Frequently Asked Questions (FAQ)

1. Gielkens PF, et al.: Clin Oral Implants Res 2008; 19 : 516-21.
2. Tal H, et al.: Clin Oral Implants Res 2008; 19: 295-302.
3. Becker J, et al.: Clin Oral Implants Res 2009; 20(7): 742-49.

Geistlich Bio-Oss® is made from the mineral part of bovine bone. The strictly controlled manufacturing process ensures high quality and safety standards by:

• Country of origin: Australia (and for some countries also New Zealand and Switzerland)
• Selected and certified slaughterhouses
• Pre- and post-mortem health inspection for each individual animal
• Extremity bone (according to WHO Guideline on tissue infectivity classified as tissues with no detected infectivity or infectious prions)
• Effective inactivation methods with 15h treatment at high temperature and cleaning with strong alkaline solutins
• Sterilization, double sterile packaging
• Official controls by international authorities

1. Gielkens PF, et al.: Clin Oral Implants Res 2008; 19: 516-21.
2. Tal H, et al.: Clin Oral Implants Res 2008; 19: 295-302.
3. Becker J, et al.: Clin Oral Implants Res 2009; 20(7): 742-49.

1. Perelmann-Karmon, et al.:  Int J Periodontics Restorative Dent 2012; 32(4): 459-65.

• Augmentation/reconstruction of alveolar ridges.
• Filling of extraction sockets.
• Implantology: preparation of implant sites, filling of bone dehiscences, and sinus floor augmentations.
• Periodontology: filling of bone defects, support of the membrane during guided bone regeneration (GBR) and guided tissue regeneration (GTR).

1. Perelman-Karmon M, et al.: Int J Periodontics Restorative Dent 2013, 32(4): 459-65.

1. Schwarz F, et al.: Clin Oral Impl Res 2008; 19(4): 402-15.

Expert oral surgeons have estimated that a membrane used in Guided Bone Regeneration should maintain its barrier function until the provisional matrix and woven bone are present. As a consequence, barrier duration is considered to be necessary for 4 to 6 weeks, in most cases. Geistlich Bio-Gide® has proven to support bone regeneration on an equivalent level as membranes with a longer barrier function, with the additional benefit of complication-free wound healing.^1-4

References:

1. Tal H, et al. Clin Oral Impl Res 2008; 19: 295-302.
2. Becker J, et al. Clin Oral Impl Res 2009; 20(7): 742-49.
3. Schwarz F, et al. Clin Oral Impl Res 2008; 19(4): 402-15.
4. Nahles S, et al. Clin Oral Implants Res. 2013 Jul;24(7):812-9.

1. Tal H, et al.: Clin Oral Impl Res 2008; 19: 295-302.

1. Cardaropoli D, et al.: Int J Periodontics Restorative Dent 2012, 32(4): 421-30.

The dense layer of Geistlich Bio-Gide^® Compressed is more cell-occlusive than the porous layer. Therefore, we advise to place the membrane as described in the IFUs. However, it is not necessary to remove the membrane. 

Clinical performance of Geistlich Bio-Gide® Compressed is regarded the same as Geistlich Bio-Gide®. Various studies have shown that membranes of the Geistlich Bio-Gide® product family support excellent wound healing^1-3 and predictable bone regeneration⁴.

Referenzen:

1. Tal H, et al.: Clin. Oral Implants Res 2008; 19: 295-302.
2. Zitzmann NU, et al.: Int J Oral Maxillofac Implants 1997; 12: 844-52.
3. Becker J, et al.: Clin. Oral Implants Res 2009; 20(7): 742-93.
4. Schwarz F, et al.: Clin Oral Implants Res. 2014, 25(9): 1010-15.

Penetration of the membrane by blood and exudate during the surgery allows excellent adhesion of the membrane to the defect. Fixation of the membrane with sutures or pins is possible due to its high tensile strength. Fixation may be indicated to avoid membrane displacement due to shear loading or mobilization.  

Both Geistlich Bio-Gide® Compressed and GeistlichBio-Gide® are intended to be used as barrier membranes in theregeneration of bone defects, for example in the context of Guided Bone Regeneration, for delayed or immediate augmentation around implants, reconstruction of the alveolar ridge, filling bone defects in the maxillofacial area and cleft closure surgeries. For further details, please consult the Geistlich Bio-Gide® and Geistlich Bio-Gide® Compressed IFU. 

Geistlich Bio-Gide® Compressed has a smoother surface, a firmer feel and is easier to cut compared to Geistlich Bio-Gide®. Therefore, it offers an alternative handling for those dentists who prefer a firmer membrane. Geistlich Bio-Gide® Compressed is available in the sizes 13 x 25 mm and 20 x 30 mm. Availability may vary from country to country.

