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Treatment Solutions
- 2-Stage Implant Placement(7)
- Gain of Keratinized Tissue(2)
- GBR Procedure(9)
- Peri-Implantitis Therapy(3)
- Ridge Preservation(6)
- Sinus Floor Elevation(1)
- Soft Tissue Thickening(13)
- Surgical Periodontal Treatment(6)
Products
- Geistlich Bio-Gide Compressed®(1)
- Geistlich Bio-Gide Shape®(1)
- Geistlich Bio-Gide®(14)
- Geistlich Bio-Oss Collagen®(8)
- Geistlich Bio-Oss Pen®(1)
- Geistlich Bio-Oss®(16)
- Geistlich Fibro-Gide®(10)
- Geistlich Mucograft®(7)
- GEM 21S®(1)
- Micross(1)
- Safescraper Twist(3)
- vallomix™(1)
- vallos®(4)
- vallos®f(1)
- Yxoss CBR®(4)

Found 32 Results

Pre-operative situation showing the horizontal ridge deficiency (left). Buccal bone concavity evident after full thickness flap elevation (middle). There is insufficient bone to place implants in an ideal restorative position (right).

It is important to locate the mental foramen. Intramarrow penetrations were done to allow for improved blood supply to the bone graft.

The clinical cocktail used for guided bone regeneration: 1) 50/50 mixture of autogenous bone chips, collected with Geistlich SafeScraper TWIST, and Geistlich Bio-Oss®, and 2) Geistlich Bio-Gide® Compressed 20 x 30 mm and 13 x 25 mm.

“Sticky bone”, created by combining PRF with the bone graft, adapted well to the site of the defect. Periosteal biting sutures were used for stabilization of the multiple layers of Geistlich Bio-Gide® Compressed and underlying bone graft.

Geistlich Bio-Gide® Compressed was carefully trimmed to be mindful of the mental nerve.

Tension-free primary closure achieved with horizontal mattress sutures and simple interrupted sutures.

Re-entry and CBCT scan at 8 months showing a significant increase in horizonal bone dimension.

Sufficient regenerated bone to allow for implant therapy (left). Implants #19 and #20 placed. Vital bone from guided bone regeneration as evidenced by the bleeding bone (middle). Tension-free primary closure achieved using 5-0 glycolon sutures.

Eswar Kandaswamy, BDS, MS
Amber Kreko, DDS

Horizontal Ridge Augmentation with a Layered Allograft-Xenograft Approach

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Image 1a depicts the pre-operative situation, while the inset shows a cross-sectional view of the deficient ridge in area #12.

Pre-operative view, post-flap reflection.

An inner layer of vallos® demineralized cortical particles (allograft) was applied to the defect.

An outer layer of Geistlich Bio-Oss® (xenograft) was applied on top of vallos® (allograft).

Bone grafts covered with Geistlich Bio-Gide® and secured via tacks

Final sutured closure over the bone grafts covered with Geistlich Bio-Gide® and secured via tacks

Four-week post-operative image demonstrating good soft tissue healing.

Sequential CBCT imaging comparisons, from pre-operative to 6 and 9 months post-operative, confirm the re-establishment of horizontal ridge width achieved through bone augmentation.

Comparative CBCT cross-sectional analysis of pre-operative (left) and 6-month post-operative (right) images reveals an increase in horizontal ridge width.

Pre-operative image showing a fractured, endodontically treated tooth #9.

Left: Pre-operative sagittal CBCT image demonstrating a Kan Class 1 sagittal root position with initial digital implant planning conducted during the consultation appointment. Right: Definitive digital implant planning.

Left: Tooth #9 was extracted with minimal flap elevation, preserving the papillae. Right: A 3.6 x 15 mm implant was placed in a fully guided manner with a palatal bias to maximize the facial gap dimension, achieving a +2mm gap.

Left: The underside of the periosteum was incised just apical to the mucogingival junction, and a supra-periosteal pocket was created using sharp dissection with a #15 blade. Right: The facial gap was packed with 50 mg of Geistlich Bio-Oss Collagen®. A cover screw was temporarily placed to prevent bone graft granules from entering the implant chamber.

Left: A 15mm x 20mm x 3mm Geistlich Fibro-Gide® collagen matrix was inserted into the supra-periosteal pocket, with the coronal portion positioned to cover the facial bone crest. Right: The provisional crown was placed, and the facial mucosal flap was coronally advanced to cover the Geistlich Fibro-Gide® collagen matrix.

2-week post-operative follow-up

Final restoration at 16 months post-operative.

Final restoration with a screw-retained crown at 16 months post-operative.

Periapical radiograph at 16 months post-operative demonstrating stable crestal bone levels.

Initial Situation: a failing mandibular molar with a vertical sub-osseous fracture.

A pre-operative radiograph and CBCT showing the cross-section of the involved tooth.

An implant site was developed by placing a pilot drill down the mesial root space, then uprighting it. This was continued up through the drill sequence. The mesial radicular septum is moved in the process.

A Camlog® 5.0 x 11 mm implant was placed with the platform set just down below the bone height of the socket walls.

