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Catalogue eng Tecnoss Osteobiol 2012 - partea I

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  • 1. OsteoBiol ®2012
  • 2. SEM image of an OsteoBiol® Gen-Os granule,highlighting the porosity of the material.Magnification x30000Source: Courtesy of Dr Ulf Nannmark,University of Göteborg, Sweden
  • 3. Welcome to the OsteoBiol® world 2012 INTRODUCTIONTissue regeneration technology: a difference that Focus on research and education: an evidence based Over recent years clinical research efforts have beenmatters. approach to biomaterials marketing. focussed on a better understanding of the precise Used in more than 200 000You may not immediately notice the xenogenic origin Our mission is simple and ambitious at the same indications for various bone augmentation surgeriesof the OsteoBiol® biomaterials, and the collagen time: acquire a leading position in every major procedures and materials. Autogenous bone iscontent preserved in each granule by the Tecnoss® market, corresponding to the outstanding quality of generally considered the gold standard however it has to be harvested and patients may not always be Distributed in over 40 countriesinnovative biotechnology. OsteoBiol® biomaterials. happy to donate their own bone since there is aYou may also not be aware of the excellent Since our start-up in 2004 already 33 scientific biological price to pay – postoperative morbidity atbiocompatibility and total safety guaranteed by the papers regarding OsteoBiol® grafting materials have Strong scientific background the donor site. The scientific literature tends to grosslyTecnoss® certified manufacturing process. been published on international peer reviewed underestimate the incidence of complications atNot until the very moment in which you will use an journals, and several new studies are on-going and donor sites simply because complications are Extraordinary clinical resultsOsteoBiol® grafting material in your first surgery: a will be published in the near future. underreported. Therefore, we do have a problem andunique handling sensation and clinical response from Each research has required a great deal of effort and we do need a solution. The solution is theoreticallyyour patient. patience, and we desire to thank all authors for their quite simple, to take bone from somewhere else.OsteoBiol® is a complete and innovative biomaterial fantastic and passionate work. Bone could be taken from other humans, fromline: a family of products designed for each specific Each research has also contributed to understand the various mammals or it could be artificially produced.clinical indication. responses of cells in hard and soft tissues to the Each alternative has potential advantages and various OsteoBiol® materials in each clinical disadvantages and personal beliefs and moralInnovation has always required to find the limits of indication. aspects play important roles in the decision making. (1) ESPOSITO M, GRUSOVIN MG, FELICE P KARATZOPOULOS G, ,existing solutions, and to explore new ways to break If we are objective and examine the scientific WORTHINGTON HV, COULTHARD Psuch limits defining new quality standards. Perfect biocompatibility, abundant new bone INTERVENTIONS FOR REPLACING MISSING TEETH: evidence we can conclude that evidence isThis requires unconventional mentality and free formation, progressive resorption and graft volume HORIZONTAL AND VERTICAL BONE AUGMENTATION accumulating that various animal derived bone grafts TECHNIQUES FOR DENTAL IMPLANT TREATMENTthinking: the essential attitudes of researchers. preservation are to be found in every OsteoBiol® may be as good if not better than autogenous bone COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2009: product. CHICHESTER, UK: JOHN WILEY & SONSWhen Dr Giuseppe Oliva founded Tecnoss®, he had (1,2) . More evidence is still needed but there areonly one goal: develop and manufacture the best We offer a variety of solutions, designed for the numerous ongoing trials which will providebiomaterials line for bone augmentation in dentistry. different clinical indications: each product has additional information in the near future. So we can (2) ESPOSITO M, GRUSOVIN MG, REES J, KARASOULOS D, specific advantages and handling properties to make FELICE P ALISSA R, ET AL , hazard to say that after the revolution ofHis philosophy has always been to achieve tissue your augmentation surgery easier and safer in the INTERVENTIONS FOR REPLACING MISSING TEETH: osseointegrated implants in the seventies and eighties AUGMENTATION PROCEDURES OF THE MAXILLARY SINUSregeneration respecting biological principles and laws. recommended indication. we are now very much part of the bone substitute COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010:These concepts, together with accurate design, pioneer CHICHESTER, UK: JOHN WILEY & SONS We also want to share this knowledge with you: this is revolution.technologies and meticulous quality control, have why we believe and invest in professional education So what is the situation today? That xenografts offer abeen and will be the driving force of our company. and communication. reliable if not better alternative to autogenous bone inAt Tecnoss we dedicate all our energy and resources ® Participating to one of the Symposiums or Live practically all indications when used in conjunctionto improve hard and soft tissue regeneration: this is Surgery courses organized by our company, or simply with dental implants or in periodontal therapy. Thatour only activity and focus. browsing through our catalog or website will there is more evidence supporting the use ofOur unconditional passion for biomaterials reflects in introduce you to the best approach in regeneration: xenografts than other types of bone substitutes. Thatevery single product we manufacture. the respect of biological principles and laws. the ideal bone substitute should be easy to handle and should not be resorbed too fast via anAnd every OsteoBiol® product contains a biological This is our marketing: evidence based scientific data inflammatory process or induce adverse reactions.added value that will create confidence in your enriched by the operatory experience of outstanding We now need to understand and identify the bestregenerative surgery and clinical success with your surgeons, ready to share it with you in a wide variety materials and techniques to reconstruct bone in thepatients. of educational programmes. most challenging situations such as the heavilyTecnoss biomaterials are different, a difference that Welcome to our “regeneration network”! resorbed maxilla.matters!Davide Oliva MD Marco Boarolo BEc Marco Esposito DDS, PhDManaging Director Managing Director Director Postgraduate Dental SpecialtiesTecnoss s.r.l. Tecnoss Dental s.r.l. Manchester Academic Health Science CentreBiomaterials Engineering International Sales & Marketing The University of Manchester, UK
  • 4. The most complete range of bone grafting materials 2012 INDEXINTRODUCTION PRODUCTS 57A significant step ahead 7 BONE SUBSTITUTES 58Why xenografts? 8 Gen-Os 60Collagen: a key factor for clinical success 9 mp3 64Collagen and bone regeneration 10 Putty 68From heterologous bone to biomaterial 12 Gel 40 72Characteristics of Tecnoss® process 13 MEMBRANES AND BONE BARRIERS 76 Evolution 78 Lamina 82CLINICAL INDICATIONS 15 SPECIFIC PRODUCTS 86ALVEOLAR REGENERATION 18 Sp-Block 87 Characteristics Dual-Block 88 OsteoBiol® products Apatos 89 Case reports Tablet 90DEHISCENCES AND FENESTRATIONS 24 Duo-Teck 91 Characteristics Special 92 OsteoBiol® products Derma 93 Case reports LIVE SURGERY COURSES 94CRESTAL ACCESS SINUS LIFT 30 Brånemark Osseointegration Center 95 Characteristics Marseille, France OsteoBiol® products Lake Como Institute 96 Case reports Como, ItalyLATERAL ACCESS SINUS LIFT 36 Venice Dental Center 97 Characteristics Venice, Italy OsteoBiol® products Case reports CERTIFICATIONS AND LITERATURE 99HORIZONTAL AND VERTICAL AUGMENTATION 42 From nature to man 100 Characteristics CE certificates 101 OsteoBiol® products Case reports Biocompatibility tests Gen-Os 102PERIODONTAL REGENERATION 50 Evolution 103 Characteristics mp3 104 OsteoBiol® products Case reports ISO 13485 105 Literature review 106 Scientific literature 108 5
  • 5. SEM image of an OsteoBiol® Gen-Os granule: osteoblasticcolonisation. Magnification x3000Source: Courtesy of Dr Ulf Nannmark, University of Göteborg, Sweden 4
  • 6. A significant step ahead INTRODUCTION INNOVATIONSEM images of an OsteoBiol® Gen-Os granule colonised by osteoblasts from a cell-line (MG63)Source: Courtesy of Dr Ulf Nannmark, Göteborg University, SwedenResearch and development of biomaterials The first products developed through thesehave gone through many stages, but technologies have shown encouragingalways toward one goal: to heal bone clinical results, even if made of bonedeficit with newly-formed quality tissue in mineral matrix only.order to achieve functional recovery. The OsteoBiol® new generation ofAll of this in the least time possible. biomaterials, thanks to a revolutionary technology, goes beyond the simple role ofThe examination of clinical results and the aiding natural bone regrowth bycommercial diffusion of various kinds of stimulating and accelerating contactproducts developed by the biomedical osteogenesis.industry show a clear superiority ofproducts of natural origin over those ofsynthetic derivation.The structure of animal bone ismorphologically more similar to humanbone than any synthesized product.Over the last twenty years severalprocesses have been developed to allowthe grafting of heterologous originproducts in the human body withoutadverse reaction.
  • 7. Why xenografts?“Xenografts offer a reliable Xenografts are the most used biomaterials worldwide SEM image of OsteoBiol® granulesif not better alternative to Source: Courtesy of Dr Ulf Nannmark, Göteborg University, Sweden This is because:autogenous bone inpractically all indications >> tissues of origin are extremely safe and available in unlimited quantitieswhen used in conjunction >> xenogenic bone surface and porosity are extremely similar to autogenous bonewith dental implants or inperiodontal therapy. There >> there is no need to harvest autogenous bone in extraoral sites, with the relatedis more evidence >> risk of morbidity and post-operatory complicationssupporting the use of >> sterile xenografts are completely biocompatible and safexenografts than other typesof bone substitutes” >> no adverse reactions after grafting deriving from biomaterial degradation >> easy to handle, quick learning curveMarco Esposito DDS, PhDDirector Postgraduate Dental >> collagenated xenografts enhance osteoblasts and osteoclasts activitySpecialtiesManchester Academic Health >> wide scientific documentationScience Centre, The University ofManchester, UK >> excellent clinical performance >> storage can be done at room temperature >> long shelf life (5 years from production date) >> excellent price/quality ratio 8
  • 8. Collagen: a key factor for clinical success INTRODUCTION THE COLLAGEN FACTOR Tecnoss® exclusive manufacturing process >> it stimulates the activation of the is able to neutralize the antigenic platelets, osteoblasts and osteoclasts in the components present in heterologous bone tissue healing process (achievement of biocompatibility) and to The presence of collagen inside each preserve the collagen matrix inside the granule makes OsteoBiol® Gen-Os granules of biomaterial. hydrophilic and facilitates further mixing Moreover, the molecular structure of with collagen gel (OsteoBiol® Gel 0). natural hydroxyapatite is not significantly This technology has permitted the altered thanks to the limited maximum development of three new versatile and process temperature(1). innovative products: OsteoBiol® mp3, These characteristics of OsteoBiol® OsteoBiol® Putty and OsteoBiol® Gel 40. products allow a consistent bone Their consistency allows an ideal filling of neo-formation and a close contact bone defects and guarantees simple between mature neo-formed bone and handling and fast application. biomaterial granules. The OsteoBiol® new generation of Collagen has a key role in bone biomaterials, thanks to a revolutionary regeneration process in that: technology, goes beyond the simple role of >> it acts as a valid substrate for platelet aiding natural bone regrowth by activation and aggregation stimulating and accelerating this vital physiological process. >> it serves to attract and differentiate the mesenchymal stem cells present in the (1) FIGUEIREDO M, ET AL. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH PART B: APPLIED BIOMATERIALS (2010): 92B: 409–419 bone marrow(2) (2) SALASZNYK RM, ET AL. JOURNAL OF BIOMEDICINE AND >> it increases the proliferation rate of the BIOTECHNOLOGY (2004), 1: 24-34 osteoblasts up to 2/3 times(3) (3) HSU FY, ET AL. BIOMATERIALS (1999), 20: 1931-1936 Composition of OsteoBiol® Gen-Os Source: Courtesy of Nobil Bio Ricerche, Villafranca d’Asti, Italy OsteoBiol® membrane collagenic structure Mineral bone Collagen Source: University of Duisburg-Essen, Germany 9
