Fibro-Gide® Structure
Video: Exposed Tooth Roots – Now What?
Video: Root Coverage of a Single Recession Defect
Video: Using a Strip Gingival Autograft and Geistlich Mucograft®
Video: What are the Differences Between Geistlich Mucograft® Geistlich Fibro-Gide®?

Put Palate Free Innovation Into Practice

Offer your patients the benefits of Geistlich Biomaterials.

Why are clinicians and patients choosing Palate Free treatments?

NO PALATE
REQUIRED

Traditional treatment options, such as a Connective Tissue Graft or a Free Gingival Graft are effective, but have several limitations:

Geistlich Biomaterials is grateful to Dr. A. Charles, Dr. R. Abundo, Dr. G. Corrente and ACME Publishing for kindly supplying the image used in this section.

Soft tissue graft harvesting
Geistlich Matrices with vascularization illustration

Take a Closer Look

Palate Free Regeneration

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Collagen structure histology
Vascularization histology
Cell ingrowth histology
Integration/Regeneration histology

Collagen Structure

Geistlich matrices consist of specially processed collagen which supports optimal ingrowth for healthy bone formation.

Easy Vascularization

Histological image showing early vascularization 15 days after matrix implantation (mouse model).6,7

Cell Ingrowth

Histological image 30 days after implantation (mouse model) showing soft tissue cell ingrowth.6,7

Integration/Regeneration

6 weeks after clinical implantation. No signs of a foreign body reaction.6,7

Palate Free Innovation from Geistlich Biomaterials

At Geistlich, our pioneering path from biomaterial developer to market leader has been built firmly upon science. Our 165+ years of collagen expertise has fueled soft tissue advancement with a selection of matrices to expand therapeutic options in both open and closed healing situations.

The result is an evolution in care – soft tissue procedures without going to the palate. This palate free approach can positively impact patient satisfaction with faster treatment times and considerably less pain and discomfort.1-5

Your Palate Free solutions are:

What Palate Free Can Mean to Your Patients and Practice

Improve patient satisfaction with faster treatment times and considerably less pain and discomfort.1-5

Dentist talking to patient during check-up

A Leading Clinician Shares His Thoughts

In a recent interview with Prof. Dr. Daniel Thoma, he discussed the benefits of palate free procedures in his practice.

“Avoiding a second surgical site reduces patient morbidity, as well as my surgical time.”

Access the
Full Interview

Prof. Dr. Daniel Thoma

Prof. Dr. Daniel Thoma interviewing patient

The Most Effective Treatments Begin With A Choice

Geistlich Fibro-Gide® and Geistlich Mucograft® each offer unique benefits, allowing you to select the right Palate Free matrix for your specific clinical needs.

Toggle between indications at any time to compare Palate Free solutions

Geistlich Mucograft® for the Gain of Keratinized Tissue and Recession Coverage

Geistlich Mucograft® Details

Geistlich Fibro-Gide® for Volume Stability

Geistlich Fibro-Gide® Details
Ideal Matrix for the Gain of Keratinized Tissue and Recession Coverage
Product
Comparison
StructureCompact and spongy layer
Cross-LinkingReconstituted collagen – no cross-linking
StabilityGood volume stability
HealingOpen and submerged healing
Indications
  • - Gain of keratinized tissue
  • - Socket Seal
  • - Vestibuloplasty
  • - Recession Coverage
Patient Reported Outcomes“More than two-thirds of the patients preferred the appearance of collagen matrix therapy.”8
Ideal Matrix for Volume Stability
Product
Comparison
StructurePorous layer
Cross-LinkingReconstituted collagen – smart cross-linking
StabilityIncrease volume stability
HealingSubmerged healing
Indications
  • - Soft tissue volume augmentation around implants and natural teeth, and under pontics
  • - Recession Coverage
Patient Reported Outcomes“One of the greatest benefits of using soft tissue substitutes is decreased patient morbidity.”9

