Video: Exposed Tooth Roots – Now What?
Video: Root Coverage of a Single Recession Defect
Video: Using a Strip Gingival Autograft and Geistlich Mucograft®
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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:

Take a Closer Look

Palate Free Regeneration

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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

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

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 Fibro-Gide® for Volume Stability

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
Recession Coverage Treatment with Geistlich Mucograft® Dr. Michael K. McGuire Houston, TX, USA
Recession Coverage Treatment with Geistlich Mucograft®
Recession Coverage Treatment with Geistlich Mucograft® Dr. Michael K. McGuire Houston, TX, USA
1 - Pre-operative image showing the recession defect on tooth #6.
2 - After elevation of a partial thickness flap, the interdental papillae are de-epithelialized.
3 - Geistlich Mucograft® is placed over the defect and sutured to the papillae.
4 - The flap is coronally advanced and sutured completely covering the matrix.
5 - Follow-up after 1 week: healing of the surgical site.
6 - Follow-up situation after 4 weeks.
7 - Follow-up after 3 months.
8 - Follow-up after 6 months: note the natural appearance of the soft tissue achieved with Geistlich Mucograft®.
9 - Follow-up after 1 year.
Single recession coverage with coronally advanced flap in thick biotype Dr. Daniele Cardaropoli Turin, Italy
Single recession coverage with coronally advanced flap in thick biotype
Single recession coverage with coronally advanced flap in thick biotype Dr. Daniele Cardaropoli Turin, Italy
1 - Before preparation of the flap the exposed root portion is cleaned with a scraper and is wiped with EDTA (or similar).
2 - After measuring the dimension of the recession defect using a periodontal probe, the incisions for raising the flap are cut.
3 - A split-full-split thickness flap is elevated and coronally mobilized.
4 - The area of the papillae is de-epithelialized to allow anchorage of the flap coronal to the cemento-enamel junction.
5 - Geistlich Mucograft® is applied dry to the defect and is fixed with 4 single sutures.
6 - The coronally advanced flap is sutured over Geistlich Mucograft®.
7 - Nice, uneventful healing 15 days post-operatively at suture removal.
8 - Soft tissue situation immediately after suture removal.
9 - Complete root coverage 7 months after surgery. Note the excellent color match.
Single 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
Single recession coverage with coronally advanced flap in thin biotype Prof. Dr. Giovanni Zucchelli Bologna, Italy
1 - Pre-operative lateral smile showing the recession defect of tooth 5.
2 - Pre-operative image of recession defect (tooth 5).
3 - After elevation of split-full-split flap the interdental papillae are de-epithelialized.
4 - Geistlich Mucograft® is placed over the root and sutured to the papillae.
5 - The flap is mobilized, coronally advanced and sutured completely covering the Geistlich Mucograft®.
6 - Healing of the surgical site 2 weeks after surgery.
7 - Surgical site 6 months after surgery.
8 - Outcome 1 year after treatment.
9 - Lateral smile 1 year after surgery showing the optimal esthetic outcome.
Multiple Tooth Recession Coverage
Geistlich 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
Geistlich Mucograft® for the Treatment of Multiple Adjacent Recession Defects Dr. Daniel Gober Cedarhurst, NY, USA
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.
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.
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.
4 - Side-view of the recession defects. It is clearly visible how deep the recession defects are.
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.
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.
7 - Follow-up after 1 week: note that the flap margins appear stable. Erythema and edema evident with maturation of the tissue beginning.
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.
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
1 - Pre-operative picture of the area intended to treat. Note the thin biotype.
2 - Initial situation showing Miller Class I defects on region 4 (3 mm) and 5 (2 mm).
3 - A split-full-split thickness flap without releasing incisions is elevated.
4 - The anatomical papillae are de epithelialized.
5 - The collagen matrix Geistlich Mucograft® is placed under the flap.
6 - Immediate post-operative situation after suturing of the flap covering Geistlich Mucograft® completely.