  • 9. Collagen and bone regeneration“All OsteoBiol® Guided bone regeneration (GBR) is necessary In fact, the primary post-haemorrhagic clot Sampath and Reddi (1980) demonstratedcollagenated biomaterials to treat bone deficits due to lesions or formation process through platelet crosslinked type I collagen to be the mostprovide the natural bacterial infections. aggregation and lysis causes the release of appropriate carrier for promotingsubstrate for correct bone both the coagulation cascade factors and osteoinductive signal activity. The bone defect recovery occurs through thetissue regeneration and growth factors, such as PDGF, IGF 1, IGF 2 general mechanisms of tissue healing, that is, The continuous progresses in comprehensionrepair, facilitating and and VEGF which are known for their by complex dynamic mechanisms directed of biological mechanisms regulating boneaccelerating the activating effect on osteoblasts and towards the repair of tissue function and tissue morphogenesis can be exploited alsophysiological regeneration osteoclasts, and TGF-β (Bone Morphogenetic anatomic integrity. for elaboration of natural or artificial productsprocess and allowing Proteins belong to this superfamily) which able to restore or maintain the function ofoptimal results within a The discovery of the events pathway leading starts bony callus formation. damaged tissues and organs (tissuereasonable period of time” to tissue healing has helped to clearly identify >> the osteoblastic precursors deriving engineering)(1,2,3).Giuseppe Oliva MD the main actors in bone healing process; the from bone marrow mesenchymal stem cellsR&D Director concomitant presence of the following three In vitro studies demonstrated that are responsible, after cell differentiation inTecnoss s.r.l. components is necessary for the formation of heterologous collagen is able to induce osteoblasts, for the second phase of the “de novo” bone tissue: differentiation of mesenchymal healing process (enchondral and/or osteoprogenitor stem cells into osteoblasts(4), >> the platelets represent the principal intramembranous ossification) thanks to the and that association of collagen type I with a actors during the first phase of the healing synthesis of collagen and other components scaffold of hydroxyapatite significantly process, when, subsequent to a lesion, an of the extracellular matrix. enhances osteoblasts proliferation rate(5). initial deposition of fibrin and the formation of >> an insoluble substrate, suitable carrier blood clot take place. This phase is This important scientific evidence provides the for osteoinductive signal and able to support characterized by significant activation of the rationale behind OsteoBiol® product line: and guide new bone tissue formation. chemical signals mediated by cytokines and a complete series of biomaterials with growth factors. collagen base. 10
  • 10. INTRODUCTION GUIDED BONE REGENERATIONCollagen, in addition to its well-known 3. Angiogenesisstructural action carried on connective The drawn monocytes/macrophages, in BIBLIOGRAPHYtissues, is endowed with the following their turn, stimulate both osteoblastic (1) GRIFFITH LG, NAUGHTON G, SCIENCE (2002); 295: 1009-14important properties, useful in tissue activity and angiogenesis process in SUBSTRATE (2) REDDI AH, TISSUE ENGINEERING (2000); 6: 351-59reparation processes: grafting site. Collagen (3) NAKASHIMA N, REDDI AH, NATURE BIOTECHNOLOGY1. Haemostasis 4. Osteoblastic activity (2003); 9: 1025-32Collagen is able to activate the receptors Collagen, binding to fibronectin, promotes (4) SALASZNYK RM, ET AL., JOURNAL OF BIOMEDICINE AND BIOTECHNOLOGY (2004), 1: 24-34present on cellular membranes of the anchorage of mesenchymal stem (5) HSU FY, ET AL., BIOMATERIALS (1999), 20: 1931-36platelets, responsible for their aggregation progenitors, on which it exerts itsand lysis process; moreover, during the chemotactic action, and induces OSTEOPROGENITOR GROWTH FACTORSfirst week, it reinforces the action of fibrin differentiation into osteoblasts(4). CELLS TGFβ1 – BMP: bloodin the formation of the primary clot, and Bone marrow 5. Receiving site remodelingthen, in the second week, it replaces the Exogenous collagen grafting canfunction of fibrin. contribute in decreasing remodeling times2. Debridement of immature bone tissue.Collagen has a chemotactic action on 6. Osteoconduction and guidedmonocyte/macrophage cell lines, from regenerationwhich osteoclasts derive; these cells, Naturally integrated with mineralthrough their action on mineral REGENERATION component, collagen is able to increasecomponent resorption of both bone tissue Alveolar bone osteoblasts proliferation rate(5), while as aand OsteoBiol® biomaterials, can draw, periodontal ligament cementum resorbable membrane it is able to guideactivate and collaborate with osteoblasts in connective tissue regeneration.bone rearranging and remodeling. 11
  • 11. From heterologous bone to biomaterial RESULTS OF INORGANIC CHEMICAL ANALYSES RESULTS OF ORGANIC CHEMICAL ANALYSES PERFORMED ON OSTEOBIOL® GEN-OS PERFORMED ON OSTEOBIOL® GEN-OS “The separated proteins (one lane) were OsteoBiol® Gen-Os fractionated in ten portions and analysed Chemical element (% in weight) with nano-LC-ESI MS/MS. In the fractions Ca 25.7% Mineral 1-5 in the range from 20-200kDa we PO43- 35.2% component found ONLY COLLAGEN. In the fractions C 13.6% 73.6% 6-10 we identify NO PROTEIN” H 2.2% N 2.9% O (not in PO4 ) 3- 20.4% TOTAL 100.0% Organic matrix 22.4% Ca/P (n:n) 1.73 Water 4.0% Inorganic chemical analyses results Organic chemical analyses results Source: University of Duisburg-Essen, Germany Source: Proteome Factory, Germany“The ideal bone substitute A biomaterial for the reconstruction of bone defects must beshould be easy to handle biocompatible and have good handling and modeling properties; inand should not be resorbed specific clinical situations, it must also provide sufficient resistance totoo fast via an inflammatory loading.process or induce adverse Tecnoss® laboratories are specialized in processing heterologous bonyreactions” and collagenic tissues. OsteoBiol® bone process, in particular, hasMarco Esposito DDS, PhD been developed to modify but maintain the original collagen matrix ofDirector Postgraduate DentalSpecialties heterologous tissue, in order to preserve its positive biological functions, obtaining at the same time complete biocompatibility(1,3).Manchester Academic HealthScience Centre, The University of Most biomaterials are inert products that do not interfere, or rather, doManchester, UK not take part in the physiology of bone remodeling: since they have been developed according to the sole concept of biocompatibility, their function is limited only to preservation of the graft volume (scaffold). The concept of biocompatibility by itself has an essential purpose in the implant of permanent prosthetic elements inside the human body, but it is extremely restrictive in case of materials used for bone reconstruction. In the case of synthesized hydroxyapatite or natural bone hydroxyapatite derived from aggressive manufacturing processes osteoclastic cellular response is slow, causing extremely prolonged resorption time. 12
  • 12. Characteristics of Tecnoss® process INTRODUCTION A UNIQUE PROCESSTecnoss® has developed treatment BIBLIOGRAPHYmanufacturing processes of various (1) FIGUEIREDO M, ET AL. JOURNAL OF BIOMEDICAL MATERIALSanimal species connective tissues, allowing RESEARCH PART B: APPLIED BIOMATERIALS (2010): 92B: 409–419to obtain the biocompatibility of these (2) TRUBIANI O, ET AL. JOURNAL OF IMMUNOPATHOLOGY ANDtissues, preserving at the same time their PHARMACOLOGY (2007); 20: 89-93collagen matrix(1). (3) NANNMARK U, SENNERBY L. CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH (2008) DEC; 10(4):264-70The protein components of animal tissues (4) CRESPI R, ET AL. INTERNATIONAL JOURNAL OF ORAL ANDare determinant to make every individual MAXILLOFACIAL IMPLANTS (2011) JUL-AUG; 26(4):866-72unique. They activate the cells of theimmune system of the receiving organismby interacting with receptors of the MajorHistocompatibility Complex (MHC).Their neutralization/denaturation allowsthe mineral bone and collagen matrix tobe transferred from animal to man withoutany dangerous adverse reaction outbreak.Successful Guided Bone Regeneration(GBR) depends both on stimulation oftissues involved in new bone formationand on the characteristics of graftedbiomaterials, which can determine thequality of bone/graft interface(2).The basic research for development of Image showing bone formation on collagenated porcine bone granules (OsteoBiol® Gen-Os) 2 weeks after implantation in a rabbit. In the lower left and right corners granules can be seen. These granules are covered by newly formed bone and a seamOsteoBiol® product line has thus been of osteoblasts. Osteocytes in lacunae are visible in the newly formed bone. Close to the osteoblastic seam, both feeding microvessels and a venule can be seen. Staining hematoxyline-eosine. Original magnification x40driven by the ideal biomaterial concept: a Source: Courtesy of Drs Ulf Nannmark and Lars Sennerby, Göteborg University, Swedenmaterial with the highest affinity to the newendogenous bone.To pursue this aim, Tecnoss® developed a Thanks to this innovative technology, the OsteoBiol® line has the following importantbiotechnology, able, by avoiding the high characteristics:temperature ceramization phase, to 1. Absence of a foreign body response(4)preserve the structure of naturalhydroxyapatite and therefore allow an 2. Gradual resorption over timeosteoclastic-type remodeling of 3. Stimulation and acceleration of physiological tissue healing processbiomaterial, similar to physiological boneturnover time(3). 4. Protection of the grafting site from infection (membranes) 5. Capability of carrying medication to the surgical site 13
  • 13. CLINICALINDICATIONS ALVEOLAR REGENERATION DEHISCENCES AND FENESTRATIONS CRESTAL ACCESS SINUS LIFT Source: Courtesy of Dr Ulf Nannmark, Göteborg University, Sweden LATERAL ACCESS SINUS LIFT HORIZONTAL AND VERTICAL AUGMENTATION PERIODONTAL REGENERATION 15
  • 14. Clinical indications for specific clinical indications Products specifically engineered ALVEOLAR MAXILLARY PERI-IMPLANT HORIZONTAL REGENERATION SINUS LIFT DEFECTS AUGMENTATION SOCKET RIDGE LATERAL CRESTAL DEHISCENCES AND 2-WALL RIDGE PRESERVATION PRESERVATION ACCESS ACCESS FENESTRATIONS, DEFECTS SPLIT PERI-IMPLANT LESIONS ONE OR TWO IF ONE OR TWO Gen-Os Collagenated heterologous cortico-cancellous bone mix | Granulometry 250-1000 µm For information on OsteoBiol® Gen-Os see page 60 WALLS MISSING WALLS ARE MISSING TO DY ready to mp3 USE REA use Pre-hydrated collagenated heterologous cortico-cancellous bone mix Granulometry 600-1000 µm For information on OsteoBiol® mp3 see page 64 TO IF DEFECT WALLS DY Putty USE REA Pre-hydrated collagenated heterologous cortico-cancellous bone paste Granulometry up to 300 µm For information on OsteoBiol® Putty see page 68 ARE PRESERVED TO DY Gel 40 USE REA Pre-hydrated collagenated heterologous cortico-cancellous bone gel Granulometry up to 300 µm For information on OsteoBiol® Gel 40 see page 72 Sp-Block Collagenated heterologous cancellous block For information on OsteoBiol® Sp-Block see page 88 Evolution Heterologous collagen membrane For information on OsteoBiol® Evolution see page 78 STANDARD MODEL FINE MODEL Lamina Collagenated heterologous cortical bone For information on OsteoBiol® Lamina see page 82 CURVED MODEL 16
  • 15. VERTICAL PERIODONTAL CLINICAL INDICATIONSAUGMENTATION REGENERATION INDICATION VS PRODUCT MATRIX INLAY 2-WALL 3-WALL GINGIVAL INTRABONY INTRABONY TECHNIQUE RECESSIONS DEFECTS DEFECTS “OsteoBiol® is the most complete range of biomaterials available on the market today. Our products are specifically engineered to fulfill your needs in every IN ASSOCIATION single clinical indication. We believe that your valuable regenerative work should not be limited to one single product adapted to all clinical indications but it should be given instead a solution thought and designed specifically for your different needs. WITH SP-BLOCK Each regeneration protocol is in fact different: this is why we work hard to deliver you the best solutions to help you improve your surgical procedures everyday. Your clinical success is our only mission” Katia Gaetano BPharm Production Manager Tecnoss s.r.l. DEEP/NARROW IN ASSOCIATION INTRABONY DEFECTS WITH MP3 STANDARD MODEL FINE MODEL
  • 16. Alveolar regeneration Post-extractive socket preservation Ridge preservation Post-extractive alveolus grafted with OsteoBiol® mp3 Source: Courtesy of Dr Roberto Rossi, Genova, Italy