After placing a 4.0 mm height cylindrical gingiva former in the implant, 250 mg of Geistlich Bio-Oss Collagen® was packed down in the socket around the implant.

Geistlich Mucograft® was adapted to the region then tucked down under the gingival margin.

The gingival margins were adapted and closed together with 4.0 teflon sutures (Cytoplast™, Osteogenics). The region was then covered with Glustich - PeriAcryl®90 Oral Tissue Adhesive.

After 3 months of healing, the top of the gingiva former is exposed and the situation is ready for Emergence Profile Development. This is quite standard.

4 months later following Emergence Profile Development.

An occlusal view of the final one-piece, screw-retained zirconia crown restoration based on a Camlog® Titanium Base Abutment.

Baseline situation and planning: vertical bone deficit of 5.29mm in section 18-20.

Central incision in the keratinized mucosa and perforated cortical bone

Yxoss CBR® filled with a 50:50 mix of autologous bone and Geistlich Bio-Oss®. Coverage of the titanium scaffold with Geistlich Bio-Gide®

Geistlich Fibro-Gide® is tailored to the defect and a tension-free suture is done.

4 months after augmentation shows the bone situation after removal of the titanium scaffold and insertion of implants. Autologous bone chips are applied on top of the implants. Occlusal view of the mucosa level after implantation and wound closure.

6 weeks after implantation and 5 1/2 months after augmentation. The mucosa is prepared apically; the preparation reaches the periosteum apically. The recipient site is fully surrounded by keratinized mucosa. Geistlich Mucograft® is sutured into the area.

6 months after regeneration shows about 5mm of vertical bone regeneration. Panoram ic X-Ray after implant placement shows clearly recognizable mucosa shadows.

One year after augmentation shows the dental prosthesis inserted occlusally.

CT scan showing insufficient bone width for implant placement < 4mm.

Initial incisions on the midcrest of the ridge were performed for full-thickness flap preparation.

Four mucoperiosteal flaps were done with vertical releasing incisions and interosseous holes created to stimulate bone formation (RAP phenomenon).

Harvesting of the autologous cortical bone from the lateral surface of the ramus, utilizing the Geistlich Micross.

Geistlich Bio-Oss® granules mixed with harvested autologous bone chips.

Geistlich Bio-Oss® and autologous bone mixture was placed and covered with Geistlich Bio-Gide®. Pins and screws were utilized for fixation to provide primary stability.

Re-entry 8 months post-grafting: sufficient bone has been regenerated to place implants in the desired positions.

Follow-up at the time of implant uncovering and placement of the healing abutments, (4 months post- implant placement). All implants were successfully reverse torqued at 20ncm.

At re-entry eight months post-grafting, the width of the bone had increased significantly and measured 7.46mm at position #21.

Initial panoramic radiograph.

Atrophic edentulous alveolar ridge.

Alveolar ridge split with Geistlich Bio-Oss® graft in place (subsequently applied Geistlich Mucograft®).

6 months post grafting with Geistlich Bio-Oss® and Geistlich Mucograft®.

Implant osteotomies with adequate alveolar width.

Implants in tooth positions 29, 30 and 31.

Panoramic radiograph of implants.

Final restorations.

Pre-op mandibular ridge after the extraction of teeth #17 and #20. Note the significant horizontal ridge deficiency.

Yxoss CBR® Protect Customized Bone Regeneration Titanium Mesh in place, secured with two Stryker screws, 1.2 mm in diameter and 6 mm in length.

Note the excellent adaptation of the Yxoss CBR® Protect and that the edges are apical to the adjacent bony sockets.

Geistlich Bio-Gide® (resorbable collagen membrane) draped over the Yxoss CBR® Protect to separate osteoblasts from fibroblasts.

Implants restored with single-unit crowns.

Six months post-ridge augmentation.

Guide pins in place for implants #19, #20, and #21, with adequate ridge height and width.

Screw-retained final implant crowns with healthy keratinized tissue on the facial side.

Initial clinical and radiographic presentation shows buccal soft tissue enlargement and bone loss #21-22 area.

Clinical facial view showing full thickness flap reflection with complete enucleation of cystic lesion (excisional biopsy).

Clinical view showing hydration of vallos®f and Geistlich Bio-Oss® as two separate grafts.

Clinical facial view showing placement of vallos®f internally for maximum osteogenic/osteoinductive potential and Geistlich Bio-Oss® externally for space maintenance.

Clinical facial view showing placement of Geistlich Bio-Gide® covering the defect and extending one tooth mesillay and distally.

Clinical facial view showing primary closure using 6-0 prolene sutures.

CBCT immediately post-surgery showing radiolucent allograft internally for osseoinduction and radiopaque xenograft externally for space maintenance.

After flap elevation at 4 months showing, the new buccal bone plate together with a completely filled alveolus.

Clinical facial views showing healing at 2 and 4 weeks with proper soft tissue healing.

6 months post-surgery radiographic presentation showing stable periodontium and proper bone fill #21-22 area.

Comparison of pre- and post-surgical CBCT views showing good bone formation.

Comparison of pre- and post-surgical clinical views showing stable periodontium.