7 - Follow-up picture 2 weeks after surgery.
8 - Nice healing of the site 1.5 months post-operative.
9 - Pleasant esthetic outcome 7 months after surgery.
Gain of Keratinized Tissue
Treatment to Increase Keratinized Tissue with Geistlich Mucograft® Dr. Alan Charles Pasadena, CA, USA
Treatment to Increase Keratinized Tissue with Geistlich Mucograft®
Treatment to Increase Keratinized Tissue with Geistlich Mucograft® Dr. Alan Charles Pasadena, CA, USA
1 - Pre-operative view. A small band of keratinized gingiva is present.
2 - The band of keratinized gingiva is split and a split-thickness flap is elevated exposing connective tissue and periosteum.
3 - Geistlich Mucograft® is sutured to the recipient bed and left exposed.
4 - Follow-up after 1 week: the area appears to granulate underneath the fibrin clot.
5 - Follow-up after 4 weeks: excellent wound healing.
6 - Follow-up situation after 2 months.
7 - Follow-up after 3 months.
8 - Follow-up after 6 months: Lugol’s iodine staining indicates delineating keratinized tissue.
9 - Follow-up after 6 months: mucogingival appearance with 4 mm of keratinized tissue.
Gain 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®
Gain of Keratinized Tissue in Edentulous Patient Using Geistlich Mucograft® PD Dr. Christian Schmitt, MSc Munich, Germany
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).
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®.
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.
4 - Geistlich Mucograft® is sutured directly onto the periosteum with 5.0 resorbable sutures and left exposed for open healing (healed by secondary intention).
5 - 10 days post-operative: favorable healing where granulation tissue and new soft tissues have formed.
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.
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.
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%.
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
Ramal 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
Ramal Bone Graft for Congenitally Missing Maxillary Lateral Incisor Richard E. Bauer, III, DMD, MD Pittsburgh, PA, USA
1 - A flap has been raised and reveals a significant facial and palatal defect at congenitally missing site #10.
2 - Harvested ramal graft. Slightly over-sized to allow for mitering and harvest of particulate autograft with a bone trap on the suction.
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.
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.
5 - Geistlich Mucograft® matrix placed over facial augmentation of the adjacent dentition and ridge crest of the augmented site.
6 - Closure following ramal grafting and Geistlich Mucograft® matrix application.
7 - Implant placement with static guide and dental implant hand driver.
8 - Implant placement with slight subcrestal placement of the platform just prior to osteoplasty by the periodontist.
Extraction Socket Management
Immediate Mandibular Molar Transition Peter Hunt, BDS, Msc, LDSRCS Eng Philadelphia, PA, USA
Immediate Mandibular Molar Transition
Immediate Mandibular Molar Transition Peter Hunt, BDS, Msc, LDSRCS Eng Philadelphia, PA, USA
1 - Initial Situation: a failing mandibular molar with a vertical sub-osseous fracture.
2 - A pre-operative radiograph and CBCT showing the cross-section of the involved tooth.
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.
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.
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.
6 - Geistlich Mucograft® was adapted to the region then tucked down under the gingival margin.
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.
8 - 4 months later following Emergence Profile Development.
9 - An occlusal view of the final onepiece, screw-retained zirconia crown restoration based on a Camlog® Titanium Base Abutment.
Insufficient 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
Insufficient Soft Tissue Thickness in a Single Tooth Gap in the Anterior Maxilla Dr. Ken Akimoto Issaquah, WA, USA
1 - Pre-operative situation, tooth #7 with periapical infection and horizontal fracture.
2 - CT Scan showing tooth #7 with significant bone loss.
3 - Occlusal view of the clinical situation prior to extraction of tooth #7.
4 - Extraction socket with Geistlich Bio-Oss Collagen® in place.
5 - Geistlich Mucograft® Seal is placed over the extraction socket and secured with single interrupted sutures.