  • 17. Characteristics CLINICAL INDICATIONS ALVEOLAR REGENERATIONDEFECT ORIGIN AND DESCRIPTION REGENERATION PROCEDURES BIBLIOGRAPHY | PAGES 19-21After the loss of dental elements alveolar Socket preservation technique (1) LEKOVIC V, CAMARGO PM, KLOKKEVOLD PR, ET ALbone starts resorbing due to the absence The goal is the preservation of the alveolar PRESERVATION OF ALVEOLAR BONE IN EXTRACTION SOCKETS USING BIORESORBABLE MEMBRANESof mechanical solicitation transmitted by ridge and extraction socket, in particular if JOURNAL OF PERIODONTOLOGY (1998); 69: 1044-1049dental roots. patient will be rehabilitated with placement (2) LEKOVIC V, KENNEY EB, WEINLAENDER M, ET AL of endosseous implants. A BONE REGENERATIVE APPROACH TO ALVEOLAR RIDGEThis physiologic resorption subsequent to MAINTENANCE FOLLOWING TOOTH EXTRACTION. REPORT OF 10 CASEStooth loss or extraction is due to both The physiologic bone resorption of JOURNAL OF PERIODONTOLOGY (1997); 68: 563-570impossibility of regenerated bone to reach alveolar ridge after tooth extraction is (3) AMLER MH, JOHNSON PL, SALMAN Ithe pre-existing coronal level when the particularly consistent in the anterior HISTOLOGICAL AND HISTOCHEMICAL INVESTIGATION OF HUMAN ALVEOLAR SOCKET HEALING IN UNDISTURBEDbone is left healing in physiologic maxilla, where the buccal plate often is EXTRACTION SOCKETS JOURNAL OF AMERICAN DENTAL ASSOCIATION (1960); 61:conditions (without any biomaterial graft) extremely thin and friable. 32-44and the simultaneous cortical bone To minimize bone resorption the first (4) SCHROPP L, WENZEL A, KOSTOPOULOS L, KARRING Tremodeling process, both in BONE HEALING AND SOFT TISSUE CONTOUR CHANGES important step is the less traumatic FOLLOWING SINGLE-TOOTH EXTRACTION: A CLINICALcoronal-apical and vestibular-lingual AND RADIOGRAPHIC 12 MONTH PROSPECTIVE STUDY extraction technique for tooth removal.directions. JOURNAL OF PERIODONTICS AND RESTORATIVE DENTISTRY (2003); 23: 313-323 Often this procedure is associated withLekovic and coll.(1) demonstrated that the (5) OKAMOTO T, ONOFRE DA SILVA A socket augmentation using a variety of HISTOLOGICAL STUDY ON THE HEALING OF RAT DENTALpost-extraction bone loss is accelerated in SOCKETS AFTER PARTIAL REMOVAL OF THE BUCCAL BONY particulate bone graft materials with orthe first 6 months, followed by a gradual PLATE without membrane barriers. J NIHON UNIV SCH DENT (1983); 25: 202-213modeling (change in size or shape) and (6) SIMPSON HEturnover of the remaining bone, with as Several studies(2-4) demonstrated EXPERIMENTAL INVESTIGATION INTO THE HEALING OF Source: Tecnoss Dental Media Library EXTRACTION WOUNDS IN MACACUS RHESUS MONKEYSmuch as 40% of the alveolar height and significantly reduced alveolar ridge ® JOURNAL OF ORAL SURGERY AND ANESTHETIC HOSPITAL60% of alveolar width lost in the first 6 dimensional changes associated with DENTAL SERVICE (1960); 18: 391-399months. these preservation techniques. (7) NANNMARK U, SENNERBY L THE BONE TISSUE RESPONSES TO PREHYDRATED AND COLLAGENATED CORTICO-CANCELLOUS PORCINE BONEThe result of this resorption often is a In case of a defect involving the original GRAFTS. A STUDY IN RABBIT MAXILLARY DEFECTSclinical problem able to compromise buccal plate, multiple animal studies CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, 2008, 10: 264-270esthetic outcome and/or functional and showed that these defects do not heal (8) CARDAROPOLI D, CARDAROPOLI Gstructural aspects of restoration treatment. completely without use of grafting PRESERVATION OF THE POSTEXTRACTION ALVEOLAR techniques(5,6). RIDGE: A CLINICAL AND HISTOLOGIC STUDY THE INTERNATIONAL JOURNAL OF PERIODONTICS AND RESTORATIVE DENTISTRY, 2008, 28: 469-477 Thus, in the anterior maxilla, grafting for (9) ARCURI C, CECCHETTI F, GERMANO F, MOTTA A, space maintenance and ridge preservation SANTACROCE C may be beneficial. CLINICAL AND HISTOLOGICAL STUDY OF A XENOGENIC SUBSTITUTE USED AS A FILLER IN POSTEXTRACTIVE ALVEOLUS Moreover, for situations where the MINERVA STOMATOLOGICA, 2005, 54: 351-362 periapical bone or the socket walls are not (10) BARONE A, ALDINI NN, FINI M, GIARDINO R, intact, bone augmentation techniques may CALVO GUIRADO JL, COVANI U XENOGRAFT VERSUS EXTRACTION ALONE FOR RIDGE be used to restore the original anatomy, PRESERVATION AFTER TOOTH REMOVAL: A CLINICAL AND HISTOMORPHOMETRIC STUDY with a particular attention to soft tissue JOURNAL OF PERIODONTOLOGY, 2008, 79: 1370-1377 perfect closure and graft containment, which are the main difficulties of this Alveolar preservation procedure. Source: Tecnoss® Dental Media Library 19
  • 18. Alveolar regeneration OsteoBiol® product range PRODUCT CODES Gen-Os M1052FS | 1 Vial | 0.25 g | Porcine M1052FE | 1 Vial | 0.25 g | Equine M1005FS | 1 Vial | 0.5 g | Porcine M1005FE | 1 Vial | 0.5 g | Equine M1010FS | 1 Vial | 1.0 g | Porcine M1010FE | 1 Vial | 1.0 g | Equine M1020FS | 1 Vial | 2.0 g | Porcine M1020FE | 1 Vial | 2.0 g | Equine Putty Tissue of origin Collagenated heterologous cortico-cancellous Tissue of origin Pre-hydrated collagenated heterologous HPT09S | 1 Syringe | 0.5 cc | Porcine bone mix cortico-cancellous bone paste HPT09E | 1 Syringe | 0.5 cc | Equine Tissue collagen Preserved Tissue collagen Preserved + 20% additional collagen gel Physical form Slightly radiopaque granules Physical form Plastic consistency composed of collagen gel HPT35S | 3 Syringe | 3x0.5 cc | Porcine Composition 100% granulated mix loaded with 80% micronized bone mix HPT35E | 3 Syringe | 3x0.5 cc | Equine Granulometry 250-1000 µm Composition 80% granulated mix, 20% collagen gel HPT32S | 3 Syringe | 3x0.25 cc | Porcine Re-entry time 4/5 months, depending on grafting site Granulometry Up to 300 µm HPT32E | 3 Syringe | 3x0.25 cc | Equine characteristics Re-entry time About 4 months Packaging Vial: 0.25 g, 0.5 g, 1.0 g, 2.0 g Packaging Syringe: 0.5 cc, 3x0.5 cc, 3x0.25 cc mp3 For more information on OsteoBiol® Gen-Os see page 60 For more information on OsteoBiol® Putty see page 68 A3005FS | 1 Syringe | 1.0 cc | Porcine A3005FE | 1 Syringe | 1.0 cc | Equine A3015FS | 3 Syringe | 3x0.5 cc | Porcine A3015FE | 3 Syringe | 3x0.5 cc | Equine A3030FS | 3 Syringe | 3x1.0 cc | Porcine A3030FE | 3 Syringe | 3x1.0 cc | Equine Evolution EV02LLE | 20x20 mm | Fine | Equine EV02HHE | 20x20 mm | Standard | Equine EV03LLE | 30x30 mm | Fine | Equine EV03HHE | 30x30 mm | Standard | Equine EVOLLE | 25x35 mm (oval) | Fine | Equine EVOHHE | 25x35 mm (oval) | Standard | Equine Tablet Tissue of origin Pre-hydrated collagenated heterologous Tissue of origin Heterologous collagen membrane BLE10S | 10x10x10 mm | 6 Blister | Porcine cortico-cancellous bone mix Tissue collagen Preserved BLE10E | 10x10x10 mm | 6 Blister | Equine Tissue collagen Preserved + 10% additional collagen gel Physical form Dried membrane with one smooth side and one For more information on OsteoBiol® Tablet see page 90 Physical form Pre-hydrated granules and collagen gel micro-rough side Composition 90% granulated mix, 10% collagen gel Composition 100% pericardium Granulometry 600-1000 µm Thickness Fine: 0.4 mm (±0.1). Standard: 0.6 mm (±0.1) Re-entry time About 5 months Resorption time Fine: approx 3 months. Standard: approx 4 Packaging Syringe: 1.0 cc, 3x0.5 cc, 3x1.0 cc months Packaging Fine: 20x20 mm, 30x30 mm, 25x35 mm (oval) For more information on OsteoBiol® mp3 see page 64 Standard: 20x20 mm, 30x30 mm, 25x35 mm (oval) For more information on OsteoBiol® Evolution see page 78 20
  • 19. OsteoBiol® products description CLINICAL INDICATIONS ALVEOLAR REGENERATIONThe entire OsteoBiol® line consists of SCIENTIFIC LITERATURE ON ALVEOLAR REGENERATIONxenografts, i.e. biomaterials deriving from WITH OSTEOBIOL® PRODUCTSheterologous bone. COVANI U, AMERI S, CRESPI R, BARONE A PRESERVAZIONE DEL PROCESSO ALVEOLARE CONThe Tecnoss patented manufacturing ® OSSO ETEROLOGO. CONSIDERAZIONI ISTOLOGICHE ITALIAN ORAL SURGERY, 2004, VOL 3, 1: 17-23process used to obtain these materials is ARCURI C, CECCHETTI F, GERMANO F, MOTTA A,able to achieve biocompatibility preserving SANTACROCE C CLINICAL AND HISTOLOGICAL STUDY OF Apart of the collagen matrix of the animal XENOGENIC BONE SUBSTITUTE USED AS A FILLER INbone and avoiding at the same time high POSTEXTRACTIVE ALVEOLUS MINERVA STOMATOLOGICA, 2005 JUN;54(6):351-62temperatures that would cause BARONE A, ALDINI NN, FINI M, GIARDINO R,ceramization of the granules: the result is a CALVO GUIRADO JL, COVANI Uunique particulate material, consisting of XENOGRAFT VERSUS EXTRACTION ALONE FOR RIDGE PRESERVATION AFTER TOOTH REMOVAL: A CLINICALmineral component and organic matrix, OsteoBiol® Putty | For more information see page 68 OsteoBiol® mp3 | For more information see page 64 AND HISTOMORPHOMETRIC STUDY Source: Tecnoss® Dental Media Library Source: Tecnoss® Dental Media Library JOURNAL OF PERIODONTOLOGY, 2008 AUG;79(8):1370-7with a porous surface extremely similar toautogenous bone and able to resorb granulometry packed in a sterile vial: due In case of insufficient soft tissue to cover CARDAROPOLI D, CARDAROPOLI G PRESERVATION OF THE POSTEXTRACTION ALVEOLARprogressively while new bone formation to its collagen content, once hydrated with and protect the graft, an OsteoBiol® RIDGE: A CLINICAL AND HISTOLOGIC STUDY INTERNATIONAL JOURNAL OF PERIODONTICS ANDtakes place(7). saline, it allows an excellent graft stability Evolution membrane is recommended(8-10): RESTORATIVE DENTISTRY, 2008 OCT;28(5):469-77 while its hydrophilia guarantees quick Evolution pericardium membranes CRESPI R, CAPPARÈ P GHERLONE E ,These cortical and cancellous particles blood absorption and therefore the guarantee an efficient barrier effect, DENTAL IMPLANTS PLACED IN EXTRACTION SITEShave been mixed in various proportions GRAFTED WITH DIFFERENT BONE SUBSTITUTES: necessary graft vascularization. Its favour the correct soft tissue regrowth and RADIOGRAPHIC EVALUATION AT 24 MONTHSand granulometries with and without JOURNAL OF PERIODONTOLOGY, 2009 OCT;80(10):1616-1621 cortico-cancellous composition allows a wound closure and do not get infected incollagen gel, in order to develop various progressive resorption of osteoclastic type, case of exposure. ROSSI R, SANTOS MORALES R, FRASCARIA M, BENZI R,products aimed at different clinical SQUADRITO N with in parallel a similar rate of new bone PLANNING IMPLANTS IN THE ESTHETIC ZONE USING Aindications: the OsteoBiol® materials OsteoBiol® Putty is a collagen gel matrix NEW IMPLANT 3D NAVIGATION SYSTEM formation(7). These unique properties allow THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY, 2010indicated for alveolar regeneration are loaded for 80% of its volume with a very good graft volume preservation, a SUMMER;5(2):172-88OsteoBiol® Gen-Os and OsteoBiol® Putty. micronized cortico-cancellous bone healthy new bony tissue and ultimately, a CRESPI R, CAPPARÈ P ROMANOS GE, MARIANI E, BENASCIUTTI , particles (granulometry ≤300 µm) packed E, GHERLONE EOsteoBiol Gen-Os is a cortico-cancellous ® successful implant rehabilitation(8). CORTICOCANCELLOUS PORCINE BONE IN THE HEALING in a sterile syringe. OF HUMAN EXTRACTION SOCKETS: COMBININGcollagenated bone mix with 250-1000 µm HISTOMORPHOMETRY WITH OSTEOBLAST GENE The exclusive Tecnoss® manufacturing EXPRESSION PROFILES IN VIVO INTERNATIONAL JOURNAL OF ORAL AND MAXILLOFACIAL process guarantees an exceptional IMPLANTS, 2011 JUL-AUG; 26(4):866-72 malleability and plasticity(9): furthermore the syringe packaging gives Putty extraordinary handling properties making this product the ideal choice for incisors narrow sockets with intact walls. OsteoBiol® mp3 has also been used successfully for alveolar ridge preservation(10) while OsteoBiol® Tablet is an anti-haemorrhagic biomaterial suitable to accelerate blood clotting inOsteoBiol® Evolution | For more information see page 78 OsteoBiol® Tablet | For more information see page 90 post-extractive sockets and to favourSource: Tecnoss® Dental Media Library Source: Tecnoss® Dental Media Library regeneration. 21
  • 20. Case reportAlveolar ridge preservation Sex: male | Age: 51 Fig. 1 Initial x-ray Fig. 2 Root separation Fig. 3 Extracted tooth Fig. 4 Ridge preservation with OsteoBiol® mp3 Fig. 5 Grafting site protected with OsteoBiol® Evolution collagen membraneFig. 1 Fig. 2 Fig. 3 Fig. 6 Site before grafting Fig. 7 Site after grafting Fig. 8 Healing and bone regeneration at 12 months Fig. 9 Osteotomy for the insertion of the implant Fig. 10 Thommen implant (Ø 5x12 mm) Fig. 11 Healing of peri-implant tissues Fig. 12 Final resultFig. 4 Fig. 5 Fig. 6Fig. 7 Fig. 8 Fig. 9 Documentation provided by Dr Roberto Rossi M.Sc.D. in Periodontology, Genova, Italy e-mail: drrossi@mac.com Bone substitute: OsteoBiol® mp3 For more information on OsteoBiol® mp3 see page 64 Membrane: OsteoBiol® Evolution For more information on OsteoBiol® Evolution see page 78Fig. 10 Fig. 11 Fig. 1222
  • 21. Case report CLINICAL INDICATIONS ALVEOLAR REGENERATIONTreatment of bone defects due to peri-implantitis Sex: male | Age: 54 Fig. 1 Initial intraoral image: it is possible to appreciate severe inflammation of the soft tissues. The prosthesis is subjected to considerable mobility Fig. 2 Endoral x-ray image: the diagnosis of peri-implantitis in 3.5-3.6 zone was confirmed Fig. 3 Intraoral image showing the residual bone defects: in particular 3.5 site was defective of all buccal coronal halfFig. 1 Fig. 2 Fig. 3 Fig. 4 Defects were grafted with OsteoBiol® Gen-Os Fig. 5 The graft was stabilized and protected by a properly shaped OsteoBiol® Evolution membrane Fig. 6 Soft tissues were repositioned and sutured Fig. 7 Intraoral image of second surgical phase (re-entry after 8 months). It is possible to appreciate a complete regeneration of pre-existent bone defects Fig. 8 Placement of 3 implants on the base of a monophasic protocol Fig. 9 Placement of titanium prosthesis abutmentsFig. 4 Fig. 5 Fig. 6 after 3 months from implant placement surgery: the verification of perfect implant osteointegration was performed with the resonance frequency analysis (ISQ>70) Fig. 10 Endoral x-ray image. It is possible to proceed with “Platform Switching” Fig. 11 Final restoration with definitive prosthesis was completed 3 months after surgery. Picture showing the situation 12 months after surgery Fig. 12 Control endoral x-ray image 12 months after surgeryFig. 7 Fig. 8 Fig. 9 Documentation provided by Dr Roberto Cocchetto Private practitioner in Zevio, Italy e-mail: rcocchetto@yahoo.it Bone substitute: OsteoBiol® Gen-Os For more information on OsteoBiol® Gen-Os see page 60 Membrane: OsteoBiol® Evolution For more information on OsteoBiol® Evolution see page 78Fig. 10 Fig. 11 Fig. 12 23