La capa compacta de Geistlich Bio-Gide® Perio es menos permeable a las células que la capa rugosa y porosa. Si la membrana se aplica con los lados invertidos, la integración de las células óseas puede producirse con bastante más lentitud. Sin embargo, no es necesario retirar la membrana.

In general, Geistlich Bio-Gide® Shape is based on the Geistlich Bio-Gide® Perio technology to facilitate application comfort. For easier handling, the membrane is pre-cut to a shape that fits for extraction sockets. This also reduces your preparation time.

The use of Geistlich Mucograft® Seal and Geistlich Bio-Oss® Collagen is recommended in extraction sockets with intact buccal bone walls.¹

Reference:

1. Geistlich Mucograft Seal Advisory Board Meeting Report, 2013. Data on file, Geistlich Pharma AG, Wolhusen, Switzerland.

The membrane should be placed inside the alveolus or outside (between the bone and the soft-tissue). From the convenience point of view, it might be easier to place Geistlich Bio-Gide® Shape inside the alveolus.

The long strap of the Geistlich Bio-Gide® Shape should be placed to cover the bony defect of the socket, if present. Thereby the dense surface should face towards the soft tissue, and the rough side should face the defect.

To close the extraction socket, both lateral wings of the Geistlich Bio-Gide® Shape membrane should be tucked underneath the mucosa, located mesially and distally of the socket. The upper wing should be tucked  lingually / pallatinally in-between the soft tissue and bone wall.

Loading with minimal pressure can be done immediately after surgery, taking into account the swelling due to the intervention. Loading by applying pressure can be performed as soon as the site has healed 3-8 weeks after grafting and should not be delayed more than 3 months. This might be beneficial for conditioning the new soft-tissue and favoring its maturation based on experience from clinical studies.

 The result of the whole remodeling process of Geistlich Fibro-Gide® is the formation of new soft-tissue (connective tissue). Animal models have shown good integration of Geistlich Fibro-Gide® into the surrounding soft-tissue without formation of scar tissue. 

It is important to adjust the size of Geistlich Fibro-Gide® to the dimensions of the defect site, taking swelling into consideration, in order to ensure tension-free wound closure. Slight over-augmentation with Geistlich Fibro-Gide®, on the contrary, might be needed (similar to Guided Bone Regeneration), but tension-free wound closure is key.

Geistlich Fibro-Gide® is intended to be used for soft-tissue regeneration at the alveolar ridge. Indications of Geistlich Fibro-Gide® are insufficient soft-tissue volume and recession defects.

Geistlich Fibro-Gide® is a porcine, porous, resorbable and volume-stable collagen matrix specifically designed for soft-tissue regeneration. The matrix is made of reconstituted collagen undergoes smart chemically cross-linking to improve volume stability of the device while maintaining its excellent biocompatibility.

 Animal models have shown good integration of Geistlich Fibro-Gide® into the surrounding soft-tissue combined with the ability to degrade and be replaced by connective tissue while maintaining three dimensional volumetric stability over time.

Geistlich Fibro-Gide® is an alternative to autologous connective tissue grafts (CTG) for soft-tissue volume augmentation around dental implants and natural teeth. Geistlich Fibro-Gide® obviously has the advantage of reducing patient morbidity since there is no additional harvest site. Furthermore, there is no risk of necrosis when using Geistlich Fibro-Gide® compared to CTG.

Geistlich Fibro-Gide® is ready to be applied to the defect and does not need pretreatment or conditioning before application. Geistlich Fibro-Gide® possesses excellent hydrophilic characteristics that lead to a rapid hydration of the collagen matrix (patient’s own blood and/or sterile saline). When applied dry to the defect site, the matrix will hydrate easily by soaking up patient’s own blood and/or sterile saline very fast.

Geistlich Fibro-Gide^® can be applied either in a dry or wet state subject to individual preference: pre-wetting can be done with blood and/or sterile saline. Geistlich Fibro-Gide® can be cut and trimmed both in a dry or wet state, using scissors and/or a scalpel. The scalpel is recommended for dry handling. Using a scalpel will help to obtain smooth edges and tapers for improved wound adaptation and precise fit of the matrix.

The device will gain approx. 25% in volume once wet. This increase in volume has to be taken into account when deciding upon final dimensions. A generous flap design is the key to full submersion of the matrix.

Use your preferred flap design. A generous preparation of the flap is key to promoting successful healing by complete coverage of Geistlich Fibro-Gide® (submerged healing). Different surgical techniques, such as tunneling and/or envelope techniques are currently being clinically tested (not all under studies).

