Regenerative Biomaterials

The collagen in Geistlich Bio-Oss Collagen® does not function as a membrane. When space maintenance is required, it is recommended to use a membrane for optimal results.

No. Geistlich Bio-Oss® Collagen is a mixture of 90% Geistlich Bio-Oss® spongiosa granules and 10% highly purified porcine collagen in a block form. Geistlich Bio-Oss® is a natural bone mineral of bovine origin. The collagen facilitates adaptation of the Geistlich Bio-Oss® to the defect site.

Geistlich Bio-Oss® and Geistlich Bio-Oss Collagen® share the same indications. These products may be used interchangeably in the following procedures: Augmentation or reconstructive treatment of the alveolar ridge. Filling of periodontal defects. Filling of defects after root resection, apicoectomy, and cystectomy. Filling of extraction sockets to enhance preservation of the alveolar ridge. Elevation of the maxillary sinus floor. Filling of periodontal defects in conjunction with products intended for Guided Tissue Regeneration(GTR) and Guided Bone Regeneration (GBR). Filling of peri-implant defects in conjunction with products intended for Guided Bone Regeneration (GBR).

Geistlich Bio-Oss Collagen® is recommended for reconstruction of bone defects in the following procedures: Augmentation/reconstruction of alveolar ridges. Filling of extraction sockets. Preparation of implant sites, filling of bone dehiscences, and sinus floor augmentations. Filling of periodontal bone defects, membrane support during guided bone regeneration (GBR) and guided tissue regeneration (GTR).

No. If Geistlich Bio-Oss® is autoclaved, moisture can collect in the particles due to the high porosity of the product, which can change the hydrophilic properties. Moreover, Geistlich Bio-Oss® is not approved for re-sterilization. Re-sterilization under any circumstances is not recommended.

No, Geistlich does not recommend mixing autologous bone with the Geistlich Bio-Oss® granules within the syringe.

0.5 cc Geistlich Bio-Oss Pen®: ~0.5 ml 1.0 cc Geistlich Bio-Oss Pen®: ~1.0 ml 1.5 cc Geistlich Bio-Oss Pen®: ~1.5 ml

Fundamentally, the use of small particles is recommended for small defects (up to 2 dental alveoli) and for augmenting autogenous grafts. The large particles are recommended for large defects (> 2 dental alveoli, sinus lifts), however, preferences can vary from dentist to dentist.

Blood from the defect may be used for mixing. Care should be taken to avoid contamination with salivary bacteria.

Geistlich Bio-Oss® is made from the mineral part of bovine bone. The strictly controlled manufacturing process ensures high quality and safety standards by: - defined origin of the raw material - country of origin: Australia (and for some countries also New Zealand) which is historically and currently free of BSE - 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 solutions - sterilization, double sterile packaging - official controls by international authorities

No. If Geistlich Bio-Oss® is autoclaved, moisture can collect in the particles due to the high porosity of the product, which can change the hydrophilic properties. Moreover, Geistlich Bio-Oss® is not approved for re-sterilization. Re-sterilization under any circumstances is not recommended.

A membrane should be used in conjunction with Geistlich Bio-Oss® as a barrier against the ingrowth of soft tissue1. Native collagen membranes such as Geistlich Bio-Gide® also promote wound healing and increase therapeutic safety in the event of a postoperative wound dehiscence2,3. Physicians should read the package insert prior to use. References: Gielkens PF, et al.: Clin Oral Implants Res 2008; 19(5) : 516-21. Tal H, et al.: Clin Oral Implants Res 2008; 19(3): 295-302. Becker J, et al.: Clin Oral Implants Res 2009; 20(7): 742-49.

Fundamentally, the use of small particles is recommended for small defects (up to 2 dental alveoli) and for augmenting autogenous grafts. The large particles are recommended for large defects (> 2 dental alveoli, sinus lifts), however, preferences can vary from dentist to dentist.

Geistlich Combi-Kit Collagen is recommended for the reconstruction of the alveolar ridge, extraction socket management and augmentation of bone dehiscences.

Geistlich Combi-Kit Collagen is packed in a double blister. After the outer blister has been opened sterility can no longer be guaranteed. The product Geistlich Combi-Kit Collagen is registered for one time use only. It is not recommended to use the products separately.

Composition of PentOS OI™ Flex. PentOS OI™ Flex is made of demineralized, osteoinductive 100% cortical bone.

The five elements of bone formation with PentOS OI™ Flex. Post sterilization in-vivo testing is performed on each batch, and each batch must demonstrate the presence of new bone, bone marrow, osteocytes, cartilage and chondrocytes within 28 days in an athymic rat model. If not, they do not call it PentOS OI™.

PentOS OI™ Max is made from 100% human allograft demineralized bone matrix and is cortical bone.

If primary closure is not possible, the use of a membrane is highly recommended. Normally, a dental membrane is used to prevent the epithelial cells from growing into the bone graft site, where new bone is forming. A Neomem® membrane also helps to keep the granules at the graft sight, preventing migration of the granules. A membrane is also used when primary closure is not possible. However, if the periosteum is still intact, it can be used to achieve primary closure. If the periosteum is damaged in any way, a membrane, such as Neomem® or Neomem® FlexPlus, should be used.