  • 22. Dehiscences and fenestrations Peri-implant lesions Fenestration. Cortical stimulation before grafting with OsteoBiol® Gen-Os Source: Courtesy of Dr Claudio Stacchi, Gorizia, Italy
  • 23. Characteristics CLINICAL INDICATIONS DEHISCENCES AND FENESTRATIONSDEFECT ORIGIN AND DESCRIPTION REGENERATION PROCEDURES BIBLIOGRAPHY | PAGES 25-27After placement of implants, there are two The healing of these defects takes (1) CORRENTE G, ABUNDO R, CARDAROPOLI D, ET ALtypes of residual defects that can be advantage to the principle of Guided Bone LONG-TERM EVALUATION OF OSSEOINTEGRATED IMPLANTS IN REGENERATED AND NON- REGENERATED BONEtreated with predictable regenerative Regeneration (GBR) with the use of barrier INTERNATIONAL JOURNAL OF PERIODONTICS AND RESTORATIVE DENTISTRY (2000); 20: 390-397techniques, because these defects are able membranes that protect and isolate the (2) ZITZMANN NU, SCHARER P MARINELLO CP ,to self-maintain the space necessary for defect allowing the growth of neo- LONG-TERM RESULTS OF IMPLANTS TREATED WITH GUIDED BONE REGENERATION: A 5-YEAR PROSPECTIVE STUDYregeneration. In fact, positive results have regenerated bone in sites showing INTERNATIONAL JOURNAL OF ORAL AND MAXILLOFACIAL IMPLANTS.been confirmed by long-term studies both insufficient bone volume. (2001); 16(3):355-366controlled(1-2) and non controlled(3-4), (3) BECKER W, DAHLIN C, LEKHOLM U, BERGSTROM C, In fact, significant more bone formation VAN STEENBERGHE D, HIGUCHI K, BECKER BEgrafting different kinds of biomaterials. FIVE-YEAR EVALUATION OF IMPLANTS PLACED AT EXTRACTION has been shown around defects protected AND WITH DEHISCENCES AND FENESTRATION DEFECTS AUGMENTED WITH EPTFE MEMBRANES: RESULTS FROM ADepending from their morphology, these with a barrier membrane compared with PROSPECTIVE MULTICENTER STUDY CLINICAL IMPLANT DENTISTRY RELATED RESEARCH (1999);1(1):27-32defects can be classified as follows, controls(7-9). (4) NEVINS M, MELLONIG JT, CLEM DS 3RD, REISER GM, BUSER DAaccording to Tinti and Parma-Benfenati Bio-absorbable collagen membranes are Fenestration grafted with OsteoBiol® Gen-Os IMPLANTS IN REGENERATED BONE: LONG-TERM SURVIVALclinical classification(5): For more information see page 60 INTERNATIONAL JOURNAL OF PERIODONTICS AND RESTORATIVE equally effective as non resorbable e-PTFE Source: Courtesy of Dr Claudio Stacchi, Gorizia, Italy DENTISTRY (1998); 18(1):34-45Fenestration: it is a vestibular or membranes, but reduce significantly the (5) TINTI C, PARMA-BENFENATI S CLINICAL CLASSIFICATION OF BONE DEFECTS CONCERNINGlinguo-palatal defect associated with a risk of complications in case of exposure THE PLACEMENT OF DENTAL IMPLANTS INTERNATIONAL JOURNAL OF PERIODONTICS AND RESTORATIVElack of bone thickness, creating a partial since they do not get infected. DENTISTRY (2003) ; 23:147-155exposure of an implant which is completely (6) CORRENTE G, ABUNDO R The use of pins to fix the membranes can IMMEDIATE POST-EXTRACTIVE IMPLANTSsurrounded by bone. limit significantly the risk of premature MAXILLARY SINUS LIFT WITH CRESTAL ACCESS. (2003) RC LIBRI (ITALY): 83-95Dehiscence: it is a vestibular or exposure. In association with cover (7) DAHLIN C, ANDERSSON L, LINDE Alinguo-palatal defect represented by a lack membranes, several studies reported the BONE AUGMENTATION AT FENESTRATED IMPLANTS BY AN OSTEOPROMOTIVE MEMBRANE TECHNIQUE. A CONTROLLED<50% of bone thickness, resulting in the successful healing of dehiscences and CLINICAL STUDY CLINICAL ORAL IMPLANTS RESEARCH (1991); 2(4):159-165exposure of the vestibular surface of fenestrations treated with particulate (8) JOVANOVIC SA, SPIEKERMANN H, RICHTER EJimplant, starting from its head in apical biomaterials in association or not with BONE REGENERATION AROUND TITANIUM DENTAL IMPLANTS IN DEHISCED DEFECT SITES: A CLINICAL STUDYdirection. autogenous bone. INTERNATIONAL JOURNAL OF ORAL AND MAXILLOFACIAL IMPLANTS (1992); 7(2):233-245Combined defects: if the defect is the (9) MOSES O, PITARU S, ARTZI Z, NEMCOVSKY CEassociation of both dehiscence and HEALING OF DEHISCENCE-TYPE DEFECTS IN IMPLANTS PLACED TOGETHER WITH DIFFERENT BARRIER MEMBRANES: Afenestration together, it can be defined as COMPARATIVE CLINICAL STUDY CLINICAL ORAL IMPLANTS RESEARCH (2005); 16(2):210-219a combined defect. (10) NANNMARK U, SENNERBY L THE BONE TISSUE RESPONSES TO PREHYDRATED ANDMoreover, in the most severe cases, these COLLAGENATED CORTICO-CANCELLOUS PORCINE BONEcombined defects can be associated with GRAFTS. A STUDY IN RABBIT MAXILLARY DEFECTS CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, 2008, 10:horizontal supra-crestal or extra-crestal 264-270defects, which necessitates the creation of (11) COVANI U, BARONE A, CORNELINI R, CRESPI R CLINICAL OUTCOME OF IMPLANTS PLACED IMMEDIATELY AFTERan adequate space for bone IMPLANT REMOVAL JOURNAL OF PERIODONTOLOGY, 2006, 77: 722-727regeneration(6). (12) ARCURI C, CECCHETTI F, GERMANO F, MOTTA A, SANTACROCE C CLINICAL AND HISTOLOGICAL STUDY OF A XENOGENIC SUBSTITUTE USED AS A FILLER IN POSTEXTRACTIVE ALVEOLUS MINERVA STOMATOLOGICA, 2005, 54: 351-362 Peri-implant defect grafted with OsteoBiol® Putty Peri-implant defect grafted with OsteoBiol® Putty For more information see page 68 For more information see page 68 Source: Tecnoss® Dental Media Library Source: Tecnoss® Dental Media Library 25
  • 24. Dehiscences and fenestrations OsteoBiol® product range PRODUCT CODES Gen-Os M1052FS | 1 Vial | 0.25 g | Porcine M1052FE | 1 Vial | 0.25 g | Equine M1005FS | 1 Vial | 0.5 g | Porcine M1005FE | 1 Vial | 0.5 g | Equine M1010FS | 1 Vial | 1.0 g | Porcine M1010FE | 1 Vial | 1.0 g | Equine M1020FS | 1 Vial | 2.0 g | Porcine M1020FE | 1 Vial | 2.0 g | Equine Putty Tissue of origin Collagenated heterologous cortico-cancellous Tissue of origin Pre-hydrated collagenated heterologous HPT09S | 1 Syringe | 0.5 cc | Porcine bone mix cortico-cancellous bone paste HPT09E | 1 Syringe | 0.5 cc | Equine Tissue collagen Preserved Tissue collagen Preserved + 20% additional collagen gel Physical form Slightly radiopaque granules Physical form Plastic consistency composed of collagen gel HPT35S | 3 Syringe | 3x0.5 cc | Porcine Composition 100% granulated mix loaded with 80% micronized bone mix HPT35E | 3 Syringe | 3x0.5 cc | Equine Granulometry 250-1000 µm Composition 80% granulated mix, 20% collagen gel HPT32S | 3 Syringe | 3x0.25 cc | Porcine Re-entry time 4/5 months, depending on grafting site Granulometry Up to 300 µm HPT32E | 3 Syringe | 3x0.25 cc | Equine characteristics Re-entry time About 4 months Packaging Vial: 0.25 g, 0.5 g, 1.0 g, 2.0 g Packaging Syringe: 0.5 cc, 3x0.5 cc, 3x0.25 cc mp3 For more information on OsteoBiol® Gen-Os see page 60 For more information on OsteoBiol® Putty see page 68 A3005FS | 1 Syringe | 1.0 cc | Porcine A3005FE | 1 Syringe | 1.0 cc | Equine A3015FS | 3 Syringe | 3x0.5 cc | Porcine A3015FE | 3 Syringe | 3x0.5 cc | Equine A3030FS | 3 Syringe | 3x1.0 cc | Porcine A3030FE | 3 Syringe | 3x1.0 cc | Equine Evolution EV02LLE | 20x20 mm | Fine | Equine EV02HHE | 20x20 mm | Standard | Equine EV03LLE | 30x30 mm | Fine | Equine EV03HHE | 30x30 mm | Standard | Equine EVOLLE | 25x35 mm (oval) | Fine | Equine EVOHHE | 25x35 mm (oval) | Standard | Equine Tissue of origin Pre-hydrated collagenated heterologous Tissue of origin Heterologous collagen membrane cortico-cancellous bone mix Tissue collagen Preserved Tissue collagen Preserved + 10% additional collagen gel Physical form Dried membrane with one smooth side and one Physical form Pre-hydrated granules and collagen gel micro-rough side Composition 90% granulated mix, 10% collagen gel Composition 100% pericardium Granulometry 600-1000 µm Thickness Fine: 0.4 mm (±0.1). Standard: 0.6 mm (±0.1) Re-entry time About 5 months Resorption time Fine: approx 3 months. Standard: approx 4 Packaging Syringe: 1.0 cc, 3x0.5 cc, 3x1.0 cc months Packaging Fine: 20x20 mm, 30x30 mm, 25x35 mm (oval) For more information on OsteoBiol® mp3 see page 64 Standard: 20x20 mm, 30x30 mm, 25x35 mm (oval) For more information on OsteoBiol® Evolution see page 78 26
  • 25. OsteoBiol® products description CLINICAL INDICATIONS DEHISCENCES AND FENESTRATIONSThe entire OsteoBiol® line consists of The exclusive Tecnoss® manufacturing SCIENTIFIC LITERATURE ON DEHISCENCE ANDxenografts, i.e. biomaterials deriving from process guarantees an exceptional FENESTRATION GBR WITH OSTEOBIOL® PRODUCTSheterologous bone. malleability and plasticity(12): furthermore BARONE A, AMERI S, COVANI U the syringe packaging gives Putty IMMEDIATE POSTEXTRACTION IMPLANTS: TREATMENTThe Tecnoss patented manufacturing ® OF RESIDUAL PERI-IMPLANT DEFECTS. A extraordinary handling properties making RETROSPECTIVE ANALYSISprocess used to obtain these materials is EUROPEAN JOURNAL OF IMPLANT PROSTHODONTICS, this product the ideal choice for peri 2006, 2: 99-106able to achieve biocompatibility preserving implant defects with intact bony walls. COVANI U, BARONE A, CORNELINI R, CRESPI Rpart of the collagen matrix of the animal CLINICAL OUTCOME OF IMPLANTS PLACEDbone and avoiding at the same time high IMMEDIATELY AFTER IMPLANT REMOVAL JOURNAL OF PERIODONTOLOGY, 2006 APR;77(4):722-7temperatures that would cause COVANI U, CORNELINI R, BARONE Aceramization of the granules: the result is a BUCCAL BONE AUGMENTATION AROUND IMMEDIATEunique particulate material, consisting of IMPLANTS WITH AND WITHOUT FLAP ELEVATION: A MODIFIED APPROACHmineral component and organic matrix, OsteoBiol® Putty | For more information see page 68 INTERNATIONAL JOURNAL OF ORAL AND MAXILLOFACIAL Source: Tecnoss® Dental Media Library IMPLANTS, 2008 SEP-OCT;23(5):841-6with a porous surface extremely similar to COVANI U, MARCONCINI S, CRESPI R, BARONE Aautogenous bone and able to resorb IMMEDIATE IMPLANT PLACEMENT AFTER REMOVAL OFprogressively while new bone formation A FAILED IMPLANT: A CLINICAL AND HISTOLOGICAL CASE REPORTtakes place(10). JOURNAL OF ORAL IMPLANTOLOGY, 2009; 35(4):189-95 SLOTTE C, LINDFORS N, NANNMARK UThese cortical and cancellous particles SURGICAL RECONSTRUCTION OF PERI-IMPLANT BONEhave been mixed in various proportions DEFECTS WITH PREHYDRATED AND COLLAGENATED PORCINE BONE AND COLLAGEN BARRIERS: CASEand granulometries with and without PRESENTATIONS CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH,collagen gel, in order to develop various 2011 DEC 6, EPUB AHEAD OF PRINTproducts aimed at different clinicalindications: the OsteoBiol® materialsindicated for dehiscence regeneration areOsteoBiol® Gen-Os and OsteoBiol® Putty. OsteoBiol® Evolution | For more information see page 78OsteoBiol® Gen-Os is a cortico-cancellous Source: Tecnoss® Dental Media Librarycollagenated bone mix with 250-1000 µm rehabilitation(11).granulometry packed in a sterile vial: due In case partially compromised bone walls,to its collagen content, once hydrated with an OsteoBiol® Evolution membrane issaline, it allows an excellent graft stability recommended: Evolution pericardiumwhile its hydrophilia guarantees quick membranes efficiently contain andblood absorption and therefore the stabilize the Gen-Os graft, guarantee annecessary graft vascularization. Its efficient barrier effect, favour the correctcortico-cancellous composition allows a wound healing and do not get infected inprogressive resorption of osteoclastic type, case of exposure.with in parallel a similar rate of new boneformation(10). These unique properties OsteoBiol® Putty is a collagen gel matrixallow a very good graft volume loaded for 80% of its volume withpreservation, a healthy new bony tissue micronized cortico-cancellous boneand ultimately, a successful implant particles (granulometry up to 300 µm) OsteoBiol® Putty grafted in a fenestration defect packed in a sterile syringe. Source: Courtesy of Dr Bernd Siewert, Madrid, Spain 27
  • 26. Case reportPeri-implant bone regeneration on 1.1 e 2.1 Sex: male | Age: 60 Fig. 1 OPT exam: the defect area is 1.2 Fig. 2 Clinical inspection of edentulous area 1.2 Fig. 3 Implant placed with a significant vestibular dehiscence Fig. 4 A considerable bone resorption is evident from the occlusal view Fig. 5 An OsteoBiol® Evolution standardFig. 1 Fig. 2 Fig. 3 membrane is fixed to the palatal bone Fig. 6 OsteoBiol® mp3 is grafted into the defect Fig. 7 Self-contained defect fully filled with OsteoBiol® mp3 Fig. 8 The membrane is adapted to the vestibular side and soaked with blood Fig. 9 SutureFig. 4 Fig. 5 Fig. 6 Documentation provided by Dr. Giuseppe Fama’Fig. 7 Fig. 8 Fig. 9 MD - DDS Private Practitioners in Perugia, Italy e-mail: pino@famadental.com www.famadental.com (Sezione Gruppo Implantazio) Bone substitute: OsteoBiol® mp3 For more information on OsteoBiol® mp3 see page 64 Membrane: OsteoBiol® Evolution For more information on OsteoBiol® Evolution see page 7828