6 - 3 months post-operative: soft tissue healing at the time of implant placement.
7 - Buccal view showing excellent soft tissue healing and keratinized tissue.
8 - 5 months post-operative.
9 - 2 years post-operative: final restoration in place.
Socket seal of anterior alveole in late implant placement Dr. Ronald E. Jung Zurich, Switzerland
Socket seal of anterior alveole in late implant placement
Socket seal of anterior alveole in late implant placement Dr. Ronald E. Jung Zurich, Switzerland
1 - Extraction of tooth 21 due to a trauma with concomitant external resorptions. Care was taken in preserving the alveolar bone.
2 - Crestal view of the socket after tooth extraction. No flaps are raised around the affected area. A slight buccal bone defect was observed.
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.
4 - Filling of the extraction socket with Geistlich Bio-Oss® Collagen to the level of the palatal bone.
5 - After measuring the alveole, Geistlich Mucograft® is punched (8 mm diameter).
6 - The Geistlich Mucograft® punch is placed on top of Geistlich Bio-Oss® Collagen to seal the filled alveole.
7 - Suturing of the Geistlich Mucograft® with 6-0 single interrupted sutures.
8 - Nice healing of the soft tissues 1 week after extraction.
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
Single Stage Immediate Implant Placement and Soft Tissue Thickening Dr. Jeffrey Ganeles Ft. Lauderdale, FL, USA
Single Stage Immediate Implant Placement and Soft Tissue Thickening
Single Stage Immediate Implant Placement and Soft Tissue Thickening Dr. Jeffrey Ganeles Ft. Lauderdale, FL, USA
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).
Immediate 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
Immediate Implant Placement and Soft Tissue Thickening in a Split-Mouth Approach Dr. Waldemar Polido Indianapolis, IN, USA
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®.
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.
Implant 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®
Implant Placement & Simultaneous Soft Tissue Graft Using Geistlich Fibro-Gide® Dr. Hawra AlQallaf Indianapolis, INIndiana University School of Dentistry
Acknowledgments to Dr. Waldemar D. Polido
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.
After Implant Placement: Soft Tissue Thickening
Esthetic 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
Esthetic Soft Tissue Augmentation of Two Implant Sites in the Same Patient Dr. Alan Fetner, DMD Jacksonville, FL, USA
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.
Thickening 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
Thickening Soft Tissue When Uncovering an Implant in the Anterior Maxilla Prof. Leonardo Trombelli Ferrara, Italy
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 week 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.
Insufficient 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
Insufficient Soft Tissue Thickness in a Single Tooth Gap in the Anterior Maxilla Prof. Dr. Daniel Thoma Zurich, Switzerland
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.
Insufficient 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
Insufficient Soft Tissue Thickness Around Single Implant in the Posterior Maxilla Prof. Mariano Sanz and Dr. Ignacio Sanz Martín Madrid, Spain
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.
Simultaneous Guided Bone Regeneration
Ridge 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
Ridge Preservation and Simultaneous Soft Tissue Augmentation in the Posterior Mandible Prof. Dr. Daniel Thoma Zurich, Switzerland
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.
Insufficient 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
Insufficient Soft Tissue Thickness in Extended Gap in the Posterior Mandible Dr. Daniele Cardaropoli Torino, Italy
1 - Baseline before implant placement showing the soft tissue deficiency.
2 - Implant surgery after implant placement showing the need for guided bone regeneration.
3 - Guided bone regeneration with Geistlich Bio-Oss® and Geistlich Bio-Gide®.
4 - Geistlich Fibro-Gide® was trimmed to the defect size and placed at full thickness (6 mm) on top of Geistlich Bio-Gide®.
5 - Wound closure (PTFE 5/0 sutures) by combining horizontal mattress sutures and single sutures in a double layer.
6 - 2 weeks follow-up post-surgery.
7 - 3 months follow-up post-surgery.
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.
9 - Clinical and radiographic situation 2 years after implant insertion.