Clinical Cases

Single Tooth Recession Coverage
Dr. Michael K. McGuireRecession Coverage Treatment with Geistlich Mucograft® Dr. Michael K. McGuire Houston, TX, USA
Recession Coverage Treatment with Geistlich Mucograft®
Dr. Michael K. McGuireRecession Coverage Treatment with Geistlich Mucograft® Dr. Michael K. McGuire Houston, TX, USA
McGuire case overview 1
McGuire case overview 9
McGuire case 1
1 - Pre-operative image showing the recession defect on tooth #6.
McGuire case 2
2 - After elevation of a partial thickness flap, the interdental papillae are de-epithelialized.
McGuire case 3
3 - Geistlich Mucograft® is placed over the defect and sutured to the papillae.
McGuire case 4
4 - The flap is coronally advanced and sutured completely covering the matrix.
McGuire case 5
5 - Follow-up after 1 week: healing of the surgical site.
McGuire case 6
6 - Follow-up situation after 4 weeks.
McGuire case 7
7 - Follow-up after 3 months.
McGuire case 8
8 - Follow-up after 6 months: note the natural appearance of the soft tissue achieved with Geistlich Mucograft®.
McGuire case 9
9 - Follow-up after 1 year.
Dr. Daniele CardaropoliSingle recession coverage with coronally advanced flap in thick biotype Dr. Daniele Cardaropoli Turin, Italy
Single recession coverage with coronally advanced flap in thick biotype
Dr. Daniele CardaropoliSingle recession coverage with coronally advanced flap in thick biotype Dr. Daniele Cardaropoli Turin, Italy
Cardaropoli case overview 1
Cardaropoli case overview 9
Cardaropoli case 1
1 - Before preparation of the flap the exposed root portion is cleaned with a scraper and is wiped with EDTA (or similar).
Cardaropoli case 2
2 - After measuring the dimension of the recession defect using a periodontal probe, the incisions for raising the flap are cut.
Cardaropoli case 3
3 - A split-full-split thickness flap is elevated and coronally mobilized.
Cardaropoli case 4
4 - The area of the papillae is de-epithelialized to allow anchorage of the flap coronal to the cemento-enamel junction.
Cardaropoli case 5
5 - Geistlich Mucograft® is applied dry to the defect and is fixed with 4 single sutures.
Cardaropoli case 6
6 - The coronally advanced flap is sutured over Geistlich Mucograft®.
Cardaropoli case 7
7 - Nice, uneventful healing 15 days post-operatively at suture removal.
Cardaropoli case 8
8 - Soft tissue situation immediately after suture removal.
Cardaropoli case 9
9 - Complete root coverage 7 months after surgery. Note the excellent color match.
Prof. Dr. Giovanni ZucchelliSingle recession coverage with coronally advanced flap in thin biotype Prof. Dr. Giovanni Zucchelli Bologna, Italy
Single recession coverage with coronally advanced flap in thin biotype
Prof. Dr. Giovanni ZucchelliSingle recession coverage with coronally advanced flap in thin biotype Prof. Dr. Giovanni Zucchelli Bologna, Italy
Zucchelli case overview 1
Zucchelli case overview 9
Zucchelli case 1
1 - Pre-operative lateral smile showing the recession defect of tooth 5.
Zucchelli case 2
2 - Pre-operative image of recession defect (tooth 5).
Zucchelli case 3
3 - After elevation of split-full-split flap the interdental papillae are de-epithelialized.
Zucchelli case 4
4 - Geistlich Mucograft® is placed over the root and sutured to the papillae.
Zucchelli case 5
5 - The flap is mobilized, coronally advanced and sutured completely covering the Geistlich Mucograft®.
Zucchelli case 6
6 - Healing of the surgical site 2 weeks after surgery.
Zucchelli case 7
7 - Surgical site 6 months after surgery.
Zucchelli case 8
8 - Outcome 1 year after treatment.
Zucchelli case 9
9 - Lateral smile 1 year after surgery showing the optimal esthetic outcome.
Multiple Tooth Recession Coverage
Dr. Daniel GoberGeistlich Mucograft® for the Treatment of Multiple Adjacent Recession Defects Dr. Daniel Gober Cedarhurst, NY, USA
Geistlich Mucograft® for the Treatment of Multiple Adjacent Recession Defects
Dr. Daniel GoberGeistlich Mucograft® for the Treatment of Multiple Adjacent Recession Defects Dr. Daniel Gober Cedarhurst, NY, USA
Dr. Daniel Gober case overview 1
Dr. Daniel Gober case overview 9
Dr. Daniel Gober case 1
1 - 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.
Dr. Daniel Gober case 2
2 - 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.
Dr. Daniel Gober case 3
3 - 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.
Dr. Daniel Gober case 4
4 - Side-view of the recession defects. It is clearly visible how deep the recession defects are.
Dr. Daniel Gober case 5
5 - 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.
Dr. Daniel Gober case 6
6 - 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.
Dr. Daniel Gober case 7
7 - Follow-up after 1 week: note that the flap margins appear stable. Erythema and edema evident with maturation of the tissue beginning.
Dr. Daniel Gober case 8
8 - 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.
Dr. Daniel Gober case 9
9 - Follow-up after 1 year: stability of the graft is evident, complete coverage and a healthy and maintainable gingival situation have been achieved.
Multiple recession coverage with flap without releasing incisions Dr. Christine Romagna Auxerre, France
Multiple recession coverage with flap without releasing incisions
Multiple recession coverage with flap without releasing incisions Dr. Christine Romagna Auxerre, France
Dr. Christine Romagna case overview 1
Dr. Christine Romagna case overview 9
