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Treatment Solutions
- 2-Stage Implant Placement(32)
- Gain of Keratinized Tissue(14)
- GBR Procedure(36)
- Peri-Implantitis Therapy(7)
- Recession Coverage(19)
- Ridge Preservation(32)
- Sinus Floor Elevation(8)
- Soft Tissue Thickening(47)
- Surgical Periodontal Treatment(47)
Products
- Geistlich Bio-Gide Compressed®(2)
- Geistlich Bio-Gide Shape®(1)
- Geistlich Bio-Gide®(66)
- Geistlich Bio-Oss Collagen®(31)
- Geistlich Bio-Oss Pen®(1)
- Geistlich Bio-Oss®(73)
- Geistlich Fibro-Gide®(42)
- Geistlich Mucograft®(27)
- Geistlich Mucograft® Seal(4)
- GEM 21S®(23)
- Micross(1)
- RPM™(1)
- Safescraper Twist(4)
- vallomix™(1)
- vallos®(15)
- vallos®f(10)
- Yxoss CBR®(17)

Found 159 Results

Pre-operative view of recession defects that ranges from 2-5 mm. There is minimal keratinized tissue on #14. Pocket depths are within limits with no loss of interproximal tissue.

A 15c blade is used to make sulcular incisions with scooping incisions at the level of the CEJ. A combination flap consisting of full-thickness coronally followed by a partial-thickness dissection apically is reflected.

The papillary tissue is de-epithelialized with a football diamond bur on a rotary hand piece. This exposes a vascular bed for the graft and intended coronal positioning of the flap.

Side-view of the recession defects. It is clearly visible how deep the recession defects are.

Geistlich Mucograft® is trimmed and positioned to extend beyond the root surfaces. A combination of simple interrupted sutures at its coronal edge and mattress sutures extending over the entire graft are used to adapt the graft to the recipient site.

The flap is then advanced and coronally positioned with horizontal mattress sutures to release tension and simple interrupted sutures to approximate the flap edges to the de-epithelialized papillas.

Follow-up after 1 week: note that the flap margins appear stable. Erythema and edema evident with maturation of the tissue beginning.

Follow-up after 3 months: maturation of the tissue evident with complete root coverage. An increase in the zone of keratinized tissue by #14 is also visible.

Follow-up after 1 year: stability of the graft is evident, complete coverage and a healthy and maintainable gingival situation have been achieved.

1 - Baseline frontal view: missing central incisor.

2 - Baseline occlusal view: The facial contour is flattened by physiological dimensional ridge alterations post-extraction.

3 - Full-thickness flap using one releasing incision in the distal aspect of the canine. Simultaneous contour augmentation using GBR was performed with autogenous bone chips to cover the exposed implant combined with a layer of Geistlich Bio-Oss®and Geistlich Bio-Gide®.

4 - Application of Geistlich Fibro-Gide® on top of the augmented area. A tension-free primary wound closure was obtained by a periosteal releasing incision.

5 - Suture removal 14 days post-surgery. Uneventful wound healing and an increase in soft-tissue volume.

6 - Frontal view 4 weeks post-surgery.

7 - 2 months follow-up combined with abutment connection.

8 - Occlusal view of final restoration 2 years post-surgery.

9 - Final restoration 2 years post-surgery shows pleasing esthetics.

Initial clinical and radiographic presentation showing vertical bone loss #9-10 area

Initial CBCT presentation showing bone loss between #9-10 wrapping palatally

Occlusal clinical views showing sulcular incision with paracrestal incision #9-10

Facial and occlusal clinical views showing full thickness flap reflection with wide 1-2 bony wall defect measuring ~7mm vertical bone loss

Facial clinical views showing full thickness flap reflection and GTR procedure using Geistlich vallomix™ bone graft (allograft as an internal first layer and xenograft as an outside second layer) and collagen membrane

Facial and occlusal clinical views showing primary closure using 6-0 prolene sutures with immediate post-surgical bone addition

Facial and occlusal clinical views showing healing at 10 days with tissue granulating in

Facial and occlusal clinical views showing healing at 6 weeks

Pre-operative vs post-surgical clinical and radiographic views showing adequate bone fill and reduction in probing depths

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.

Baseline: compromised soft-tissue architecture at site #9 due to ill-fitting Nesbit appliance.

Sulcular and paracrestal incision for full thickness flap elevation with single vertical incision distal to the site.

Presence of horizontal tissue deficiency clearly visible following flap elevation.

Application of 50:50 mixture of Geistlich Bio-Oss® and autologous bone chips harvested using Geistlich SafeScraper Twist.

Geistlich Bio-Gide® stabilized using fixation pins and covering the graft material.

Tension-free primary closure achieved using 4-0 PTFE sutures.

Soft-tissue contour at 4-month healing. Fixed provisional in place for soft-tissue contouring.

Occlusal view demonstrating gain in horizontal dimension for prosthetically guided implant placement.

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.

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.

Page 5 of 14

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