Pre-operative assessment demonstrates minimal zone and thickness of buccal keratinized gingiva, with a medium periodontal phenotype.

Pre-operative CBCT with virtually planned implant placement. A thin buccal plate (<1mm) is measured. Good apical bone is noted for the placement of a Straumann® 12mmx4.1mm bone level tapered implant.

Minimally invasive removal of #12 using only a buccal approach mini-flap showing an intact buccal plate with immediate placement of the implant (1 mm below the intact buccal wall) in a screw-retained position. A 3mm buccal gap is measured and a 1.5mm palatal gap.

Both the buccal and palatal gaps have been packed with Geistlich Bio-Oss Collagen® hydrated with Gem 21S. It’s my preference to squeeze Geistlich Fbro-Gide® between thumb and forefinger, prior to placement. A dry-carved piece of Geistlich Fibro-Gide® is in position thinned approximately 2mm with beveling laterally and coronally with a new #15 blade.

Geistlich Fibro-Gide® in place facial to the intact buccal wall under a full thickness buccal approach mini-flap. Immediate contour management was completed using an Anatotemp® for a maxillary bicuspid tooth.

Suturing completed using 4-0PTFE and 5 -0 polypropylene non-resorbable sutures. Anticipated short-term 25% post-operative swelling is discussed with the patient.

3 months post-operative appointment showing a well-developed subgingival transition zone created with immediate contour management. A reverse torque test was completed, and the case proceeded to completion.

9 month post-operative view with final screw-retained crown in place. Good interproximal papilla healing is noted with thickening of the buccal periodontal phenotype compared with Fig. #1. (Restorative Therapy: Drew Shulman DMD, MAGD; Philadelphia, PA)

Andrea Ravidà, DDS, MS, PhD
Anu Viswanathan DDS, MDS

Prosthetic-Surgical Approach to Regenerative Treatment for Peri-Implantitis

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Clinical presentation of tooth #31 showing radiographic evidence of bone loss, profuse bleeding on probing (BOP), deep probing depths, and suppuration, indicative of peri-implantitis with a Class I-infraosseous (c) circumferential-type defect, as described in the study by Monje et al. (2019) Clin Implant Relat Res, 21(4)635-643.

Crown removal by the prosthodontist, followed by placement of a healing abutment for non-surgical therapy using PerioFlow®. After therapy, a cover screw was placed, and the tissue was allowed to heal over the implant for eight weeks.

Surgical treatment initiated with a midcrestal incision and full-thickness flap elevation. Granulation tissue was removed using a surgical curette, revealing a deep infrabony defect.

Implant thoroughly decontaminated using Perioflow® with erythritol powder to ensure a clean surface for regeneration.

rhPDGF-BB was used to hydrate bone grafting materials (vallos® Demineralized Cortical Granules and Geistlich Bio-Oss®), which were first hydrated with sterile water before rhPDGF-BB was added. The materials were mixed in a 1:1 ratio and allowed to sit for 10 minutes before being applied to the deep infrabony defect to promote regeneration.

Flap closed primarily with 5-0 PTFE horizontal mattress and single interrupted suture for secure closure.

Collagen membrane stabilized with 5-0 chromic gut sutures using the lasso technique.

After 5 months of healing, significant bone gain is evident. Geistlich Bio-Oss® was placed on the buccal site to enhance thickness, covered with an amnion-chorion membrane. A healing abutment was placed at this stage.

Two-year follow-up shows disease resolution with shallow probing depths, no bleeding or suppuration, and complete bone gain. A new crown was fabricated with an increased final abutment height (>2mm), contributing to optimal maintenance and long-term stability based on evidence supporting its role in promoting long-term success. A second surgery may be necessary to gain additional tissue thickness or cover residual thread exposure to achieve the desired long-term results.

Baseline full-mouth intra-oral view: the residual maxillary teeth were preliminarily reconstructed with a composite mock-up. The horizontal atrophy of the posterior areas of the maxilla is clearly visible.

The cone beam, realized with a radio-opaque diagnostic template, shows inadequate bone volume for implant placement in all the analyzed sites.

The use of the diagnostic template during the augmentation procedure helps to highlight the presence of bone defects in relationship to the restorative plan and future position of implants.

Large Geistlich Bio-Oss® particles are directly applied inside the sinus with Geistlich Bio-Oss Pen®.

The Geistlich Bio-Gide®, fixed with titanium pins is used to protect and stabilize the augmented site. As the surgical template shows, the bone augmentation is based on the future restorative project following the principle of PGR.

The same surgical procedure is performed on the left posterior side of the maxilla.

Cone-beam 6 months after surgery and prior to implant placement. The relationship between the template used for diagnosis and the bone crest reveals adequate bone volume to place implants in the correct prosthetically driven position.

Implant placement was guided by the same template utilized for diagnosis and bone augmentation.

Final view of the prosthetic reconstruction demonstrates bio-mimetic integration of implant-supported prostheses and ceramic veneers bonded to residual natural teeth.

The panoramic radiograph shows adequate integration of the implants and absence of peri-implant bone resorption.

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