Dr. Christine Romagna case 1
1 - Pre-operative picture of the area intended to treat. Note the thin biotype.
Dr. Christine Romagna case 2
2 - Initial situation showing Miller Class I defects on region 4 (3 mm) and 5 (2 mm).
Dr. Christine Romagna case 3
3 - A split-full-split thickness flap without releasing incisions is elevated.
Dr. Christine Romagna case 4
4 - The anatomical papillae are de epithelialized.
Dr. Christine Romagna case 5
5 - The collagen matrix Geistlich Mucograft® is placed under the flap.
Dr. Christine Romagna case 6
6 - Immediate post-operative situation after suturing of the flap covering Geistlich Mucograft® completely.
Dr. Christine Romagna case 7
7 - Follow-up picture 2 weeks after surgery.
Dr. Christine Romagna case 8
8 - Nice healing of the site 1.5 months post-operative.
Dr. Christine Romagna case 9
9 - Pleasant esthetic outcome 7 months after surgery.
Gain of Keratinized Tissue
Dr. Alan CharlesTreatment to Increase Keratinized Tissue with Geistlich Mucograft® Dr. Alan Charles Pasadena, CA, USA
Treatment to Increase Keratinized Tissue with Geistlich Mucograft®
Dr. Alan CharlesTreatment to Increase Keratinized Tissue with Geistlich Mucograft® Dr. Alan Charles Pasadena, CA, USA
Dr. Alan Charles case overview 1
Dr. Alan Charles case overview 2
Dr. Alan Charles case 1
1 - Pre-operative view. A small band of keratinized gingiva is present.
Dr. Alan Charles case 2
2 - The band of keratinized gingiva is split and a split-thickness flap is elevated exposing connective tissue and periosteum.
Dr. Alan Charles case 3
3 - Geistlich Mucograft® is sutured to the recipient bed and left exposed.
Dr. Alan Charles case 4
4 - Follow-up after 1 week: the area appears to granulate underneath the fibrin clot.
Dr. Alan Charles case 5
5 - Follow-up after 4 weeks: excellent wound healing.
Dr. Alan Charles case 6
6 - Follow-up situation after 2 months.
Dr. Alan Charles case 7
7 - Follow-up after 3 months.
Dr. Alan Charles case 8
8 - Follow-up after 6 months: Lugol’s iodine staining indicates delineating keratinized tissue.
Dr. Alan Charles case 9
9 - Follow-up after 6 months: mucogingival appearance with 4 mm of keratinized tissue.
PD Dr. Christian Schmitt, MScGain of Keratinized Tissue in Edentulous Patient Using Geistlich Mucograft® PD Dr. Christian Schmitt, MSc Munich, Germany
Gain of Keratinized Tissue in Edentulous Patient Using Geistlich Mucograft®
PD Dr. Christian Schmitt, MScGain of Keratinized Tissue in Edentulous Patient Using Geistlich Mucograft® PD Dr. Christian Schmitt, MSc Munich, Germany
PD Dr. Christian Schmitt, MSc case overview 1
PD Dr. Christian Schmitt, MSc case overview 9
PD Dr. Christian Schmitt, MSc case 1
1 - This case shows a shallow vestibule and almost no keratinized tissue on the lower crestal part. The horizontal incision has to be made within the keratinized tissue (see depicted line).
PD Dr. Christian Schmitt, MSc case 2
2 - Ensure the incision is within the keratinized tissue: an apically fixed split flap is used here. Remove the muscles, scar fibers and ligaments before application of Geistlich Mucograft®.
PD Dr. Christian Schmitt, MSc case 3
3 - Measure the defect carefully with a periodontal probe and cut Geistlich Mucograft® in a dry state. In the case of a large vestibuloplasty, several pieces of Geistlich Mucograft® can be sutured side by side.
PD Dr. Christian Schmitt, MSc case 4
4 - Geistlich Mucograft® is sutured directly onto the periosteum with 5.0 resorbable sutures and left exposed for open healing (healed by secondary intention).
PD Dr. Christian Schmitt, MSc case 5
5 - 10 days post-operative: favorable healing where granulation tissue and new soft tissues have formed.
PD Dr. Christian Schmitt, MSc case 6
6 - 1 month post-operative: excellent wound healing with complete integration and epithelialization of Geistlich Mucograft® as well as keratinization of the crestal aspect could be observed.
PD Dr. Christian Schmitt, MSc case 7
7 - 3 months post-operative: excellent esthetic outcome with full integration and epithelialization of Geistlich Mucograft® to the surrounding tissue and keratinization of the crestal aspect.
PD Dr. Christian Schmitt, MSc case 8
8 - 1 year post-operative: the formed keratinized tissue fulfills its functionality and shows an esthetically pleasing result matching the structure and color of the surrounding tissues. The mean width of the peri-implant keratinized mucosa was 4.0 mm, and a low shrinkage was assessed at 38%.
PD Dr. Christian Schmitt, MSc case 9
9 - 5 years post-operative: the mucogingival appearance remains stable. The resulting keratinized tissue fulfills its functionality and shows an esthetically pleasing result.
Soft Tissue Esthetics
Richard E. Bauer, III, DMD, MDRamal Bone Graft for Congenitally Missing Maxillary Lateral Incisor Richard E. Bauer, III, DMD, MD Pittsburgh, PA, USA
Ramal Bone Graft for Congenitally Missing Maxillary Lateral Incisor
Richard E. Bauer, III, DMD, MDRamal Bone Graft for Congenitally Missing Maxillary Lateral Incisor Richard E. Bauer, III, DMD, MD Pittsburgh, PA, USA
Richard E. Bauer, III, DMD, MD case overview 1
Richard E. Bauer, III, DMD, MD case overview 9
Richard E. Bauer, III, DMD, MD case 1
1 - A flap has been raised and reveals a significant facial and palatal defect at congenitally missing site #10.
Richard E. Bauer, III, DMD, MD case 2
2 - Harvested ramal graft. Slightly over-sized to allow for mitering and harvest of particulate autograft with a bone trap on the suction.
