect seen at 1 week appears to be healing. Soft-tissue thickness is also evident at this stage.
At 6 months, 100% root coverage has been achieved. Note the increase in keratinized gingiva at the canine tooth where there was previously delayed healing. The patient is happy with the esthetic and functional outcome.

CLINICAL CASE

1 – Baseline: recession defects on teeth #19 to #22 in the lower left quadrant. Exposed root surfaces of these teeth were thoroughly scaled and root planed before surgery.
2 – A full thickness muco-gingival tunnel was prepared through a minimally-invasive vestibular access incision apical to the teeth with gingival recessions.
3 – Geistlich Fibro-Gide® was cut into small pieces in a dry state using a scalpel.
4 – Insertion of Geistlich Fibro-Gide® into the subperiosteal tunnel.
5 – Geistlich Fibro-Gide® in situ: the gingival margin had been coronally advanced and stabilized after pieces of Geistlich Fibro-Gide® were placed.
6 – 1 week post-surgery: anchoring sutures were left in place for 1-2 weeks.
7 – 2 weeks post-surgery: anchoring sutures in place.
8 – 2 weeks post-surgery: removal of anchoring sutures.
9 – 7 months post-surgery: complete recession coverage.

CLINICAL CASE

1 – Baseline frontal view: missing central incisor. Implant visible through mucosa due to thin biotype.
2 – Baseline occlusal view: soft-tissue deficit in the buccal and occlusal area.
3 – Flap elevation on the buccal side using a full flap crestally and a split flap buccally.
4 – Adaption of Geistlich Fibro-Gide® to the defect size.
5 – Palatal island flap prepared to allow for tension-free wound closure. Geistlich Fibro-Gide® in situ, immobilized with a mattress suture.
6 – Tension-free wound closure using single interrupted sutures (Dafilon 5-0, Braun).
7 – Abutment connection.
8 – 6 months follow-up: final crown in place.
9 – 2.5 year follow-up shows stable soft-tissue conditions.

CLINICAL CASE

1 – Pre-operative view of the atrophied ridge.
2 – Application of a 1:1 mixture of autologous bone and Geistlich Bio-Oss®.
3 – Geistlich Bio-Gide® is tightly fixed and pinned, thus immobilizing the particulate graft. The sausage-like augmentation allows extended horizontal augmentation.
4 – Primary wound closure is obtained with a combination of mattress and single-interrupted sutures.
5 – Sufficient amount of augmented bone for implant placement 8 months after augmentation. Implants are placed in a submerged procedure.
6 – Insufficient vestibular depth and keratinized tissue after alveolar ridge augmentation.
7 – Application of a keratinized strip towards the vestibulum and Geistlich Mucograft® over the augmented area where it is left exposed for healing.
8 – Situation before reopening for abutment connection after 3 months showing increased vestibular depth

CONCLUSIONS:

  • Geistlich Mucograft® with a keratinized tissue strip was utilized to increase vestibular depth and gain additional keratinized tissue.
  • Augmentation of severely atrophied alveolar ridge provided sufficient bone for implant placement 8 months following augmentation.

CLINICAL CASE

1 – Baseline buccal view: immediate implant placement was performed 3 months prior to replacing tooth #8.
2 – Baseline occlusal view: soft-tissue deficiency on the buccal aspect.
3 – Placement of Geistlich Fibro-Gide® with minimal envelope flap and inserting a temporary crown.
4 – Stabilization of Geistlich Fibro-Gide® to the buccal mucosa using internal mattress sutures.
5 – 2-week follow-up at suture removal.
6 – 4 weeks post-surgery: uneventful wound healing and an increase in soft-tissue volume.
7 – Occlusal view 11 months post-surgery: there is a clear substantial increase in the soft-tissue thickness.
8 – Buccal view 11 months post-surgery: a substantial increase in soft-tissue thickness is evident.
9 – Buccal view 2 years post-surgery.

CLINICAL CASE

1 – Thin mucosal tissue over implant #7 creating an unesthetic appearance.
2 – Occlusal view of #7 reveals buccal soft-tissue defects.
3 – Augmentation of the soft-tissue on two implant sites, #7 and #10, using a conventional full thickness flap with vertical releasing incisions on site #7 and an envelope flap on site #10.
4 – Geistlich Fibro-Gide® is split into two 3mm thick matrices to be used in both sites, hydrated with sterile saline and trimmed to the defect dimensions.
5 – Geistlich Fibro-Gide® is secured to the periosteum apically and the interproximal papillae with 5-0 chromic gut sutures.
6 – Passive closure of the flap achieved with 6-0 vicryl sutures.
7 – 1 week post-surgery reveals uneventful healing with maintenance of tissue volume.
8 – Buccal view at 8 weeks reveals uneventful healing with maintenance of tissue volume.
9 – Occlusal view at 8 weeks post-surgery.

CLINICAL CASE

1 – Initial Clinical Situation, Occlusal/Buccal Shots of Missing teeth #12 and 13.
2 – Intra-Operative, Implant Placement of #12 and 13.
3 – Intra-Operative, Placement of Geistlich Fibro-Gide® in the Buccal Concavity of #12 and 13.
4 – Immediate Post-Operative Buccal Soft Tissue Thickness.
5 – Two Months Post-Operative Healing with Provisional Restorations.

CLINICAL CASE

Implant placement planned for site #3 and #5 with soft-tissue treatment utilizing a CTG and for sites #10, #12 and #13 with soft-tissue augmentation using Geistlich Fibro-Gide®
2 – Uncovering of site #10 shows a narrow ridge width and an insufficient amount of soft-tissue thickness.
3 – Tooth #10 was extracted and immediately replaced by an implant.
4 – Fill the gap procedure with Geistlich Bio-Oss Collagen® to achieve contour augmentation and preserve horizontal ridge dimensions.
5 – Geistlich Fibro-Gide® was trimmed to half of the thickness to fit the defect and placed into sites #10, 11, 12 and 13.
6 – The entire site was closed tension-free to facilitate uneventful wound healing.
7 – The 3 month follow-up shows uneventful soft-tissue healing and an increase of soft-tissue thickness at the desired sites.
8 – The 6 month follow-up with the final reconstruction shows that the soft-tissue thickness at the desired site is maintained over time. This contributes to an esthetic and pleasing outcome. (Restorative work by Dr. Chao-Chieh Yang, IUSD)
9 – The 2 month follow-up showing a comparison of the treated sites, one with CTG (left) and one with Geistlich Fibro-Gide® (right) in the same patient. Comparable results have been achieved with both treatments, but without the need for a donor site.

7 – Immediate implant placement with the bone mixture applied was performed.

CLINICAL CASE

1 – Initial clinical situation, tooth #8 and #9 require extraction.
2 – Clinical view post extraction of tooth #8 and #9.
3 – Evaluation of the buccal soft-tissue thickness.
4 – Trimming of Geistlich Fibro-Gide® to fit in the gap between the buccal soft-tissue and the buccal bone wall.
5 – Geistlich Fibro-Gide® in place: an immediate volume increase of the buccal soft-tissues are visible.
6 – Mixing of autologous bone and Geistlich Bio-Oss® particles for placement in the gaps around the implants.
7 – Immediate implant placement with the bone mixture applied was performed.
8 – Provisional restoration at time of surgery (occlusal view).
9 – Provisional restoration at time of surgery (frontal view).

VIDEO

Introducing the first xenogenic / allogenic validated bone substitute1

LEARN MORE