  • 27. Case report CLINICAL INDICATIONS DEHISCENCES AND FENESTRATIONSTreatment of peri-implant defect after post-extractive implant placement Sex: female | Age: 32 Fig. 1 Preliminary panoramic view Fig. 2 Denta scan shows internal root resorption of tooth 1.1 Fig. 3 Buccal view Fig. 4 Palatal view Fig. 5 Occlusal view after extractionFig. 1 Fig. 2 Fig. 3 Fig. 6 Osteotomy performed Fig. 7 Implant in place Fig. 8 Peri-implant gap grafted with OsteoBiol® Putty Fig. 9 Free gingival graft harvested from the palate Fig. 10 Occlusal view Fig. 11 Buccal view Fig. 12 Temporary restoration in placeFig. 4 Fig. 5 Fig. 6Fig. 7 Fig. 8 Fig. 9 Documentation provided by Dr Roberto Rossi M.Sc.D. in Periodontology, Genova, Italy e-mail: drrossi@mac.it Bone substitute: OsteoBiol® Putty For more information on OsteoBiol® Putty see page 68Fig. 10 Fig. 11 Fig. 12 29
  • 28. Osteotome sinus floor augmentationCrestal access sinus lift Crestal access sinus lift performed with OsteoBiol® Gel 40 Source: Courtesy of Prof Dr Jose Louis Calvo Guirado, Murcia, Spain
  • 29. Characteristics CLINICAL INDICATIONS CRESTAL ACCESS SINUS LIFTDEFECT ORIGIN AND DESCRIPTION In year 1996 the Consensus Conference properly grafted BIBLIOGRAPHY | PAGES 31-33After the loss of dental elements alveolar came to the conclusion that sinus floor >> The implant is inserted and soft tissues (1) JENSEN OT, SHULMANN LB, BLOCK MS, IACONO VJbone starts resorbing due to the absence elevation is an effective bone restoration REPORT OF THE SINUS CONSENSUS CONFERENCE are suturedof mechanical solicitation transmitted by procedure in the upper jaw, with highly INTERNATIONAL JOURNAL OF ORAL AND MAXILLOFACIAL IMPLANTS (1998); 13: 9-41dental roots. In the maxilla such bone predictable results(1). Through a little crestal breach and the (2) SUMMERS RBresorption process is complicated by the proper use of osteotomes and hammer, A NEW CONCEPT IN MAXILLARY IMPLANT SURGERY: The crestal access approach with THE OSTEOTOME TECHNIQUEmaxillary sinus, a cavity which undergoes the biomaterial can be pushed into the osteotomes for sinus floor elevation was COMPENDIUM OF CONTINUING EDUCATION IN DENTISTRYpneumatization expanding progressively sinus cavity and, on the base of the (1994); 15: 152-158 first published in 1994 by Summers(2) andinto the space previously occupied by physical principle called Pascal Law, the (3) NANNMARK U, SENNERBY L can briefly described as follows: THE BONE TISSUE RESPONSES TO PREHYDRATED ANDalveolar bone. Schneider membrane can be elevated, due COLLAGENATED CORTICO-CANCELLOUS PORCINE >> Elevation of a total thickness flap in to the increase of hydraulic pressure under BONE GRAFTS. A STUDY IN RABBIT MAXILLARY DEFECTSREGENERATION PROCEDURES order to expose the crestal bone; with the membrane itself. CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, 2008, 10: 264-270Athrophic maxillary alveolar bone needs proper osteotomes and burs the implantregeneration in order to restore the ideal With this technique it is possible to (4) NANNMARK U, AZARMEHR I site is prepared and the cortical plate isconditions for placement of endosseous simultaneously insert implants, in presence COLLAGENATED CORTICO-CANCELLOUS PORCINE fractured BONE GRAFTS. A STUDY IN RABBIT MAXILLARYimplants of proper diameter and height. of a residual bone height of 5-6 mm and a DEFECTS IN PRESS >> The biomaterial is introduced and sinus floor elevation of 4-5 mm. (5) BARONE A, CORNELINI R, CIAGLIA R, COVANI U IMPLANT PLACEMENT IN FRESH EXTRACTION SOCKETS AND SIMULTANEOUS OSTEOTOME SINUS FLOOR ELEVATION: A CASE SERIES INTERNATIONAL JOURNAL OF PERIODONTICS AND RESTORATIVE DENTISTRY, 2008, 28:283-289Source: Tecnoss® Dental Media Library Maxillary Sinus grafted with OsteoBiol® Gel 40 | For more information see page 72 Source: Tecnoss® Dental Media Library 31
  • 30. Crestal access sinus lift OsteoBiol® product range PRODUCT CODES Gel 40 05GEL40S | 1 Syringe | 0.5 cc | Porcine 05GEL40E | 1 Syringe | 0.5 cc | Equine 15GEL40S | 3 Syringe | 3x0.5 cc | Porcine 15GEL40E | 3 Syringe | 3x0.5 cc | Equine Gen-Os M1052FS | 1 Vial | 0.25 g | Porcine M1052FE | 1 Vial | 0.25 g | Equine M1005FS | 1 Vial | 0.5 g | Porcine M1005FE | 1 Vial | 0.5 g | Equine Tissue of origin Pre-hydrated collagenated heterologous Tissue of origin Collagenated heterologous cortico-cancellous M1010FS | 1 Vial | 1.0 g | Porcine cortico-cancellous bone gel bone mix M1010FE | 1 Vial | 1.0 g | Equine Tissue collagen Preserved + 40% additional collagen gel Tissue collagen Preserved M1020FS | 1 Vial | 2.0 g | Porcine Physical form Collagen gel type I and III loaded with 60% Physical form Slightly radiopaque granules M1020FE | 1 Vial | 2.0 g | Equine collagenated bone mix Composition 100% granulated mix Composition 60% granulated mix, 40% collagen gel Granulometry 250-1000 µm Granulometry Up to 300 µm Re-entry time 4/5 months, depending on grafting site Putty Re-entry time About 4 months characteristics HPT09S | 1 Syringe | 0.5 cc | Porcine Packaging Syringe: 0.5 cc, 3x0.5 cc Packaging Vial: 0.25 g, 0.5 g, 1.0 g, 2.0 g HPT09E | 1 Syringe | 0.5 cc | Equine For more information on OsteoBiol® Gel 40 see page 72 For more information on OsteoBiol® Gen-Os see page 60 HPT35S | 3 Syringe | 3x0.5 cc | Porcine HPT35E | 3 Syringe | 3x0.5 cc | Equine HPT32S | 3 Syringe | 3x0.25 cc | Porcine HPT32E | 3 Syringe | 3x0.25 cc | Equine Tissue of origin Pre-hydrated collagenated heterologous cortico-cancellous bone paste Tissue collagen Preserved + 20% additional collagen gel Physical form Plastic consistency composed of collagen gel loaded with 80% micronized bone mix Composition 80% granulated mix, 20% collagen gel Granulometry Up to 300 µm Re-entry time About 4 months Packaging Syringe: 0.5 cc, 3x0.5 cc, 3x0.25 cc For more information on OsteoBiol® Putty see page 68 32
  • 31. OsteoBiol® products description CLINICAL INDICATIONS CRESTAL ACCESS SINUS LIFTThe entire OsteoBiol® line consists of These unique properties allow a very good The “soft” consistency of Gel 40 is suitable SCIENTIFIC LITERATURE ON CRESTAL ACCESS SINUS LIFTxenografts, i.e. biomaterials deriving from graft volume preservation, a healthy new to lift the Schneider membrane using the WITH OSTEOBIOL® PRODUCTSheterologous bone. The Tecnoss® patented bony tissue and ultimately, a successful syringe pressure, reducing laceration risk BARONE A, CORNELINI R, CIAGLIA R, COVANI Umanufacturing process used to obtain implant rehabilitation. Gel 40 is a collagen to minimum and allowing a tight IMPLANT PLACEMENT IN FRESH EXTRACTION SOCKETS AND SIMULTANEOUS OSTEOTOME SINUS FLOORthese materials is able to achieve gel matrix loaded for 60% of its volume positioning of the biomaterial around the ELEVATION: A CASE SERIES INTERNATIONAL JOURNAL OF PERIODONTICS ANDbiocompatibility preserving part of the with micronized cortico-cancellous bone implant threads. RESTORATIVE DENTISTRY, 2008 JUN;28(3):283-9collagen matrix of the animal bone and particles (granulometry up to 300 µm) CALVO GUIRADO JL, GOMEZ MORENO G, LOPEZ MARI L,avoiding at the same time high packed in a sterile syringe. ORTIZ RUIZ AJ, GUARDIA J ATRAUMATIC MAXILLARY SINUS ELEVATION USINGtemperatures that would cause THREADED BONE DILATORS FOR IMMEDIATE The exclusive Tecnoss® manufacturing IMPLANTS. A THREE-YEAR CLINICAL STUDYceramization of the granules: the result is a process guarantees an exceptional MEDICINA ORAL, PATOLOGIA ORAL Y CIRUGIA BUCAL, 2010unique particulate material, consisting of MAR 1;15(2):E366-70 malleability and plasticity: furthermore themineral component and organic matrix, syringe packaging gives Gel 40with a porous surface extremely similar to extraordinary handling properties(5)autogenous bone and able to resorb making this product the ideal choice forprogressively while new bone formation crestal access sinus lift (squeezetakes place(3). technique). OsteoBiol® Gel 40 | For more information see page 72These cortical and cancellous particles Source: Tecnoss® Dental Media Libraryhave been mixed in various proportionsand granulometries with collagen gel, inorder to develop various products aimedat different clinical indications: the specificmaterials for crestal access sinus lift areOsteoBiol® Gen-Os (osteotome andhammer technique), OsteoBiol® Gel 40(4)and OsteoBiol® Putty.Gen-Os is a cortico-cancellouscollagenated bone mix with 250-1000 µmgranulometry packed in a sterile vial: dueto its collagen content, once hydrated withsaline, it allows an excellent graft stabilitywhile its hydrophilia guarantees quickblood absorption and therefore thenecessary graft vascularization.Its cortico-cancellous composition allows aprogressive resorption of osteoclastic type,with in parallel a similar rate of new boneformation(3). Crestal access sinus lift grafted with OsteoBiol® Putty | For more information see page 68 Source: Courtesy of Dr Roberto Rossi, Genova, Italy 33
  • 32. Case reportCrestal access sinus lift Sex: male | Age: 45 Fig. 1 Pre-operative panoramic x-ray Fig. 2 Initial situation, the three missing teeth will be replaced by three single prothesis Fig. 3 Flap opening and crest exposure, an horizontal defect is also present Fig. 4 Osteotomy is performed on the three sites Fig. 5 Maxillary sinus lifted with OsteoBiol®Fig. 1 Fig. 2 Fig. 3 Gel 40 Fig. 6 Grafting has been completed and implants can now be inserted Fig. 7 Three implants placed into position Fig. 8 A mix of autologous bone and OsteoBiol® Gel 40 is prepared Fig. 9 The bone/biomaterials mixture is grafted on the vestibular side of the defect to complete the horizontal augmentation Fig. 10 Flaps are repositioned and suturedFig. 4 Fig. 5 Fig. 6 Fig. 11 Post-operative panoramic x-ray Fig. 12 Final situationFig. 7 Fig. 8 Fig. 9 Documentation provided by Prof Dr Jose Luis Calvo Guirado University of Murcia, Spain e-mail: josecalvog@ono.com Bone substitute: OsteoBiol® Gel 40 For more information on OsteoBiol® Gel 40 see page 72Fig. 10 Fig. 11 Fig. 1234
  • 33. Case report CLINICAL INDICATIONS CRESTAL ACCESS SINUS LIFTCrestal access sinus lift, x-ray analysis Sex: female | Age: 43 Fig. 1 Initial x-ray Fig. 2 Control x-ray before osteotomy Fig. 3 Measuring before osteotomy Fig. 4 Maxillary sinus lifted with OsteoBiol® Putty Fig. 5 Implant placed in the grafted site: final x-ray Fig. 6 Implant placed in the grafted site: final x-rayFig. 1 Fig. 2Fig. 3 Fig. 4 Documentation provided by Dr Roberto Rossi M.Sc.D in Periodontology, Genova, Italy e-mail: drrossi@mac.it Bone substitute: OsteoBiol® Putty For more information on OsteoBiol® Putty see page 68Fig. 5 Fig. 6 35
  • 34. Maxillary sinus augmentationLateral access sinus lift Maxillary sinus grafted with OsteoBiol® mp3 Source: Courtesy of Dr Antonio Barone, Lido di Camaiore, Italy
  • 35. Characteristics CLINICAL INDICATIONS LATERAL ACCESS SINUS LIFTDEFECT ORIGIN AND DESCRIPTION REGENERATION PROCEDURES >> The sinus mucosa is carefully BIBLIOGRAPHY | PAGES 37-39After the loss of dental elements alveolar Athrophic maxillary alveolar bone needs dissected and elevated. The bony wall is (1) JENSEN OT, SHULMANN LB, BLOCK MS, IACONO VJbone starts resorbing due to the absence regeneration in order to restore the ideal gently pushed inside the sinus cavity to REPORT OF THE SINUS CONSENSUS CONFERENCEof mechanical solicitation transmitted by conditions for placement of endosseous form the roof of the graft INTERNATIONAL JOURNAL OF ORAL AND MAXILLOFACIAL IMPLANTS (1998); 13: 9-41dental roots. implants of proper diameter and height. >> Sinus cavity is grafted with (2) BOYNE PJ, JAMES RA GRAFTING OF THE MAXILLARY SINUS FLOOR WITHIn the maxilla such bone resorption In year 1996 the Consensus Conference biomaterial, a resorbable membrane is AUTOGENOUS MARROW AND BONEprocess is complicated by the maxillary came to the conclusion that sinus floor applied to cover the bony window in order JOURNAL OF ORAL SURGERY (1980); 38: 613-616sinus, a cavity which undergoes elevation is an effective bone restoration to protect and stabilize the graft and then (3) NANNMARK U, PALACCI P MAXILLARY SINUS AUGMENTATION USINGpneumatization expanding progressively procedure in the upper jaw, with highly soft tissues are sutured COLLAGENATED CORTICO-CANCELLOUS PORCINE BONE IN A ONE-STEP PROCEDURE. A CASE REPORTinto the space previously occupied by predictable results(1). Implants can be simultaneously placed L’INFORMATION DENTAIRE, 2011 JUN, 23:19-23alveolar bone. during the sinus lift procedure(3) if at least (4) NANNMARK U, SENNERBY L The lateral access approach for sinus floor THE BONE TISSUE RESPONSES TO PREHYDRATED AND elevation was first published in 1980 by 3-4 mm of residual crestal bone is COLLAGENATED CORTICO-CANCELLOUS PORCINE BONE GRAFTS. A STUDY IN RABBIT MAXILLARY Boyne and James(2) and subsequently available, essential to guarantee a good DEFECTS modified by other clinicians. primary stability of implants. CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, 2008, 10: 264-270 In brief, the operative phases of this In absence of this minimal bone height, (5) BARONE A, RICCI M, COVANI U, NANNMARK U, AZARMEHR I, CALVO GUIRADO JL technique are the following: implant placement has to be postponed a MAXILLARY SINUS AUGMENTATION USING few months after sinus lift procedure (5-7 PREHYDRATED CORTICOCANCELLOUS PORCINE BONE: >> Elevation of a total thickness flap to months), when sufficient new regenerated HYSTOMORPHOMETRIC EVALUATION AFTER 6 MONTHS CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, uncover the anterior wall of maxillary sinus bone will guarantee stability. 2010 MAY 11 EPUB and consequent opening of a bony (6) BARONE A, MARCONCINI S, SANTINI S, COVANI U OSTEOTOMY AND MEMBRANE ELEVATION DURING THE window in this site to uncover Schneider MAXILLARY SINUS AUGMENTATION PROCEDURE. membrane A COMPARATIVE STUDY: PIEZOELECTRIC DEVICE VS. CONVENTIONAL ROTATIVE INSTRUMENTS CLINICAL ORAL IMPLANTS RESEARCH, 2008, 19: 511-515 (7) BARONE A, CRESPI R, ALDINI NN, FINI M, GIARDINO R, COVANI U MAXILLARY SINUS AUGMENTATION: HISTOLOGIC AND HISTOMORPHOMETRIC ANALYSIS INTERNATIONAL JOURNAL OF ORAL AND MAXILLOFACIAL IMPLANTS, 2005 JUL-AUG;20(4):519-25Maxillary sinus grafted with OsteoBiol® mp3 Maxillary sinus grafted with OsteoBiol® Gen-Os Antrostomy covered with OsteoBiol® EvolutionFor more informtation see page 64 For more informtation see page 60 For more informtation see page 78Source: Tecnoss® Dental Media Library Source: Tecnoss® Dental Media Library Source: Tecnoss® Dental Media Library 37