Richard E. Bauer, III, DMD, MD case 3
3 - Onlay graft now secured with two fixation screws (Stryker) with a lag screw technique. Geistlich Bio-Oss Collagen® has been placed on the palatal aspect of site #10.
Richard E. Bauer, III, DMD, MD case 4
4 - Combination of a fixated onlay graft with Geistlich Bio-Oss®/autograft particulate graft at the periphery and over the facial plate of the adjacent dentition.
Richard E. Bauer, III, DMD, MD case 5
5 - Geistlich Mucograft® matrix placed over facial augmentation of the adjacent dentition and ridge crest of the augmented site.
Richard E. Bauer, III, DMD, MD case 6
6 - Closure following ramal grafting and Geistlich Mucograft® matrix application.
Richard E. Bauer, III, DMD, MD case 7
7 - Implant placement with static guide and dental implant hand driver.
Richard E. Bauer, III, DMD, MD case 8
8 - Implant placement with slight subcrestal placement of the platform just prior to osteoplasty by the periodontist.
Extraction Socket Management
Peter Hunt, BDS, Msc, LDSRCS EngImmediate Mandibular Molar Transition Peter Hunt, BDS, Msc, LDSRCS Eng Philadelphia, PA, USA
Immediate Mandibular Molar Transition
Peter Hunt, BDS, Msc, LDSRCS EngImmediate Mandibular Molar Transition Peter Hunt, BDS, Msc, LDSRCS Eng Philadelphia, PA, USA
Peter Hunt, BDS, Msc, LDSRCS Eng case overview 1
Peter Hunt, BDS, Msc, LDSRCS Eng case overview 9
Peter Hunt, BDS, Msc, LDSRCS Eng case 1
1 - Initial Situation: a failing mandibular molar with a vertical sub-osseous fracture.
Peter Hunt, BDS, Msc, LDSRCS Eng case 2
2 - A pre-operative radiograph and CBCT showing the cross-section of the involved tooth.
Peter Hunt, BDS, Msc, LDSRCS Eng case 3
3 - 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.
Peter Hunt, BDS, Msc, LDSRCS Eng case 4
4 - A Camlog® 5.0 x 11 mm implant was placed with the platform set just down below the bone height of the socket walls.
Peter Hunt, BDS, Msc, LDSRCS Eng case 5
5 - 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.
Peter Hunt, BDS, Msc, LDSRCS Eng case 6
6 - Geistlich Mucograft® was adapted to the region then tucked down under the gingival margin.
Peter Hunt, BDS, Msc, LDSRCS Eng case 7
7 - 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.
Peter Hunt, BDS, Msc, LDSRCS Eng case 8
8 - 4 months later following Emergence Profile Development.
Peter Hunt, BDS, Msc, LDSRCS Eng case 9
9 - An occlusal view of the final onepiece, screw-retained zirconia crown restoration based on a Camlog® Titanium Base Abutment.
Dr. Ken AkimotoInsufficient Soft Tissue Thickness in a Single Tooth Gap in the Anterior Maxilla Dr. Ken Akimoto Issaquah, WA, USA
Insufficient Soft Tissue Thickness in a Single Tooth Gap in the Anterior Maxilla
Dr. Ken AkimotoInsufficient Soft Tissue Thickness in a Single Tooth Gap in the Anterior Maxilla Dr. Ken Akimoto Issaquah, WA, USA
Dr. Ken Akimoto case overview 1
Dr. Ken Akimoto case overview 9
Dr. Ken Akimoto case 1
1 - Pre-operative situation, tooth #7 with periapical infection and horizontal fracture.
Dr. Ken Akimoto case 1
2 - CT Scan showing tooth #7 with significant bone loss.
Dr. Ken Akimoto case 1
3 - Occlusal view of the clinical situation prior to extraction of tooth #7.
Dr. Ken Akimoto case 1
4 - Extraction socket with Geistlich Bio-Oss Collagen® in place.
Dr. Ken Akimoto case 1
5 - Geistlich Mucograft® Seal is placed over the extraction socket and secured with single interrupted sutures.
Dr. Ken Akimoto case 1
6 - 3 months post-operative: soft tissue healing at the time of implant placement.
Dr. Ken Akimoto case 1
7 - Buccal view showing excellent soft tissue healing and keratinized tissue.
Dr. Ken Akimoto case 1
8 - 5 months post-operative.
Dr. Ken Akimoto case 1
9 - 2 years post-operative: final restoration in place.
Dr. Ronald E. JungSocket seal of anterior alveole in late implant placement Dr. Ronald E. Jung Zurich, Switzerland
Socket seal of anterior alveole in late implant placement
Dr. Ronald E. JungSocket seal of anterior alveole in late implant placement Dr. Ronald E. Jung Zurich, Switzerland
Dr. Ronald E. Jung case overview 1
Dr. Ronald E. Jung case overview 9
Dr. Ronald E. Jung case 1
1 - Extraction of tooth 21 due to a trauma with concomitant external resorptions. Care was taken in preserving the alveolar bone.
Dr. Ronald E. Jung case 2
2 - Crestal view of the socket after tooth extraction. No flaps are raised around the affected area. A slight buccal bone defect was observed.
Dr. Ronald E. Jung case 3
3 - The socket is gently curetted for removal of granulation tissue. Subsequently, the wound margins were de-epithelialized with a diamond in a counter piece with water cooling.
Dr. Ronald E. Jung case 4
4 - Filling of the extraction socket with Geistlich Bio-Oss® Collagen to the level of the palatal bone.
Dr. Ronald E. Jung case 5
5 - After measuring the alveole, Geistlich Mucograft® is punched (8 mm diameter).
Dr. Ronald E. Jung case 6
6 - The Geistlich Mucograft® punch is placed on top of Geistlich Bio-Oss® Collagen to seal the filled alveole.
Dr. Ronald E. Jung case 7
7 - Suturing of the Geistlich Mucograft® with 6-0 single interrupted sutures.
Dr. Ronald E. Jung case 8
8 - Nice healing of the soft tissues 1 week after extraction.
Dr. Ronald E. Jung case 9
9 - Situation 7.5 months after extraction revealing nice soft tissue situation with a slight dip at the buccal aspect.