Clinical experience has shown that tension-free wound closure is a key factor in preventing dehiscence. In open flap procedures for augmentation at the alveolar ridge a horizontal mattress suture is recommended to stabilize the matrix (5.0-6.0). In recession coverage single sutures (7.0) have been used for stabilization. Suturing of Geistlich Fibro-Gide® to the wound bed is not necessary due to its excellent hydrophilicity and adaptation. 

A tension-free closure of the flap is key to a successful and complication-free healing and avoidance of any dehiscences during the healing phase. Please avoid compression of Geistlich Fibro-Gide® at the defect site.

After treatment with Geistlich Fibro-Gide®, please follow the same postsurgical management that is usually applied with connective tissue grafts. 

The device will gain approx. 25% in volume once wet. This increase in volume has to be taken into account when deciding upon final dimensions. A generous flap design is the key to full submersion of the matrix.

In vivo animal models have shown good integration of Geistlich Fibro-Gide® into the surrounding soft-tissue while maintaining stability.

Geistlich Fibro-Gide® is a porcine, porous, resorbable and volume-stable collagen matrix specifically designed for soft-tissue regeneration. The matrix is made of reconstituted collagen undergoes smart chemically cross-linking to improve volume stability of the device while maintaining its excellent biocompatibility.

Geistlich Fibro-Gide®

is intended to be used for soft-tissue regeneration at the alveolar ridge.

Indications of Geistlich Fibro-Gide® are insufficient soft-tissue volume and

recession defects.

The device will gain approx. 25% in volume once wet. This increase in volume has to be taken into account when deciding upon final dimensions. A generous flap design is the key to full submersion of the matrix.

Clinical studies have shown a physiological increase in thickness when using CTG as the gold standard of 0.35 to 3.2 mm. Clinical studies have shown that treatment with Geistlich Fibro-Gide® results in an increase of 1-2 mm of thickness which is equivalent to results obtained with CTG. Geistlich Fibro-Gide® is provided with a thickness of 6 mm which gives freedom to the surgeon to trim it to the desired size and to use the collagen matrix for thickening of tissues under pontics where more volume might be required. For lateral soft-tissue augmentation, it is recommended to reduce the thickness of Geistlich Fibro-Gide® in order to achieve a tension-free, primary wound closure.  

After treatment with Geistlich Fibro-Gide®, please follow the same postsurgical management that is usually applied with connective tissue grafts. 

A tension-free closure of the flap is key to a successful and complication-free healing and avoidance of any dehiscences during the healing phase. 

Clinical experience has shown that tension-free wound closure is a key factor in preventing dehiscence. In open flap procedures for augmentation at the alveolar ridge a horizontal mattress suture is recommended to stabilize the matrix (5.0-6.0). In recession coverage single sutures (7.0) have been used for stabilization.

Use your preferred flap design. A generous preparation of the flap is key to promoting successful healing by complete coverage of Geistlich Fibro-Gide® (submerged healing). Different surgical techniques, such as tunneling and/or envelope techniques are currently being clinically tested (not all under studies).

Geistlich Fibro-Gide^® can be applied either in a dry or wet state subject to individual preference: pre-wetting can be done with blood and/or sterile saline. Geistlich Fibro-Gide® can be cut and trimmed both in a dry or wet state, using scissors and/or a scalpel. The scalpel is recommended for dry handling. Using a scalpel will help to obtain smooth edges and tapers for improved wound adaptation and precise fit of the matrix.

Geistlich Fibro-Gide® is an alternative to autologous connective tissue grafts (CTG) for soft-tissue volume augmentation around dental implants and natural teeth. Geistlich Fibro-Gide® obviously has the advantage of reducing patient morbidity since there is no additional harvest site. Furthermore, there is no risk of necrosis when using Geistlich Fibro-Gide® compared to CTG.

Geistlich Mucograft® is a collagen matrix designed specifically for soft-tissue regeneration as an alternative for autogenous soft-tissue grafts.

The collagen of Geistlich Mucograft® will be replaced by newly formed soft tissue. The matrix is rapidly vascularized and colonised by soft-tissue cells. This leads to a good integration of the matrix without any signs of foreign body reaction^1,2.

References:

1. Rocchietta I, et al.: Int J Periodontics Restorative Dent 2012; 32(1): e34-40 (pre-clinical study)
2. Ghanaati S, et al.: Biomed Mater 2011; 6(1): 015010 (pre-clinical study)

For both. Geistlich Mucograft® is an alternative to free gingival graft or connective tissue graft for gaining keratinized tissue^1-3. Geistlich Mucograft® is an alternative to CTG for recession coverage^4-6.