Guided 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
Guided Bone Regeneration with Simultaneous Soft Tissue Augmentation in the Anterior Maxilla PD Dr. med. Vivianne Chappuis Bern, Switzerland
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.
Single Tooth Recession Coverage
Treatment of Single Gingival Recession with Coronally Advanced Flap Technique Prof. Giovanni Zucchelli Bologna, Italy
Treatment of Single Gingival Recession with Coronally Advanced Flap Technique
Treatment of Single Gingival Recession with Coronally Advanced Flap Technique Prof. Giovanni Zucchelli Bologna, Italy
1 - Baseline: recession defect Miller Class I on tooth #11.
2 - Trapezoidal flap design: split-full-split flap elevation flap.
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.
4 - Tension-free wound closure with two sling sutures (PGA 6.0 Sutures).
5 - Suture removal 14 days post-surgery.
6 - Buccal view 3 months post-surgery.
7 - Buccal view 6 months post-surgery.
8 - Follow-up after 1 year: complete root coverage with Geistlich Fibro-Gide® is achieved.
9 - 3 year post-surgery: stable results with Geistlich Fibro-Gide®.
Geistlich Fibro-Gide® for Gingival Recessions Vanessa Marinho Glendale, Arizona
Geistlich Fibro-Gide® for Gingival Recessions
Geistlich Fibro-Gide® for gingival recessions Vanessa Marinho Glendale, Arizona
1 - Gingival recessions #23 and #22
2 - Sites at the day of the procedure after sutures placed. Tunnel between #23,24 and partial thickness flap raised between #23,22.
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
Treatment of Multiple Gingival Recession with Coronally Advanced Flap Technique Dr. Raffaele Cavalcanti Bari, Italy
Treatment of Multiple Gingival Recession with Coronally Advanced Flap Technique
Treatment of Multiple Gingival Recession with Coronally Advanced Flap Technique Dr. Raffaele Cavalcanti Bari, Italy
1 - Baseline: multiple recession defect Miller Class I with keratinized tissue less than 3 mm on teeth #7 to #5.
2 - Coronally advanced flap preparation and elevation for sufficient release.
3 - Geistlich Fibro-Gide® is cut in half to 3 mm thickness.
4 - 3 mm Geistlich Fibro-Gide® is placed in the defect and absorbs blood immediately.
5 - Positioning of Geistlich Fibro-Gide® and fixation with single sutures (7-0 PGA sutures).
6 - Tension-free wound closure with sling sutures (6-0 PGA sutures).
7 - Suture removal 14 days post-surgery.
8 - Follow-up after 12 months: complete root coverage with Geistlich Fibro-Gide® is achieved.
9 - 2 year follow-up: complete root coverage with Geistlich Fibro-Gide®.
Vestibular Incision Subperiostal Tunnel Access (Modified VISTA Technique) Dr. Ulrike Schulze-Späte Jena, Germany
Vestibular Incision Subperiostal Tunnel Access (Modified VISTA Technique)
Vestibular Incision Subperiostal Tunnel Access (Modified VISTA Technique) Dr. Ulrike Schulze-Späte Jena, Germany
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.
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
Root Coverage for Multiple Adjacent Teeth in the Maxilla with Geistlich Fibro-Gide® Vinay Bhide, DDS, MSc, FRCD(C). Aurora, Ontario
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.
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.
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.
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.
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.
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.
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.
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
A Regenerative Approach to Peri-implantitis Hector L. Sarmiento, D.M.D., MS c. New York, New York
A Regenerative Approach to Peri-implantitis
A Regenerative Approach to Peri-implantitis Hector L. Sarmiento, D.M.D., MS c. New York, New York
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.
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.
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.
4 - A protective Geistlich Bio-Gide® membrane was placed over Geistlich Bio-Oss®.
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.
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.
7 - Closure with a tension-free flap was achieved by releasing incisions and secured using 4-0 chromic gut sutures.
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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