  • 36. Lateral access sinus lift OsteoBiol® product range PRODUCT CODES mp3 A3005FS | 1 Syringe | 1.0 cc | Porcine A3005FE | 1 Syringe | 1.0 cc | Equine A3015FS | 3 Syringe | 3x0.5 cc | Porcine A3015FE | 3 Syringe | 3x0.5 cc | Equine A3030FS | 3 Syringe | 3x1.0 cc | Porcine A3030FE | 3 Syringe | 3x1.0 cc | Equine Gen-Os M1052FS | 1 Vial | 0.25 g | Porcine M1052FE | 1 Vial | 0.25 g | Equine Tissue of origin Pre-hydrated collagenated heterologous Tissue of origin Collagenated heterologous cortico-cancellous M1005FS | 1 Vial | 0.5 g | Porcine cortico-cancellous bone mix bone mix M1005FE | 1 Vial | 0.5 g | Equine Tissue collagen Preserved + 10% additional collagen gel Tissue collagen Preserved M1010FS | 1 Vial | 1.0 g | Porcine Physical form Pre-hydrated granules and collagen gel Physical form Slightly radiopaque granules M1010FE | 1 Vial | 1.0 g | Equine Composition 90% granulated mix, 10% collagen gel Composition 100% granulated mix Granulometry 600-1000 µm Granulometry 250-1000 µm M1020FS | 1 Vial | 2.0 g | Porcine Re-entry time About 5 months Re-entry time 4/5 months, depending on grafting site M1020FE | 1 Vial | 2.0 g | Equine Packaging Syringe: 1.0 cc, 3x0.5 cc, 3x1.0 cc characteristics Packaging Vial: 0.25 g, 0.5 g, 1.0 g, 2.0 g For more information on OsteoBiol® mp3 see page 64 Evolution For more information on OsteoBiol® Gen-Os see page 60 EV02LLE | 20x20 mm | Fine | Equine EV02HHE | 20x20 mm | Standard | Equine EV03LLE | 30x30 mm | Fine | Equine EV03HHE | 30x30 mm | Standard | Equine EVOLLE | 25x35mm (oval) | Fine | Equine EVOHHE | 25x35mm (oval) | Standard | Equine Tissue of origin Heterologous collagen membrane Tissue collagen Preserved Physical form Dried membrane with one smooth side and one micro-rough side Composition 100% pericardium Thickness Fine: 0.4 mm (±0.1). Standard: 0.6 mm (±0.1) Resorption time Fine: approx 3 months. Standard: approx 4 months Packaging Fine: 20x20 mm, 30x30 mm, 25x35 mm (oval) Standard: 20x20 mm, 30x30 mm, 25x35 mm (oval) For more information on OsteoBiol® Evolution see page 78 38
  • 37. OsteoBiol® products description CLINICAL INDICATIONS LATERAL ACCESS SINUS LIFTThe entire OsteoBiol® line consists of mp3, a pre-hydrated cortico-cancellous These unique properties allow a very good SCIENTIFIC LITERATURE ON LATERAL ACCESS SINUS LIFTxenografts, i.e. biomaterials deriving from bone mix with 10% collagen gel is a “ready graft volume preservation, a healthy new WITH OSTEOBIOL® PRODUCTSheterologous bone. to use” product packed in a sterile syringe: bony tissue and ultimately, a successful BARONE A, CRESPI R, ALDINI NN, FINI M, GIARDINO R, the mp3 syringe can be directly applied implant rehabilitation. COVANI UThe Tecnoss patented manufacturing ® MAXILLARY SINUS AUGMENTATION: HISTOLOGIC AND into the bony window without having to HISTOMORPHOMETRIC ANALYSISprocess used to obtain these materials is Another OsteoBiol® material successfully INTERNATIONAL JOURNAL OF ORAL AND MAXILLOFACIAL mix mp3 granules with saline. IMPLANTS, 2005 JUL-AUG;20(4):519-25able to achieve biocompatibility preserving used in lateral access sinus lift is Gen-Os,part of the collagen matrix of the animal Due to its collagen gel content, mp3 allows a cortico-cancellous collagenated bone BARONE A, SANTINI S, SBORDONE L, CRESPI R, COVANI U A CLINICAL STUDY OF THE OUTCOMES ANDbone and avoiding at the same time high an excellent graft stability while its mix with 250-1000 µm granulometry COMPLICATIONS ASSOCIATED WITH MAXILLARY SINUS AUGMENTATIONtemperatures that would cause hydrophilia guarantees quick blood packed in a sterile vial. Gen-Os can be INTERNATIONAL JOURNAL OF ORAL AND MAXILLOFACIALceramization of the granules: the result is a absorption and therefore the necessary grafted alone or in combination with IMPLANTS, 2006 JAN-FEB;21(1):81-5unique particulate material, consisting of graft vascularization. autogenous bone(7). ORSINI G, SCARANO A, PIATTELLI M, PICCIRILLI M, CAPUTI S, PIATTELLI Amineral component and organic matrix, HISTOLOGIC AND ULTRASTRUCTURAL ANALYSIS OF Its cortico-cancellous composition allows a REGENERATED BONE IN MAXILLARY SINUSwith a porous surface extremely similar to progressive resorption of osteoclastic type, AUGMENTATION USING A PORCINE BONE-DERIVEDautogenous bone and able to resorb BIOMATERIAL with in parallel a similar rate of new bone JOURNAL OF PERIODONTOLOGY, 2006 DEC;77(12):1984-90progressively while new bone formation formation(4). SCARANO A, PIATTELLI A, PERROTTI V, MANZON L, IEZZI Gtakes place(4). MAXILLARY SINUS AUGMENTATION IN HUMANS USING CORTICAL PORCINE BONE: A HISTOLOGICAL ANDThese cortical and cancellous particles HISTOMORPHOMETRICAL EVALUATION AFTER 4 AND 6 MONTHShave been mixed in various proportions CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, 2009and granulometries with collagen gel, in BARONE A, RICCI M, COVANI U, NANNMARK U, AZARMEHR I,order to develops various products aimed CALVO GUIRADO JL MAXILLARY SINUS AUGMENTATION USING PREHYDRATEDat specific clinical indications: the specific CORTICOCANCELLOUS PORCINE BONE: HYSTOMORPHOMETRIC EVALUATION AFTER 6 MONTHSmaterial for lateral access sinus lift is CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, 2010OsteoBiol® mp3(5,6), while OsteoBiol® MAY 11 EPUBEvolution is the recommended resorbable SCARANO A, PIATTELLI A, ASSENZA B, QUARANTA A, PERROTTI V, PIATTELLI M, IEZZI Gmembrane to cover the bony window. PORCINE BONE USED IN SINUS AUGMENTATION PROCEDURES: A 5-YEAR RETROSPECTIVE CLINICAL EVALUATION JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, 2010 AUG; 68(8):1869-73 PAGLIANI L, ANDERSSON P LANZA M, NAPPO A, VERROCCHI D, , VOLPE S, SENNERBY L A COLLAGENATED PORCINE BONE SUBSTITUTE FOR AUGMENTATION AT NEOSS IMPLANT SITES: A PROSPECTIVE 1-YEAR MULTICENTER CASE SERIES STUDY WITH HISTOLOGY CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, 2010 OCT 26, EPUB AHEAD OF PRINT BARONE A, ORLANDO B, TONELLI P COVANI U , SURVIVAL RATE FOR IMPLANTS PLACED IN THE POSTERIOR MAXILLA WITH AND WITHOUT SINUS AUGMENTATION: A COMPARATIVE COHORT STUDY JOURNAL OF PERIODONTOLOGY, 2011 FEB; 82(2):219-26 IEZZI G, DEGIDI M, PIATTELLI A, MANGANO C, SCARANO A, SHIBLI JA, PERROTTI V COMPARATIVE HISTOLOGICAL RESULTS OF DIFFERENT BIOMATERIALS USED IN SINUS AUGMENTATION PROCEDURES: A HUMAN STUDY AT 6 MONTHSOsteoBiol® Evolution | For more information see page 78 OsteoBiol® mp3 | For more information see page 64 2011 NOV 2, EPUB AHEAD OF PRINTSource: Tecnoss® Dental Media Library Source: Tecnoss® Dental Media Library 39
  • 38. Case reportBilateral sinus lift with lateral access Sex: female | Age: 46 Fig. 1 Preoperative panoramic x-ray image showing a severe maxillary atrophy in left posterior region Fig. 2 Osteotomy to access the left maxillary sinus Fig. 3 Autogenous bone chips collected with bone scraper from the tuberosity and anterior wall of the maxilla Fig. 4 Intraoral image showing the left maxillaryFig. 1 Fig. 2 Fig. 3 sinus filled with OsteoBiol® mp3: note also the grafting over the bucal concavity Fig. 5 Intraoral image showing the left maxillary sinus filled with OsteoBiol® mp3 Fig. 6 A properly trimmed OsteoBiol® Special membrane was placed for left maxillary sinus antrostomy covering Fig. 7 Postoperative panoramic X-ray image after 8 months of healing Fig. 8 Implant placement and restorationFig. 4 Fig. 5 Fig. 6 Fig. 9 Restoration in placeFig. 7 Fig. 8 Fig. 9 Documentation provided by Dr Bruno Negri Alicante, Spain e-mail: brunonegri2000@yahoo.com Prof Dr José Luis Calvo Guirado Murcia, Spain e-mail: josecalvog@ono.com Bone substitute: OsteoBiol® mp3 For more information on OsteoBiol® mp3 see page 64 Membrane: OsteoBiol® Special For more information on OsteoBiol® Special see page 9240
  • 39. Case report CLINICAL INDICATIONS LATERAL ACCESS SINUS LIFTLateral access sinus lift with simultaneous implant and horizontal augmentation Sex: female | Age: 42 Fig. 1 Initial x-ray showing a 3mm residual bone Fig. 2 Flap opening, a substantial vestibular bone resorption can be determined Fig. 3 Antrostomy performed with Piezo surgery technique Fig. 4 A OsteoBiol® Evolution membrane is inserted through the antrostomy to protect the Schneider membrane from grafting materialFig. 1 Fig. 2 Fig. 3 Fig. 5 Maxillary sinus grafted with OsteoBiol® mp3 Fig. 6 Immediate implant placement Fig. 7 A OsteoBiol® Evolution membrane is stabilised with osteosynthesis screws above the antrostomy Fig. 8 Cortical bone stimulation Fig. 9 OsteoBiol® mp3 is grafted on the vestibular side of the defect for horizontal augmentation Fig. 10 The OsteoBiol® Evolution membrane isFig. 4 Fig. 5 Fig. 6 stabilised into position with a transpalatal suture Fig. 11 Final situation Fig. 12 Post-operative x-rayFig. 7 Fig. 8 Fig. 9 Documentation provided by Dr Rosario Sentineri Private practitioner in Genova, Italy e-mail: rosario.sentineri@gmail.com Bone substitute: OsteoBiol® mp3 For more information on OsteoBiol® mp3 see page 64 Membrane: OsteoBiol® Evolution For more information on OsteoBiol® Evolution see page 78Fig. 10 Fig. 11 Fig. 12 41
  • 40. Horizontal and vertical augmentation Two-wall defects|Ridge split technique|Inlay technique Horizontal augmentation beyond the skeletal envelope Source: Courtesy of Dr Luca Giovanni Maria Pagliani, Milano, Italy
  • 41. Characteristics CLINICAL INDICATIONS HORIZONTAL AND VERTICAL AUGMENTATIONDEFECT ORIGIN AND DESCRIPTION REGENERATION PROCEDURES BIBLIOGRAPHY | PAGES 43-45Common sites for horizontal ridge The gold standard for rehabilitation of (1) VON ARX T, BUSER Daugmentation are the anterior (esthetic) horizontal and/or vertical ridge defects is HORIZONTAL RIDGE AUGMENTATION USING AUTOGENOUS BLOCK GRAFTS AND THE GUIDED BONEzone in the maxilla and the posterior area considered autogenous block graft(3-4). REGENERATION TECHNIQUE WITH COLLAGEN MEMBRANES: A CLINICAL STUDY WITH 42 PATIENTSin the mandible. These blocks can be harvested from CLINICAL ORAL IMPLANTS RESEARCH (2006); 17(4):359-66While traumatic tooth loss mostly affects intra-oral or extra-oral sites and they can (2) CAWOOD JI, HOWELL RA A CLASSIFICATION OF THE EDENTULOUS JAWSadolescents and young adults, resulting in be inserted into the recipient site with two INTERNATIONAL JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY (1988);17(4):232-6bone deficiencies in the anterior maxilla, different modalities: as onlay grafts or OsteoBiol® Sp-Block OsteoBiol® Gen-Osmandibular bone atrophy is often found in inlay grafts. (3) MARX RE CLINICAL APPLICATION OF BONE BIOLOGY TOthe posterior segments in elderly people MANDIBULAR AND MAXILLARY RECONSTRUCTION Whatever is the applied technique, it is CLINICAL PLASTIC SURGERY (1994);21(3):377-92. REVIEWwho may have long-standing narrow recommended to fill the gaps of block with (4) PIKOS MAridges following premature tooth loss a biomaterial in granules(5) to achieve the BLOCK AUTOGRAFTS FOR LOCALIZED RIDGEbecause of endodontic or periodontal AUGMENTATION: PART I. THE POSTERIOR MAXILLA desired volume and contour for the IMPLANT DENTISTRY (1999);8(3):279-85problems. augmented recipient site. (5) BARONE A, COVANI U MAXILLARY ALVEOLAR RIDGE RECONSTRUCTION WITHHorizontal ridge augmentation of a In order to minimize block graft resorption, NONVASCULARIZED AUTOGENOUS BLOCK BONE:deficient alveolar bone site is performed CLINICAL RESULTS several studies suggested to protect blocks JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, 2007,either simultaneously with implant 65: 2039-2046 with resorbable barrier membranes(1,4).placement, or with a staged approach OsteoBiol® mp3 OsteoBiol® Curved Lamina (6) NANNMARK U, SENNERBY Lprior to implant insertion. Ridge splitting is an alternative technique Horizontal defect grafted