Immediate Implant Placement: Soft Tissue Thickening
Dr. Jeffrey GanelesSingle Stage Immediate Implant Placement and Soft Tissue Thickening Dr. Jeffrey Ganeles Ft. Lauderdale, FL, USA
Single Stage Immediate Implant Placement and Soft Tissue Thickening
Dr. Jeffrey GanelesSingle Stage Immediate Implant Placement and Soft Tissue Thickening Dr. Jeffrey Ganeles Ft. Lauderdale, FL, USA
Dr. Jeffrey Ganeles case overview 1
Dr. Jeffrey Ganeles case overview 9
Dr. Jeffrey Ganeles case 1
1 - Initial clinical situation, tooth #8 and #9 require extraction.
Dr. Jeffrey Ganeles case 2
2 - Clinical view post extraction of tooth #8 and #9.
Dr. Jeffrey Ganeles case 3
3 - Evaluation of the buccal soft tissue thickness.
Dr. Jeffrey Ganeles case 4
4 - Trimming of Geistlich Fibro-Gide® to fit in the gap between the buccal soft tissue and the buccal bone wall.
Dr. Jeffrey Ganeles case 5
5 - Geistlich Fibro-Gide® in place: an immediate volume increase of the buccal soft tissues are visible.
Dr. Jeffrey Ganeles case 6
6 - Mixing of autologous bone and Geistlich Bio-Oss® particles for placement in the gaps around the implants.
Dr. Jeffrey Ganeles case 7
7 - Immediate implant placement with the bone mixture applied was performed.
Dr. Jeffrey Ganeles case 8
8 - Provisional restoration at time of surgery (occlusal view).
Dr. Jeffrey Ganeles case 9
9 - Provisional restoration at time of surgery (frontal view).
Dr. Waldemar PolidoImmediate Implant Placement and Soft Tissue Thickening in a Split-Mouth Approach Dr. Waldemar Polido Indianapolis, IN, USA
Immediate Implant Placement and Soft Tissue Thickening in a Split-Mouth Approach
Dr. Waldemar PolidoImmediate Implant Placement and Soft Tissue Thickening in a Split-Mouth Approach Dr. Waldemar Polido Indianapolis, IN, USA
Dr. Waldemar Polido case overview 1
Dr. Waldemar Polido case overview 9
Dr. Waldemar Polido case 1
1 - 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®.
Dr. Waldemar Polido case 2
2 - Uncovering of site #10 shows a narrow ridge width and an insufficient amount of soft tissue thickness.
Dr. Waldemar Polido case 3
3 - Tooth #10 was extracted and immediately replaced by an implant.
Dr. Waldemar Polido case 4
4 - Fill the gap procedure with Geistlich Bio-Oss Collagen® to achieve contour augmentation and preserve horizontal ridge dimensions.
Dr. Waldemar Polido case 5
5 - Geistlich Fibro-Gide® was trimmed to half of the thickness to fit the defect and placed into sites #10, 11, 12 and 13.
Dr. Waldemar Polido case 6
6 - The entire site was closed tension-free to facilitate uneventful wound healing.
Dr. Waldemar Polido case 7
7 - The 3 month follow-up shows uneventful soft tissue healing and an increase of soft tissue thickness at the desired sites.
Dr. Waldemar Polido case 8
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)
Dr. Waldemar Polido case 9
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.
Dr. Hawra AlQallafImplant Placement & Simultaneous Soft Tissue Graft Using Geistlich Fibro-Gide® Dr. Hawra AlQallaf Indianapolis, INIndiana University School of Dentistry
Acknowledgments to Dr. Waldemar D. Polido
Implant Placement & Simultaneous Soft Tissue Graft Using Geistlich Fibro-Gide®
Dr. Hawra AlQallafImplant Placement & Simultaneous Soft Tissue Graft Using Geistlich Fibro-Gide® Dr. Hawra AlQallaf Indianapolis, INIndiana University School of Dentistry
Acknowledgments to Dr. Waldemar D. Polido
Dr. Hawra AlQallaf case overview 1
Dr. Hawra AlQallaf case overview 2
Dr. Hawra AlQallaf case 1
1 - Initial Clinical Situation, Occlusal/Buccal Shots of Missing teeth #12 and 13.
Dr. Hawra AlQallaf case 2
2 - Intra-Operative, Implant Placement of #12 and 13.
Dr. Hawra AlQallaf case 3
3 - Intra-Operative, Placement of Geistlich Fibro-Gide® in the Buccal Concavity of #12 and 13.
Dr. Hawra AlQallaf case 4
4 - Immediate Post-Operative Buccal Soft Tissue Thickness.
Dr. Hawra AlQallaf case 5
5 - Two Months Post-Operative Healing with Provisional Restorations.
After Implant Placement: Soft Tissue Thickening
Dr. Alan Fetner, DMDEsthetic Soft Tissue Augmentation of Two Implant Sites in the Same Patient Dr. Alan Fetner, DMD Jacksonville, FL, USA
Esthetic Soft Tissue Augmentation of Two Implant Sites in the Same Patient
Dr. Alan Fetner, DMDEsthetic Soft Tissue Augmentation of Two Implant Sites in the Same Patient Dr. Alan Fetner, DMD Jacksonville, FL, USA
Dr. Alan Fetner, DMD case overview 1
Dr. Alan Fetner, DMD case overview 9
Dr. Alan Fetner, DMD case 1
1 - Thin mucosal tissue over implant #7 creating an unesthetic appearance.
Dr. Alan Fetner, DMD case 2
2 - Occlusal view of #7 reveals buccal soft tissue defects.
Dr. Alan Fetner, DMD case 3
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.
Dr. Alan Fetner, DMD case 4
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.
Dr. Alan Fetner, DMD case 5
5 - Geistlich Fibro-Gide® is secured to the periosteum apically and the interproximal papillae with 5-0 chromic gut sutures.
Dr. Alan Fetner, DMD case 6
6 - Passive closure of the flap achieved with 6-0 vicryl sutures.
Dr. Alan Fetner, DMD case 7
7 - 1 week post-surgery reveals uneventful healing with maintenance of tissue volume.
Dr. Alan Fetner, DMD case 8
8 - Buccal view at 8 weeks reveals uneventful healing with maintenance of tissue volume.
Dr. Alan Fetner, DMD case 9
9 - Occlusal view at 8 weeks post-surgery.
Prof. Leonardo TrombelliThickening Soft Tissue When Uncovering an Implant in the Anterior Maxilla Prof. Leonardo Trombelli Ferrara, Italy