References:

1. Sanz M, et al.: J Clin Periodontol 2009; 36(10): 868-76 (clinical study)
2. Lorenzo R, et al.: Clin. Oral Impl. Res 2012; 23(3): 316-24 (clinical study)
3. Nevins M, et al.: Int J Periodontics Restorative Dent 2011; 31(4): 367-73 (clinical study)
4. McGuire MK & Scheyer ET : J Periodontol 2010; 81(8): 1108-17 (clinical study)
5. Cardaropoli D, et al.: J Periodontol 2012; 83(3): 321-28 (clinical study)
6. Rotundo R & Pini-Prato G: Int J Periodontics Restorative Dent 2012; 32(4): 413-19 (clinical study)

1. Data on file, Geistlich Pharma AG, Wolhusen, Switzerland

Published data show different suturing techniques with Geistlich Mucograft®: non-resorbable^1,2 and resorbable³, 0-5^1,2 and 0-6⁴. There is no clinical evidence showing a benefit of one type of suture over another one, when suturing Geistlich Mucograft®.

References:

1. Sanz M, et al.: J Clin Periodontol 2009; 36(10): 868-76 (clinical study)
2. Herford AS, et al.: J Oral Maxillofac Surg 2010; 68(7): 1463-70 (clinical study)
3. Cardaropoli D, et al.: J Periodontol 2012; 83(3): 321-28 (clinical study)
4. McGuire MK & Scheyer ET : J Periodontol 2010; 81(8): 1108-17 (clinical study)

It depends on the indication:
1. Gain of keratinised tissue: Geistlich Mucograft® should be applied on a periosteal bed^1,2 since blood supply is important. In open healing, the blood is supplied through the edges of the device from the surrounding tissue and from the periosteum.
2. Recession Coverage: Geistlich Mucograft® can be used partially or completely over bone.^3-5 Blood is supplied through the edges of the device  from the surrounding tissue and from the flap covering completely the matrix.

References:

1. Sanz M, et al.: J Clin Periodontol 2009; 36(10): 868-76 (clinical study)
2. Lorenzo R, et al.: Clin Oral Impl Res 2012; 23(3): 316-24 (clinical study)
3. McGuire MK & Scheyer ET : J Periodontol 2010; 81(8): 1108-17 (clinical study)
4. Cardaropoli D, et al.: J Periodontol 2012; 83(3): 321-28 (clinical study)
5. Rotundo R & Pini-Prato G: Int J Periodontics Restorative Dent 2012; 32(4): 413-19 (clinical study)

It depends on the indication:
1. Gain of Keratinised Tissue: Open healing is recommended when Geistlich Mucograft® is used to increase width of keratinised tissue. The innovative design of Geistlich Mucograft® allows excellent healing in open healing situations¹.
2. Recession Coverage: Geistlich Mucograft® should remain completely submerged under the flap to avoid premature resorption of the collagen.^2-4 Direct blood supply is important.

References:

1. Sanz M, et al.: J Clin Periodontol 2009; 36(10): 868-76 (clinical study)
2. McGuire MK & Scheyer ET: J Periodontol 2010; 81(8): 1108-17 (clinical study)
3. Cardaropoli D, et al.: J Periodontol 2012; 83(3): 321-28 (clinical study)
4. Rotundo R & Pini-Prato G: Int J Periodontics Restorative Dent 2012; 32(4): 413-19 (clinical study)

Geistlich Mucograft® Seal is specifically designed for soft-tissue regeneration¹. The collagen of Geistlich Mucograft® is specially processed to favour immediate blood clot stabilization. This leads to early vascularization^1,3, facilitates soft-tissue cell ingrowth²  and good integration of the matrix with surrounding tissues^2,3.  In contrast to other collagen products in the market, Geistlich Mucograft® and Geistlich Mucograft® Seal are well scientifically documented and their clinical benefits are proven.

References:

1. Biocompatibility according to ISO 10993-12001. Data on file Geistlich PharmaAG, Wolhusen, Switzerland.
2. Ghanaati S, et al.:  Biomed Mater 2011; 6(1): 015010 (pre-clinical study)
3. Rocchietta I, et al.: Int J Periodontics Restorative Dent 2012; 32(1): e34-40 0 (pre-clinical study)

Geistlich Mucograft® Seal is a collagen matrix designed specifically for soft-tissue regeneration in extraction sockets for ridge preservation.

The collagen of Geistlich Mucograft® will be replaced by newly formed soft tissue. The matrix is rapidly vascularized and colonised by soft-tissue cells^1,2. This leads to a good integration of the matrix without any signs of foreign body reaction^3,4.