respectively with OsteoBiol® Sp-Block, OsteoBiol® Gen-Os, OsteoBiol® mp3 THE BONE TISSUE RESPONSES TO PREHYDRATED AND COLLAGENATED CORTICO-CANCELLOUS PORCINE for horizontal ridge augmentation. The and OsteoBiol® Curved Lamina BONE GRAFTS. A STUDY IN RABBIT MAXILLARYThe main criteria to consider when Source: Tecnoss® Dental Media Library DEFECTS surgical technique can be schematized as CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH,choosing the procedure are the residual the alveolar widening with proper The major benefit of crestal widening is 2008, 10: 264-270bone volume needed to allow correct osteotomes and chisels which produces a that the thin alveolar bone can be utilized (7) CALVO GUIRADO JL, PARDO ZAMORA G,implant positioning, the bone density SAEZ YUGUERO MR greenstick fracture leaving the remaining for implantation and the implants placed RIDGE SPLITTING TECHNIQUE IN ATROPHIC ANTERIORneeded to achieve primary implant MAXILLA WITH IMMEDIATE IMPLANTS, BONE periosteum attached to the bone. This simultaneously with the bone expansionstability, and the defect morphology of the REGENERATION AND IMMEDIATE TEMPORISATION: A periosteally pedicled buccal cortex is procedure. CASE REPORTperi-implant bone defect. In the esthetic JOURNAL OF THE IRISH DENTAL ASSOCIATION, 2007, 53: repositioned and a new implant bed is 187-190zone, additional factors must be taken into Ongoing studies are investigating the created.account, such as the gingival biotype and efficacy of augmenting alveolar ridge withthe level of the lip line(1). The direction of forces by chisels should be significant horizontal and vertical aimed palatally to decrease the damage resorption, due to non-treated extraction,The classification of Cawood & Howell(2) is exerted on the fragile buccal plate. The with particulate xenogenic biomaterialscurrently the most comprehensive way of bone can be flexed to some extent due to covered and stabilized by heterologousclassifying edentulous jaws. This its elasticity. cortical bone foils properly fixed withclassification is considered the most osteosynthesis screws.comprehensive system at present and it is After this preparation of receiving site andinternationally recommended for after placing the implants, the resultingstandardization in reports of pre-prosthetic gap can be covered by resorbablesurgery. membrane and filled with particulate biomaterial. 43
  • 42. Horizontal and vertical augmentation OsteoBiol® product range PRODUCT CODES mp3 A3005FS | 1 Syringe | 1.0 cc | Porcine A3005FE | 1 Syringe | 1.0 cc | Equine A3015FS | 3 Syringe | 3 x 0.5 cc | Porcine A3015FE | 3 Syringe | 3 x 0.5 cc | Equine A3030FS | 3 Syringe | 3 x 1.0 cc | Porcine A3030FE | 3 Syringe | 3 x 1.0 cc | Equine Putty HPT09S | 1 Syringe | 0.5 cc | Porcine HPT09E | 1 Syringe | 0.5 cc | Equine HPT61S | 1 Syringe | 1.0 cc | Porcine Tissue of origin Pre-hydrated collagenated heterologous Tissue of origin Pre-hydrated collagenated heterologous HPT61E | 1 Syringe | 1.0 cc | Equine cortico-cancellous bone mix cortico-cancellous bone paste HPT35S | 3 Syringe | 3 x 0.5 cc | Porcine Tissue collagen Preserved + 10% additional collagen gel Tissue collagen Preserved + 20% additional collagen gel HPT35E | 3 Syringe | 3 x 0.5 cc | Equine Physical form Pre-hydrated granules and collagen gel Physical form Plastic consistency composed of collagen gel Composition 90% granulated mix, 10% collagen gel loaded with 80% micronized bone mix HPT32S | 3 Syringe | 3 x 0.25 cc | Porcine Granulometry 600-1000 µm Composition 80% granulated mix, 20% collagen gel HPT32E | 3 Syringe | 3 x 0.25 cc | Equine Re-entry time About 5 months Granulometry Up to 300 µm Sp-Block Packaging Syringe: 1.0 cc, 3x0.5 cc, 3x1.0 cc Re-entry time About 4 months BN0E |10x10x10 mm | Equine Packaging Syringe: 0.5 cc, 1.0 cc, 3x0.5 cc, 3x0.25 cc For more information on OsteoBiol® mp3 see page 64 BN1E |10x10x20 mm | Equine For more information on OsteoBiol® Putty see page 68 BN2E |10x20x20 mm | Equine BN8E | 35x10x5 mm | Equine Dual-Block STS7S | 20x15x5 mm | Porcine curved STN4B | 20x15x5 mm | Bovine STN5B | 20x10x5 mm | Bovine curved STN6B | 20x20x5 mm | Bovine curved Lamina LS03SS | 30x30x(2.0-4.0) mm | Standard | Porcine LS03SE | 30x30x(2.0-4.0) mm | Standard | Equine LS10HS | 35x35x(0.8-1.0) mm | Medium Curved | Porcine LS10HE | 35x35x(0.8-1.0) mm | Medium Curved | Equine LS25FS | 25x25x(0.4-0.6) mm | Fine | Porcine LS25FE | 25x25x(0.4-0.6) mm | Fine | Equine LS24FS | 20x40x(0.4-0.6) mm | Fine | Porcine LS24FE | 20x40x(0.4-0.6) mm | Fine | Equine LS23FS | 25x35x(0.4-0.6) mm (oval) | Fine | Porcine Tissue of origin Sp-Block: cancellous bone Tissue of origin Heterologous cortical bone LS23FE | 25x35x(0.4-0.6) mm (oval) | Fine | Equine Dual-Block: cortico-cancellous bone Tissue collagen Preserved Tissue collagen Preserved Physical form Rigid dried lamina, flexible after re-hydration Evolution Physical form Rigid dried block Thickness Standard (2.0-4.0 mm). EV02LLE | 20x20 mm | Fine | Equine Re-entry time About 8 months Medium Curved (0.8-1.0 mm). Fine (0.4-0.6 mm) EV02HHE | 20x20 mm | Standard | Equine Packaging Sterile blister Resorption time Standard: about 8 months. EV03LLE | 30x30 mm | Fine | Equine (for dimension references see column on the right) Medium Curved and Fine: about 6 months EV03HHE | 30x30 mm | Standard | Equine Packaging Standard: 30x30 mm, Medium Curved: 35x35 mm, For more information on OsteoBiol® Sp-Block see page 87 EVOLLE | 25x35 mm (oval) | Fine | Equine Fine: 25x25 mm, 20x40 mm, 25x35 mm (oval) For more information on OsteoBiol® Dual-Block see page 88 EVOHHE | 25x35 mm (oval) | Standard | Equine For more information on OsteoBiol® Lamina see page 82 For more information on OsteoBiol® Evolution see page 78 44
  • 43. OsteoBiol® products description CLINICAL INDICATIONS HORIZONTAL AND VERTICAL AUGMENTATIONThe entire OsteoBiol® line consists of SCIENTIFIC LITERATURE ON HORIZONTALxenografts, i.e. biomaterials deriving from AUGMENTATION WITH OSTEOBIOL® PRODUCTSheterologous bone. The Tecnoss® patented CASSETTA M, CALASSO S, VOZZA I, DELLAQUILA D REHABILITATION OF ATROPHIC ALVEOLAR CRESTS WITHmanufacturing process used to obtain CYLINDRICAL SANDBLASTED AND ACID ETCHEDthese materials is able to achieve IMPLANTS: A PILOT STUDY EUROPEAN JOURNAL OF IMPLANT PROSTHODONTICS, 2005;biocompatibility preserving part of the (3)1:133-144collagen matrix of the animal bone and BARONE A, COVANI Uavoiding at the same time high MAXILLARY ALVEOLAR RIDGE RECONSTRUCTION WITH NONVASCULARIZED AUTOGENOUS BLOCK BONE:temperatures that would cause CLINICAL RESULTS JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, 2007ceramization of the granules: the result is a OCT; 65(10):2039-46unique particulate material, consisting of OsteoBiol® Soft Lamina stabilised with titanium post Split ridge to be grafted with OsteoBiol® Putty CALVO GUIRADO JL, PARDO ZAMORA G, SAEZ YUGUERO MRmineral component and organic matrix, Source: Courtesy of Dr Giuseppe Presti, Italy Source: Courtesy of Prof Dr Jose Louis Calvo Guirado, Murcia, Spain RIDGE SPLITTING TECHNIQUE IN ATROPHIC ANTERIOR MAXILLA WITH IMMEDIATE IMPLANTS, BONEwith a porous surface extremely similar to packed in a sterile syringe: the mp3 An OsteoBiol® Evolution membrane is REGENERATION AND IMMEDIATE TEMPORISATION: A CASE REPORTautogenous bone and able to resorb syringe can be directly applied into the recommended to cover implants and JOURNAL OF IRISH DENTAL ASSOCIATION, 2007 WINTER;progressively while new bone formation defect without having to mix the mp3 grafted biomaterial: Evolution pericardium 53(4):187-90takes place(6). granules with saline. Due to its collagen membranes guarantee an efficient barrier SANTAGATA M, GUARINIELLO L, TARTARO G A MODIFIED EDENTULOUS EXPANSION (MERE) gel content, mp3 allows an excellent graft effect, favour the correct soft tissue TECHNIQUE FOR IMMEDIATE PLACEMENT OF IMPLANTS.These cortical and cancellous particles stability while its hydrophilia guarantees regrowth and wound closure and do not A CASE REPORThave been mixed in various proportions JOURNAL OF ORAL IMPLANTOLOGY, 2010 JUN 16 quick blood absorption and therefore the get infected in case of exposure.and granulometries with collagen gel, in SCARANO A, CARINCI F, ASSENZA B, PIATTELLI M, MURMURA necessary graft vascularization. G, PIATTELLI Aorder to develop various products aimed VERTICAL RIDGE AUGMENTATION OF ATROPHICat different clinical indications: the Its cortico-cancellous composition allows a POSTERIOR MANDIBLE USING AN INLAY TECHNIQUE WITH A XENOGRAFT WITHOUT MINISCREWS ANDOsteoBiol® materials indicated for progressive resorption of osteoclastic type, MINIPLATES: CASE SERIES CLINICAL ORAL IMPLANTS RESEARCH, 2011 OCT;horizontal augmentation are OsteoBiol® with in parallel a similar rate of new bone 22(10):1125-30mp3, OsteoBiol® Lamina and OsteoBiol® formation. Used in combination withPutty. OsteoBiol® Lamina, mp3 allows a very good graft volume preservation and aOsteoBiol® mp3, a pre-hydrated healthy new bony tissue.cortico-cancellous bone mix with 10%collagen gel is a “ready to use” product OsteoBiol® Putty is a collagen gel matrix OsteoBiol® Putty | For more information see page 68 loaded for 80% of its volume with Source: Tecnoss® Dental Media Library micronized cortico-cancellous bone particles (granulometry up to 300 µm) packed in a sterile syringe. The exclusive Tecnoss® manufacturing process guarantees an exceptional malleability and plasticity: furthermore the syringe packaging gives Putty extraordinary handling properties making this product the ideal choice for filling theOsteoBiol® Curved Lamina and Soft Lamina gaps between implants in ridge splittingFor more information see page 82 OsteoBiol® mp3 | For more information see page 64Source: Tecnoss® Dental Media Library procedures(7). Source: Tecnoss® Dental Media Library 45
  • 44. Case reportHorizontal defect grafted with OsteoBiol® Lamina and mp3 Sex: female | Age: 45 Fig. 1 The preoperative cone beam scan Fig. 2 Alveolar ridge presenting an inadequate width for implant placement Fig. 3 Intraoperative view demonstrating the alveolar defect. Due to the limited vertical and horziontal dimension the elevation of the sinus has been performed Fig. 4 Fixation of Osteobiol® cortical Lamina withFig. 1 Fig. 2 Fig. 3 titanium pins performed prior to ridge augmentation. Fig. 5 Reconstruction of the alveolar ridge with bone substitute (OsteoBiol® mp3, Tecnoss). Fig. 6 Covering the augmented area with Osteobiol Lamina Fig. 7 Primary flap closure was achieved Fig. 8 Digital volumetomograph six month after augmentation procedure demonstrates the amount of new boneFig. 4 Fig. 5 Fig. 6 Fig. 9 Intraoperative view of the augmented area six months after augmentation procedure Fig. 10 Placement of two implants Fig. 11 Postoperative radiograph Fig. 12 Final prosthetic reconstructionFig. 7 Fig. 8 Fig. 9 Documentation provided by Prof Dr Hannes Wachtel Dr Tobias Thalmair Private Institute for Periodontology and Implantology, Munich, Germany Email: hannes@wachtel.biz Bone substitute: OsteoBiol® mp3 For more information on OsteoBiol® mp3 see page 64 Membrane: OsteoBiol® Lamina For more information on OsteoBiol® Evolution see page 82Fig. 10 Fig. 11 Fig. 1246
  • 45. Case report CLINICAL INDICATIONS HORIZONTAL AND VERTICALTreatment of a failing implant case AUGMENTATION Sex: female | Age: 56 Fig. 1 Clinical situation. Implant supported restoration upper left. Teeth supported restoration upper right. Fig. 2 Full thickness flap elevated showing implants placed partly outside the alveolar ridge Fig. 3 Implants are removed. Major bone loss defects can be seen Fig. 4 Ridge reconstructed with OsteoBiol® mp3Fig. 1 Fig. 2 Fig. 3 carefully compacted against the plate of bone Fig. 5 A collagen sponge is placed above the MP3 giving more stability to the material and adding volume to the soft tissues Fig. 6 Four months later a flap is elevated Fig. 7 The lateral incisor is extracted and the recreated ridge can be seen Fig. 8-9 The implants are placed into a very dense boneFig. 4 Fig. 5 Fig. 6 Fig. 10-11 Four months later a flap is elevated and abutments placed into a very stable bone (ISQ Osstell between 72 and 78) Fig. 12 Prosthetic restorations in place. Upper left and rightFig. 7 Fig. 8 Fig. 9 Documentation provided by Dr Patrick Palacci Brånemark Osseointegration Center Marseille, France e-mail: patrick@palacci.com Bone substitute: OsteoBiol® mp3 For more information on OsteoBiol® mp3 see page 64Fig. 10 Fig. 11 Fig. 12 47
  • 46. Case reportRehabilitation of a total superior edentulism with ridge split technique Sex: female | Age: 58 Fig. 1 Initial endoral image, showing a total superior edentulism Fig. 2 Pre-operative TC image showing the crestal defect width Fig. 3 Edentulous crest expansion with ridge-split technique: insertion of depth markers Fig. 4 Placement of 6 implantsFig. 1 Fig. 2 Fig. 3 Fig. 5 Bone deficits grafted with OsteoBiol® Putty Fig. 6 2 OsteoBiol® Special membranes placed as a protection of the graft Fig. 7 Intraoral image after 8 months from implant placement Fig. 8 Intraoral image at second surgical phase: it is possible to appreciate the regeneration of pre-existing bone defects Fig. 9 TC control image after 12 months from surgery: it is possible to appreciate a good preservation of crestal boneFig. 4 Fig. 5 Fig. 6 Fig. 10 Placement of a connection bar between implants Fig. 11 Detail of prosthesis: lingual view Fig. 12 Final image showing a good prosthetic rehabilitationFig. 7 Fig. 8 Fig. 9 Documentation provided by Dr Fabrizio Nanni Private practitioner in Pontedera, Italy and Contract Professor at “Università di Siena” e-mail: fabrizio.nanni7@tin.it Bone substitute: OsteoBiol® Putty For more information on OsteoBiol® Putty see page 68 Membrane: OsteoBiol® Special For more information on OsteoBiol® Special see page 92Fig. 10 Fig. 11 Fig. 1248