Thickening Soft Tissue When Uncovering an Implant in the Anterior Maxilla
Prof. Leonardo TrombelliThickening Soft Tissue When Uncovering an Implant in the Anterior Maxilla Prof. Leonardo Trombelli Ferrara, Italy
Prof. Leonardo Trombelli case overview 1
Prof. Leonardo Trombelli case overview 9
Prof. Leonardo Trombelli case 1
1 - Baseline buccal view: immediate implant placement was performed 3 months prior to replacing tooth #8.
Prof. Leonardo Trombelli case 2
2 - Baseline occlusal view: soft tissue deficiency on the buccal aspect.
Prof. Leonardo Trombelli case 3
3 - Placement of Geistlich Fibro-Gide® with minimal envelope flap and inserting a temporary crown.
Prof. Leonardo Trombelli case 4
4 - Stabilization of Geistlich Fibro-Gide® to the buccal mucosa using internal mattress sutures.
Prof. Leonardo Trombelli case 5
5 - 2 week follow-up at suture removal.
Prof. Leonardo Trombelli case 6
6 - 4 week post-surgery: uneventful wound healing and an increase in soft tissue volume.
Prof. Leonardo Trombelli case 7
7 - Occlusal view 11 months post-surgery: there is a clear substantial increase in the soft tissue thickness.
Prof. Leonardo Trombelli case 8
8 - Buccal view 11 months post-surgery: a substantial increase in soft tissue thickness is evident.
Prof. Leonardo Trombelli case 9
9 - Buccal view 2 years post-surgery.
Prof. Dr. Daniel ThomaInsufficient Soft Tissue Thickness in a Single Tooth Gap in the Anterior Maxilla Prof. Dr. Daniel Thoma Zurich, Switzerland
Insufficient Soft Tissue Thickness in a Single Tooth Gap in the Anterior Maxilla
Prof. Dr. Daniel ThomaInsufficient Soft Tissue Thickness in a Single Tooth Gap in the Anterior Maxilla Prof. Dr. Daniel Thoma Zurich, Switzerland
Prof. Dr. Daniel Thoma case overview 1
Prof. Dr. Daniel Thoma case overview 9
Prof. Dr. Daniel Thoma case 1
1 - Baseline frontal view: missing central incisor. Implant visible through mucosa due to thin biotype.
Prof. Dr. Daniel Thoma case 2
2 - Baseline occlusal view: soft tissue deficit in the buccal and occlusal area.
Prof. Dr. Daniel Thoma case 3
3 - Flap elevation on the buccal side using a full flap crestally and a split flap buccally.
Prof. Dr. Daniel Thoma case 4
4 - Adaption of Geistlich Fibro-Gide® to the defect size.
Prof. Dr. Daniel Thoma case 5
5 - Palatal island flap prepared to allow for tension-free wound closure. Geistlich Fibro-Gide® in situ, immobilized with a mattress suture.
Prof. Dr. Daniel Thoma case 6
6 - Tension-free wound closure using single interrupted sutures (Dafilon 5-0, Braun).
Prof. Dr. Daniel Thoma case 7
7 - Abutment connection.
Prof. Dr. Daniel Thoma case 8
8 - 6 months follow-up: final crown in place.
Prof. Dr. Daniel Thoma case 9
9 - 2.5 year follow-up shows stable soft tissue conditions.
Prof. Mariano SanzDr. Ignacio Sanz MartínInsufficient Soft Tissue Thickness Around Single Implant in the Posterior Maxilla Prof. Mariano Sanz and Dr. Ignacio Sanz Martín Madrid, Spain
Insufficient Soft Tissue Thickness Around Single Implant in the Posterior Maxilla
Prof. Mariano SanzDr. Ignacio Sanz MartínInsufficient Soft Tissue Thickness Around Single Implant in the Posterior Maxilla Prof. Mariano Sanz and Dr. Ignacio Sanz Martín Madrid, Spain
Sanz Martin case overview 1
Sanz Martin case overview 9
Sanz Martin case 1
1 - Baseline buccal view: soft tissue concavity at the dental implant site.
Sanz Martin case 2
2 - Baseline occlusal view: volume deficiency on the buccal aspect.
Sanz Martin case 3
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.
Sanz Martin case 4
4 - Position and fixation of Geistlich Fibro-Gide® to the buccal flap with horizontal mattress suture.
Sanz Martin case 5
5 - Primary closure obtained by horizontal mattress and single interrupted sutures.
Sanz Martin case 6
6 - 4 months follow-up: showing the healed soft tissue after augmentation surgery.
Sanz Martin case 7
7 - 4 months follow-up: provisional restoration. Notice volume recovery.
Sanz Martin case 8
8 - Occlusal view before final restoration.
Sanz Martin case 9
9 - 9 months follow-up: final restoration after soft tissue augmentation surgery.
Simultaneous Guided Bone Regeneration
Prof. Dr. Daniel ThomaRidge Preservation and Simultaneous Soft Tissue Augmentation in the Posterior Mandible Prof. Dr. Daniel Thoma Zurich, Switzerland
Ridge Preservation and Simultaneous Soft Tissue Augmentation in the Posterior Mandible
Prof. Dr. Daniel ThomaRidge Preservation and Simultaneous Soft Tissue Augmentation in the Posterior Mandible Prof. Dr. Daniel Thoma Zurich, Switzerland
Prof. Dr. Daniel Thoma case overview 1
Prof. Dr. Daniel Thoma case overview 9
Prof. Dr. Daniel Thoma case 1
1 - Baseline occlusal view: situation before removal of tooth #20.
Prof. Dr. Daniel Thoma case 2
2 - Tooth removal and extraction socket management with Gesitlich Bio-Oss® and Geistlich Bio-Gide®.
Prof. Dr. Daniel Thoma case 3
3 - Geistlich Fibro-Gide® was trimmed to the defect size, to augment the buccal and crestal soft tissue area of the ridge.
Prof. Dr. Daniel Thoma case 4
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.
Prof. Dr. Daniel Thoma case 5
5 - Immediate provisionalization of the implants.
Prof. Dr. Daniel Thoma case 6
6 - 3 weeks post-surgery: occlusal view of augmented area with created emergence profile.
Prof. Dr. Daniel Thoma case 7
7 - 3 weeks post-surgery: buccal view of augmented area with created emergence profile.
Prof. Dr. Daniel Thoma case 8
