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
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
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
SEM image of an OsteoBiol® Gen-Os granule: osteoblasticcolonisation. Magnification x3000Source: Courtesy of Dr Ulf Nannmark, University of Göteborg, Sweden 4
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.
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
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
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
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
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
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
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
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
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
Alveolar regeneration Post-extractive socket preservation Ridge preservation Post-extractive alveolus grafted with OsteoBiol® mp3 Source: Courtesy of Dr Roberto Rossi, Genova, Italy
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
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
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
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: firstname.lastname@example.org 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
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: email@example.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. 12 23
Dehiscences and fenestrations Peri-implant lesions Fenestration. Cortical stimulation before grafting with OsteoBiol® Gen-Os Source: Courtesy of Dr Claudio Stacchi, Gorizia, Italy
A particular slide catching your eye?
Clipping is a handy way to collect important slides you want to go back to later.