  • 47. Case report CLINICAL INDICATIONS HORIZONTAL AND VERTICALVertical regeneration with inlay technique AUGMENTATION Sex: female | Age: 60 Fig. 1 Pre-operatory x-ray Fig. 2 After one horizontal and two vertical osteotomies, the bone fragment is moved towards the coronal direction Fig. 3 Space obtained after moving the bone fragment Fig. 4 Positioning of OsteoBiol® Sp-BlockFig. 1 Fig. 2 Fig. 3 Fig. 5 Rx post-surgery Fig. 6 Clinical appearance of the graft during re-opening, after 3 months Fig. 7 Preparation of implant sites Fig. 8 Positioning of the implants Fig. 9 Positioning of the implants Fig. 10 Histology after 3 months* Fig. 11 Histology detail* Fig. 12 Histology detail*Fig. 4 Fig. 5 Fig. 6Fig. 7 Fig. 8 Fig. 9 Documentation provided by Dr Pietro Felice University of Bologna, Italy E-mail: pietro.felice@unibo.it *Prof Ulf Nannmark Göteborg University, Sweden Bone substitute: OsteoBiol® Sp-Block For more information on OsteoBiol® Sp-Block see page 87Fig. 10 Fig. 11 Fig. 12 49
  • 48. Periodontal regeneration Intrabony defects Gingival recessions Intrabony defect grafted with OsteoBiol® Gen-Os Source: Courtesy of Dr Roberto Abundo and Dr Giuseppe Corrente, Torino, Italy
  • 49. Characteristics CLINICAL INDICATIONS PERIODONTAL REGENERATIONDEFECT ORIGIN AND DESCRIPTION With regard to intrabony defects, two types After having coronally advanced the flap BIBLIOGRAPHY | PAGES 49-51According the glossary of terms of the of defects can be recognized: intrabony and suture, a periodontal dressing is (1) WAERHAUG JAmerican Academy of Periodontology, an defects and craters. Intrabony defects are generally placed to protect and favor the THE ANGULAR BONE DEFECT AND ITS RELATIONSHIP TOintrabony defect is defined as a bony defects whose intrabony component flap healing. Healing can be expected TRAUMA FROM OCCLUSION AND DOWNGROWTH OF SUBGINGIVAL PLAQUE“periodontal defect within the bone affects primarily one tooth, while in craters after 3-4 months from surgery. JOURNAL OF CLINICAL PERIODONTOLOGY (1979): 6: 61–82surrounded by one, two or three bony the defect affects two adjacent root (2) WAERHAUG J In case of deep intrabony defects or when THE INFRABONY POCKET AND ITS RELATIONSHIP TOwalls or combination thereof”. surfaces to a similar extent. TRAUMA FROM OCCLUSION AND SUBGINGIVAL PLAQUE bony walls are missing, healing can be JOURNAL OF PERIODONTOLOGY (1979); 50: 355–365Irrespective of the number and nature of Intrabony defects have been classified expected after 5-6 months from surgery. (3) GOLDMAN HM, COHEN WDthe contributing factors involved, the according to their morphology in terms of THE INTRABONY POCKET: CLASSIFICATION AND TREATMENTformation of an osseous periodontal lesion residual bony walls, width of the defect (or JOURNAL OF PERIODONTOLOGY (1958); 29: 272is considered to be the result of an apical radiographic angle), and in terms of their (4) GARRETT Sdowngrowth of subgingival plaque with a topographic extension around the tooth. PERIODONTAL REGENERATION AROUND NATURAL TEETH ANNALS OF PERIODONTOLOGY (1996); 1: 621-666concomitant resorption of bone within a Three-wall, two-wall and one-wall defects (5) BRUNSVOLD MA, MELLONIG JT2mm radius from the root surface(1-2). have been defined on the basis of the BONE GRAFTS AND PERIODONTAL REGENERATION number of residual alveolar bone walls. PERIODONTOLOGY 2000 (2000); 1: 80-91The more remotely located bone structures This represents the primary classification (6) LAURELL L, GOTTLOW J, ZYBUTZ M, PERSSON Rand the root surface retain their integrity system. TREATMENT OF INTRABONY DEFECTS BY DIFFERENT SURGICAL PROCEDURES. A LITERATURE REVIEWand form the anatomical boundaries of JOURNAL OF PERIODONTOLOGY (1998); 69: 303-313the osseous lesion. REGENERATION PROCEDURES (7) NANNMARK U, SENNERBY L Bone replacement grafts remain among THE BONE TISSUE RESPONSES TO PREHYDRATED ANDThe classification of these periodontal COLLAGENATED CORTICO-CANCELLOUS PORCINE BONE the most widely used therapeutic strategies GRAFTS. A STUDY IN RABBIT MAXILLARY DEFECTSdefects according to Goldman and CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, 2008, for the correction of periodontal osseous 10: 264-270Cohen(3) is based on specific intrabony defects.morphological criteria and differentiates Periodontal probingbetween suprabony, intrabony and Observational and controlled studies Source: Tecnoss® Dental Media Libraryfurcation defects. generally document improvements in clinical parameters following placement ofIntrabony defects are defined by the apical graft materials(4-6).location of the base of the pocket withrespect to the residual alveolar crest. The surgical technique for treatment of not deep intrabony defects includes elevation of a full-thickness flap, with particular care in preserving the integrity of the distal margin, in order to guarantee proper blood bedewing to the receiving site. Then, after adequate cleaning of root surface, particulate biomaterial can easily be grafted and covered with a collagen resorbable membrane, which assures protection and exclusion of epitheliumPeriodontal defect grafted with OsteoBiol® Gen-Os tissue from the attachment apparatus to be Periodontal defect grafted with OsteoBiol® Gel 40For more information see page 60 For more information see page 72Source: Tecnoss® Dental Media Library regenerated. Source: Tecnoss® Dental Media Library 51
  • 50. Periodontal regeneration OsteoBiol® product range PRODUCT CODES Gen-Os M1052FS | 1 Vial | 0.25 g | Porcine M1052FE | 1 Vial | 0.25 g | Equine M1005FS | 1 Vial | 0.5 g | Porcine M1005FE | 1 Vial | 0.5 g | Equine M1010FS | 1 Vial | 1.0 g | Porcine M1010FE | 1 Vial | 1.0 g | Equine M1020FS | 1 Vial | 2.0 g | Porcine M1020FE | 1 Vial | 2.0 g | Equine Gel 40 Tissue of origin Collagenated heterologous cortico-cancellous Tissue of origin Pre-hydrated collagenated heterologous 05GEL40S | 1 Syringe | 0.5 cc | Porcine bone mix cortico-cancellous bone gel 05GEL40E | 1 Syringe | 0.5 cc | Equine Tissue collagen Preserved Tissue collagen Preserved + 40% additional collagen gel 15GEL40S | 3 Syringe | 3x0.5 cc | Porcine Physical form Slightly radiopaque granules Physical form Collagen gel type I and III loaded with 60% 15GEL40E | 3 Syringe | 3x0.5 cc | Equine Composition 100% granulated mix collagenated bone mix Granulometry 250-1000 µm Composition 60% granulated mix, 40% collagen gel Re-entry time 4/5 months, depending on grafting site Granulometry Up to 300 µm Evolution characteristics Re-entry time About 4 months EV02LLE | 20x20 mm | Fine | Equine Packaging Vial: 0.25 g, 0.5 g, 1.0 g, 2.0 g Packaging Syringe: 0.5 cc, 3x0.5 cc EV02HHE | 20x20 mm | Standard | Equine For more information on OsteoBiol® Gen-Os see page 60 For more information on OsteoBiol® Gel 40 see page 72 EV03LLE | 30x30 mm | Fine | Equine EV03HHE | 30x30 mm | Standard | Equine EVOLLE | 25x35 mm (oval) | Fine | Equine EVOHHE | 25x35 mm (oval) | Standard | Equine Tissue of origin Heterologous collagen membrane Tissue collagen Preserved Physical form Dried membrane with one smooth side and one micro-rough side Composition 100% pericardium Thickness Fine: 0.4 mm (±0.1). Standard: 0.6 mm (±0.1) Resorption time Fine: approx 3 months. Standard: approx 4 months Packaging Fine: 20x20 mm, 30x30 mm, 25x35 mm (oval) Standard: 20x20 mm, 30x30 mm, 25x35 mm (oval) For more information on OsteoBiol® Evolution see page 78 52
  • 51. OsteoBiol® products description CLINICAL INDICATIONS PERIODONTAL REGENERATIONThe entire OsteoBiol® line consists of SCIENTIFIC LITERATURE ON PERIODONTALxenografts, i.e. biomaterials deriving from REGENERATION WITH OSTEOBIOL® PRODUCTSheterologous bone. DEL CORSO M SOFT TISSUE RESPONSE TO PLATELET RICH FIBRIN:The Tecnoss patented manufacturing ® CLINIC EVIDENCES COSMETIC DENTISTRY, 2008, 3: 16-20process used to obtain these materials is CARDAROPOLI D, CARDAROPOLI Gable to achieve biocompatibility preserving HEALING OF GINGIVAL RECESSIONS USING A COLLAGEN MEMBRANE WITH A HEMINERALIZEDpart of the collagen matrix of the animal XENOGRAFT: A RANDOMIZED CONTROLLED CLINICALbone and avoiding at the same time high TRIAL INTERNATIONAL JOURNAL OF PERIODONTICS ANDtemperatures that would cause RESTORATIVE DENTISTRY, 2009 FEB;29(1):59-67ceramization of the granules: the result is aunique particulate material, consisting of Gingival recession grafted with OsteoBiol® Gel 40 Source: Courtesy of Dr Daniele Cardaropoli, Torino, Italy Intrabony defect Source: Courtesy of Dr Roberto Rossi, Genova, Italymineral component and organic matrix,with a porous surface extremely similar to These unique properties allow a very goodautogenous bone and able to resorb graft volume preservation, a healthy newprogressively while new bone formation bony tissue and ultimately, a successfultakes place. periodontal regeneration.These cortical and cancellous particles In case of partially compromised bonehave been mixed in various proportions walls, an OsteoBiol® Evolution membraneand granulometries with and without (fine model) is recommended: Evolutioncollagen gel, in order to develop various pericardium membranes efficiently containproducts aimed at different clinical and stabilize the Gen-Os graft, guaranteeindications: the OsteoBiol® materials an efficient barrier effect, favour theindicated for intrabony defects are correct wound healing and do not getGen-Os, in case of two and one wall infected in case of exposure.defects, and Gel 40 in case of three wall OsteoBiol® Gel 40 is a collagen gel matrixdefects. loaded for 60% of its volume withOsteoBiol® Gen-Os is a cortico-cancellous micronized cortico-cancellous bonecollagenated bone mix with 250-1000 µm particles (granulometry up to 300 µm)granulometry packed in a sterile vial: due packed in a sterile syringe.to its collagen content, once hydrated with The exclusive Tecnoss® manufacturingsaline, it allows an excellent graft stability process guarantees an exceptionalwhile its hydrophilia guarantees quick malleability and plasticity: furthermore theblood absorption and therefore the syringe packaging gives Gel 40necessary graft vascularization. extraordinary handling properties makingIts cortico-cancellous composition allows a this product the ideal choice forprogressive resorption of osteoclastic type, periodontal defects with intact bony walls.with in parallel a similar rate of new boneformation(7). Intrabony defect grafted with OsteoBiol® Gen-Os Source: Courtesy of Dr Roberto Rossi, Genova, Italy 53
  • 52. Case reportPeriodontal regeneration Sex: female| Age: 30 Fig. 1 Pre-operative x-ray Fig. 2 Initial clinical situation Fig. 3 Probing intrabony defect Fig. 4 Buccal furcation on 2.6 is also present Fig. 5 Furcation and defect grafted with OsteoBiol® Gen-OsFig. 1 Fig. 2 Fig. 3 Fig. 6 Completion of grafting with OsteoBiol® Gen-Os Fig. 7 Grafting site protected with OsteoBiol® Evolution collagen membrane Fig. 8 Collagen membrane double layer Fig. 9 Coronally positioned flap: buccal view Fig. 10 Sutures: palatal view Fig. 11 Control x-ray at 12 months Fig. 12 Clinical situation at 12 monthsFig. 4 Fig. 5 Fig. 6Fig. 7 Fig. 8 Fig. 9 Documentation provided by Dr Roberto Rossi M.Sc.D. in Periodontology, Genova, Italy e-mail: drrossi@mac.com Bone substitute: OsteoBiol® Gen-Os For more information on OsteoBiol® Gen-Os see page 60 Membrane: OsteoBiol® Evolution For more information on OsteoBiol® Evolution see page 78Fig. 10 Fig. 11 Fig. 1254
  • 53. Case report CLINICAL INDICATIONS PERIODONTAL REGENERATIONTreatment of a deep intrabony defect mesial on 4.1 Sex: female | Age: 39 Fig. 1 Pre-operative endoral x-ray showing a deep intrabony defect mesial on 4.1 Fig. 2 The bone defect is 7mm deep Fig. 3 Intraoperative image showing the two-wall defect after cleansing of radicular surfaces Fig. 4 OsteoBiol® Gel 40 Fig. 5 Defect grafted with OsteoBiol® Gel 40Fig. 1 Fig. 2 Fig. 3 Fig. 6 A properly shaped OsteoBiol® Evolution membrane is placed to contain and protect the particulate grafting material Fig. 7 Control endoral x-ray at the end of surgery: it is possible to appreciate the defect grafted with biomaterial Fig. 8 Control endoral x-ray after 1 year from treatment: radiographically the biomaterial is bio-integrated with natural bone Fig. 9 The probing depth is reduced to 2mmFig. 4 Fig. 5 Fig. 6Fig. 7 Fig. 8 Fig. 9 Documentation provided by Dr Walter Rao Private practitioner in Pavia, Italy e-mail: rao@venus.it Bone substitute: OsteoBiol® Gel 40 For more information on OsteoBiol® Putty see page 72 Membrane: OsteoBiol® Evolution For more information on OsteoBiol® Evolution see page 78 55

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