8 - Provisional reconstruction 6 weeks post-surgery.
Prof. Dr. Daniel Thoma case 9
9 - Final restoration 2.5 years post-surgery: soft tissue thickness remains stable over time.
Dr. Daniele CardaropoliInsufficient Soft Tissue Thickness in Extended Gap in the Posterior Mandible Dr. Daniele Cardaropoli Torino, Italy
Insufficient Soft Tissue Thickness in Extended Gap in the Posterior Mandible
Dr. Daniele CardaropoliInsufficient Soft Tissue Thickness in Extended Gap in the Posterior Mandible Dr. Daniele Cardaropoli Torino, Italy
Dr. Daniele Cardaropoli case overview 1
Dr. Daniele Cardaropoli case overview 9
Dr. Daniele Cardaropoli case 1
1 - Baseline before implant placement showing the soft tissue deficiency.
Dr. Daniele Cardaropoli case 2
2 - Implant surgery after implant placement showing the need for guided bone regeneration.
Dr. Daniele Cardaropoli case 3
3 - Guided bone regeneration with Geistlich Bio-Oss® and Geistlich Bio-Gide®.
Dr. Daniele Cardaropoli case 4
4 - Geistlich Fibro-Gide® was trimmed to the defect size and placed at full thickness (6 mm) on top of Geistlich Bio-Gide®.
Dr. Daniele Cardaropoli case 5
5 - Wound closure (PTFE 5/0 sutures) by combining horizontal mattress sutures and single sutures in a double layer.
Dr. Daniele Cardaropoli case 6
6 - 2 weeks follow-up post-surgery.
Dr. Daniele Cardaropoli case 7
7 - 3 months follow-up post-surgery.
Dr. Daniele Cardaropoli case 8
8 - Re-entry was performed 3 months post-surgery. Soft tissue emergence profile at the time of final ceramic-crown delivery 4 months after implant placement.
Dr. Daniele Cardaropoli case 9
9 - Clinical and radiographic situation 2 years after implant insertion.
PD Dr. med. Vivianne ChappuisGuided Bone Regeneration with Simultaneous Soft Tissue Augmentation in the Anterior Maxilla PD Dr. med. Vivianne Chappuis Bern, Switzerland
Guided Bone Regeneration with Simultaneous Soft Tissue Augmentation in the Anterior Maxilla
PD Dr. med. Vivianne ChappuisGuided Bone Regeneration with Simultaneous Soft Tissue Augmentation in the Anterior Maxilla PD Dr. med. Vivianne Chappuis Bern, Switzerland
PD Dr. med. Vivianne Chappuis case overview 1
PD Dr. med. Vivianne Chappuis case overview 9
PD Dr. med. Vivianne Chappuis case 1
1 - Baseline frontal view: missing central incisor.
PD Dr. med. Vivianne Chappuis case 2
2 - Baseline occlusal view: The facial contour is flattened by physiological dimensional ridge alterations post-extraction.
PD Dr. med. Vivianne Chappuis case 3
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®.
PD Dr. med. Vivianne Chappuis case 4
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.
PD Dr. med. Vivianne Chappuis case 5
5 - Suture removal 14 days post-surgery. Uneventful wound healing and an increase in soft tissue volume.
PD Dr. med. Vivianne Chappuis case 6
6 - Frontal view 4 weeks post-surgery.
PD Dr. med. Vivianne Chappuis case 7
7 - 2 months follow-up combined with abutment connection.
PD Dr. med. Vivianne Chappuis case 8
8 - Occlusal view of final restoration 2 years post-surgery.
PD Dr. med. Vivianne Chappuis case 9
9 - Final restoration 2 years post-surgery shows pleasing esthetics.
Single Tooth Recession Coverage
Prof. Giovanni ZucchelliTreatment of Single Gingival Recession with Coronally Advanced Flap Technique Prof. Giovanni Zucchelli Bologna, Italy
Treatment of Single Gingival Recession with Coronally Advanced Flap Technique
Prof. Giovanni ZucchelliTreatment of Single Gingival Recession with Coronally Advanced Flap Technique Prof. Giovanni Zucchelli Bologna, Italy
Prof. Giovanni Zucchelli case overview 1
Prof. Giovanni Zucchelli case overview 9
Prof. Giovanni Zucchelli case 1
1 - Baseline: recession defect Miller Class I on tooth #11.
Prof. Giovanni Zucchelli case 2
2 - Trapezoidal flap design: split-full-split flap elevation flap.
Prof. Giovanni Zucchelli case 3
3 - Positioning of Geistlich Fibro-Gide® and fixation with single sutures (PGA 7.0 Sutures) at the base of the de-epithelialized anatomic papillae and in the apical mesial and distal angles.
Prof. Giovanni Zucchelli case 4
4 - Tension-free wound closure with two sling sutures (PGA 6.0 Sutures).
Prof. Giovanni Zucchelli case 5
5 - Suture removal 14 days post-surgery.
Prof. Giovanni Zucchelli case 6
6 - Buccal view 3 months post-surgery.
Prof. Giovanni Zucchelli case 7
7 - Buccal view 6 months post-surgery.
Prof. Giovanni Zucchelli case 8
8 - Follow-up after 1 year: complete root coverage with Geistlich Fibro-Gide® is achieved.
Prof. Giovanni Zucchelli case 9
9 - 3 year post-surgery: stable results with Geistlich Fibro-Gide®.
Vanessa MarinhoGeistlich Fibro-Gide® for Gingival Recessions Vanessa Marinho Glendale, Arizona
Geistlich Fibro-Gide® for Gingival Recessions
Vanessa MarinhoGeistlich Fibro-Gide® for gingival recessions Vanessa Marinho Glendale, Arizona
Vanessa Marinho case overview 1
Vanessa Marinho case overview 3
Vanessa Marinho case 1
1 - Gingival recessions #23 and #22
Vanessa Marinho case 2
2 - Sites at the day of the procedure after sutures placed. Tunnel between #23,24 and partial thickness flap raised between #23,22.
Vanessa Marinho case 3
3 - 10 week post op healing. Root coverage achieved. Patient reports no problems and is pleased with the results. More follow ups to come.
Multiple Tooth Recession Coverage
Dr. Raffaele CavalcantiTreatment of Multiple Gingival Recession with Coronally Advanced Flap Technique Dr. Raffaele Cavalcanti Bari, Italy