References:

1. Rocchietta I, et al.: Int J Periodontics Restorative Dent 2012; 32(1): e34-40 0 (pre-clinical study)
2. Ghanaati S, et al.: Biomed Mater 2011 Feb; 6(1): 015010 0 (pre-clinical study)
3. Nevins M, et al.: Int J Periodontics Restorative Dent 2011; 31(4): 367-73 0 (clinical study)
4. Camelo M, et al.: Int J Periodontics Restorative Dent 2012; 32(2): 167-73 0 (clinical study)

Geistlich Mucograft® Seal  is ready to be applied to seal the socket and does not need pretreatment or moisture before application. Due to its hydrophilicity, the matrix will hydrate quickly after implantation in the defect by soaking rapidly the patient’s blood.

1. Data on file, Geistlich Pharma AG, Wolhusen, Switzerland

The compact structure should face outward, away from underlying bone, with the spongeous structure facing the bone or soft-tissue wound bed. Geistlich Mucograft® Seal spongeous structure is striped for easier differentiation of the two sides. The striped spongeous structure should face the bone.

1. Geistlich Mucograft Seal Advisory Board Meeting Report, 2013. Data on file Geistlich Pharma AG, Wolhusen, Switzerland.

Yes, in general this product can be applied by any oral healthcare professional. However, local regulations should always be checked.

Production using fermentation, non-animal origin. The hyaluronic acid is not cross-linked.

In Israel, exclusively for the company Prudentix Ltd., which is a direct partner of Geistlich.

Storage at room temperature only: +15 °C to +25 °C guarantees product quality over the shelf life duration of 3 years. For a short term (maximum of 7 days), the product can be stored at +4 °C to +40 °C.

If the product has turned to gel prior to application, e.g. due to warm room temperature, it can be placed in a refrigerator at ≥ +4 °C for approx. two minutes until it becomes liquid again.

There have not yet been any clinical studies conducted with Pocket-X® Gel in peri-implantitis. Therefore, this indication is currently off-label.

Both Geistlich Bio-Oss® OR Geistlich Bio-Oss® Collagen AND Geistlich Bio-Gide® are recommended for bone regeneration in the management of extraction sockets with defect bone walls. When Geistlich Bio-Oss® and Geistlich Bio-Gide® are used in combination, more new bone is obtained compared to extraction site using only a bone substitute material¹.

The use of Geistlich Mucograft® Seal and Geistlich Bio-Oss® Collagen is recommended in extraction sockets with intact buccal bone wall².

Geistlich Bio-Gide® Shape and Geistlich Bio-Oss® Collagen can be used in combination for the treatment of extraction sockets with non-intact buccal bone wall.

References:

1. Perelman-Karmon M, et al.: Int J Periodontics Restorative Dent 2012; 32(4): 459-65.
2. Geistlich Mucograft Seal Advisory Board Meeting Report, 2013. Data on file, Geistlich Pharma AG, Wolhusen, Switzerland.

1. Cardaropoli D, et al.: Int J Periodontics Restorative Dent 2012; 32(4) :421-30.

1. Huynh-Ba G, et al.: Clin Oral Implants Res 2010; 21: 37-42.
2. Januario AL, et al.: Clin Oral Implants Res 2011; 22(10): 1168-71.
3. Araujo MG, Lindhe J: Journal Clin Periodontol 2005; 32: 212-18.

Regardless of the therapy approach, the bundle bone resorbs following tooth loss or extraction. The bundle bone cannot be regenerated, however Geistlich Bio-Oss® or Geistlich Bio-Oss® Collagen effectively substitutes its function in supporting soft-tissue and compensating for buccal bone loss.^1,2

References:

1. Araujo M, et al.: Int J Periodont Rest Dent 2008; 28:123-135.
2. Fickl S, et al.: Journal Clin Periodontol 2008; 35:356-363.

• Type 1: simultaneous to extraction (immediate)
• Type 2: 4-8 weeks after extraction (early implantation)
• Type 3: 12-16 weeks after extraction (delayed implantation)
• Type 4: more than 16 weeks after extraction (late implantation)¹

References:

1. Chen S, Buser D: ITI Treatment Guide Vol 3.

• Gingival recession over a period of five years¹
• Soft-tissue attachment loss²
• Increased plaque accumulation lingually¹
• Inflammation of the soft tissue²
• More frequent bleeding¹

1. Schrott AR, et al.: Clin Oral implants Res 2009; 20(10): 1170-17.
2. Chung DMT, et al.: J Periodontol 2006; 77(8): 1410-20.