Treatment of Multiple Gingival Recession with Coronally Advanced Flap Technique
Dr. Raffaele CavalcantiTreatment of Multiple Gingival Recession with Coronally Advanced Flap Technique Dr. Raffaele Cavalcanti Bari, Italy
Dr. Raffaele Cavalcanti case overview 1
Dr. Raffaele Cavalcanti case overview 9
Dr. Raffaele Cavalcanti case 1
1 - Baseline: multiple recession defect Miller Class I with keratinized tissue less than 3 mm on teeth #7 to #5.
Dr. Raffaele Cavalcanti case 2
2 - Coronally advanced flap preparation and elevation for sufficient release.
Dr. Raffaele Cavalcanti case 3
3 - Geistlich Fibro-Gide® is cut in half to 3 mm thickness.
Dr. Raffaele Cavalcanti case 4
4 - 3 mm Geistlich Fibro-Gide® is placed in the defect and absorbs blood immediately.
Dr. Raffaele Cavalcanti case 5
5 - Positioning of Geistlich Fibro-Gide® and fixation with single sutures (7-0 PGA sutures).
Dr. Raffaele Cavalcanti case 6
6 - Tension-free wound closure with sling sutures (6-0 PGA sutures).
Dr. Raffaele Cavalcanti case 7
7 - Suture removal 14 days post-surgery.
Dr. Raffaele Cavalcanti case 8
8 - Follow-up after 12 months: complete root coverage with Geistlich Fibro-Gide® is achieved.
Dr. Raffaele Cavalcanti case 9
9 - 2 year follow-up: complete root coverage with Geistlich Fibro-Gide®.
Dr. Ulrike Schulze-SpäteVestibular Incision Subperiostal Tunnel Access (Modified VISTA Technique) Dr. Ulrike Schulze-Späte Jena, Germany
Vestibular Incision Subperiostal Tunnel Access (Modified VISTA Technique)
Dr. Ulrike Schulze-SpäteVestibular Incision Subperiostal Tunnel Access (Modified VISTA Technique) Dr. Ulrike Schulze-Späte Jena, Germany
Dr. Ulrike Schulze-Späte case overview 1
Dr. Ulrike Schulze-Späte case overview 9
Dr. Ulrike Schulze-Späte case 1
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.
Dr. Ulrike Schulze-Späte case 2
2 - A full thickness muco-gingival tunnel was prepared through a minimally-invasive vestibular access incision apical to the teeth with gingival recessions.
Dr. Ulrike Schulze-Späte case 3
3 - Geistlich Fibro-Gide® was cut into small pieces in a dry state using a scalpel.
Dr. Ulrike Schulze-Späte case 4
4 - Insertion of Geistlich Fibro-Gide® into the subperiosteal tunnel.
Dr. Ulrike Schulze-Späte case 5
5 - Geistlich Fibro-Gide® in situ: the gingival margin had been coronally advanced and stabilized after pieces of Geistlich Fibro-Gide® were placed.
Dr. Ulrike Schulze-Späte case 6
6 - 1 week post-surgery: anchoring sutures were left in place for 1-2 weeks.
Dr. Ulrike Schulze-Späte case 7
7 - 2 weeks post-surgery: anchoring sutures in place.
Dr. Ulrike Schulze-Späte case 8
8 - 2 weeks post-surgery: removal of anchoring sutures.
Dr. Ulrike Schulze-Späte case 9
9 - 7 months post-surgery: complete recession coverage.
Vinay Bhide, DDS, MSc, FRCD(C).Root Coverage for Multiple Adjacent Teeth in the Maxilla with Geistlich Fibro-Gide® Vinay Bhide, DDS, MSc, FRCD(C). Aurora, Ontario
Root Coverage for Multiple Adjacent Teeth in the Maxilla with Geistlich Fibro-Gide
Vinay Bhide, DDS, MSc, FRCD(C).Root Coverage for Multiple Adjacent Teeth in the Maxilla with Geistlich Fibro-Gide® Vinay Bhide, DDS, MSc, FRCD(C). Aurora, Ontario
Vinay Bhide, DDS, MSc, FRCD(C). case overview 1
Vinay Bhide, DDS, MSc, FRCD(C). case overview 8
Vinay Bhide, DDS, MSc, FRCD(C). case 1
1 - 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.
Vinay Bhide, DDS, MSc, FRCD(C). case 2
2 - 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.
Vinay Bhide, DDS, MSc, FRCD(C). case 3
3 - 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.
Vinay Bhide, DDS, MSc, FRCD(C). case 4
4 - 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.
Vinay Bhide, DDS, MSc, FRCD(C). case 5
5 - 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.
Vinay Bhide, DDS, MSc, FRCD(C). case 6
6 - 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.
Vinay Bhide, DDS, MSc, FRCD(C). case 7
7 - 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.
Vinay Bhide, DDS, MSc, FRCD(C). case 8
8 - 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.
Peri-Implantitis
Hector L. Sarmiento, D.M.D., MS c.A Regenerative Approach to Peri-implantitis Hector L. Sarmiento, D.M.D., MS c. New York, New York
A Regenerative Approach to Peri-implantitis
Hector L. Sarmiento, D.M.D., MS c.A Regenerative Approach to Peri-implantitis Hector L. Sarmiento, D.M.D., MS c. New York, New York
Hector L. Sarmiento, D.M.D., MS c. case overview 1
Hector L. Sarmiento, D.M.D., MS c. case overview 8
Hector L. Sarmiento, D.M.D., MS c. case 1
1 - 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.
Hector L. Sarmiento, D.M.D., MS c. case 2
2 - 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.
Hector L. Sarmiento, D.M.D., MS c. case 3
3 - 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.
Hector L. Sarmiento, D.M.D., MS c. case 4
4 - A protective Geistlich Bio-Gide® membrane was placed over Geistlich Bio-Oss®.
Hector L. Sarmiento, D.M.D., MS c. case 5
5 - 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.
Hector L. Sarmiento, D.M.D., MS c. case 6
6 - 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.
Hector L. Sarmiento, D.M.D., MS c. case 7
7 - Closure with a tension-free flap was achieved by releasing incisions and secured using 4-0 chromic gut sutures.
Hector L. Sarmiento, D.M.D., MS c. case 8
8 - 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.

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