Many advantages of using the PentOS OI™ Max Mixed PentOS OI™ Max can be extruded through a syringe. It resists copious irrigation and has a five-year shelf life at ambient storage. Shown to form bone post-sterilization in-vivo. Demonstrates osteoconductivity. It can be used in patients with compromised immune systems, older patients and those who have more difficulty growing new bone. Up to 40x native BMP vs the BMP-2 control Each batch histologically demonstrates all five elements of bone formation pH balanced – non cytotoxic. Shown to form bone post-sterilization in-vivo

The features of PentOS OI™ There are many benefits to using PentOS OI™ Putty: Verified to be osteoinductive Osteoconductive Excellent handling characteristics Resists irrigation Sterilized using low-dose gamma irradiation Ready to use Stored at room temperature

You can use any grafting material at the site but you may wish to use a putty to help keep the graft material contained.

The PentOS OI™ Sponge can be trimmed with scissors, rongeurs or a scalpel, however you will want to hydrate the sponge before trimming. Hydrating the it allows you to trim the sponge to the exact size needed to avoid chipping off any areas of the sponge you may want to keep.

There are many applications for PentOS OI™ Putty: • Periodontal defects • Implant site development • Coronal defects around immediate implants • Extraction site repair • Implant dehiscence defects • Sinus lift procedures • Moderate localized ridge defects

Yes, PentOS OI™ Putty is sterilized using low-dose gamma irradiation

PentOS OI™ Putty is made from 100% human bone without any additional diluent or carriers to diminish its osteoinductive properties.

You can use PentOS OI™ Putty in an orbital floor defect, at the apex of the sinus. You have to remember that PentOS OI™Putty is demineralized and will have a tendency to resorb quickly, so you may want to add a mineralized component such as Raptos®. This would be at the 'ceiling' of the sinus cavity but, anatomically, the floor of the orbit below the eye and I assume it would be reached through the sinus cavity. Ideally, if they were using PentOS OI™ Putty, they would mix it with a mineralized component to add calcification and mechanical structure to the area. Healing time would be approximately six months.

In general, the use of a dental membrane is to prevent the soft tissue cell from entering the graft site before bone forms and to help contain granular grafting materials in place (if they are used). This is the natural role for periosteum—the separation of hard and soft tissue. As such, if there is primary closure of an intact periosteum, this is sufficient and there should be no need for a membrane when using PentOS OI™ Max. However, without primary closure, and if the periosteum is damaged, torn or cut for vertical release, it becomes less effective as a barrier and a membrane should be used.

PentOS OI™ Max is made from 100% human allograft demineralized bone matrix and is cortical bone.

You could use it by itself, layered over the defect, as long as there is adequate blood flow into it. It should be affixed with tacks or screws to prevent mobility, and covered with a resorbable membrane. It is osteoinductive so you should manage to grow some bone to the thickness of the PentOS OI™ Flex. Ideally we would backfill into the space with either autogenous or allograft bone such as Raptos® or PentOS OI™ Putty.

You could use it by itself, layered over the buccal plate defect, as long as there is adequate blood flow into it. It should be affixed with tacks or screws to prevent mobility, and covered with a resorbable membrane. It is osteoinductive so you should manage to grow some bone to the thickness of the Flex sheet. Ideally we would backfill into the space with either autogenous or allograft bone such as Raptos® or PentOS OI™ Putty.

PentOS OI™ Flex is somewhat malleable once it has been hydrated for at least 15 to 20 minutes. It is not as rigid as a bone block because it is demineralized and thinner, giving it more versatility than a bone block.

PentOS OI™ Flex can be used to regenerate bone around exposed implant threads. Essentially, PentOS OI™ Flex will remodel into a new buccal cortex to replace the deficient buccal wall. Depending on how shallow or deep the bone defect is, back-filling the space between the PentOS OI™ Flex veneer graft and the implant threads with putty or particulate bone graft may be indicated.

A bone putty such as PentOS OI™ Putty can be used when trying to repair bony defects, keeping granules at the graft site, for socket preservation or when trying to maintain the patient’s ridge height. Sometimes you will have cases that require more volume than you have available to you. One solution would be to add Raptos® particulates as well as a demineralized allograft mixture at the site to maximize regeneration and long-term retention.

Putties help keep granules on site when there is no proper pocket to contain them. The carrier allows the putty to be molded and transformed, giving surgeons the ability to manipulate the putty to the shape they want. The versatility of DBM putties such as PentOS OI™ Putty allows them to be used in different surgical procedures.

The versatility of putties such as PentOS OI™ Putty is that they can be used in a multitude of clinical cases and mixed with Raptos® particulates. They can also be used with antibiotics (as required).

PentOS OI™ Flex can be hydrated using the patient’s blood or with saline solution. To accelerate graft reconstitution, submerge PentOS OI™ Flex in saline for 10 to 30 minutes and manipulate periodically, especially for larger size grafts. A minimum of 15 minutes of hydration is necessary to start achieving the level of flexibility needed to prevent cracking the Flex veneer. Graft pliability may occur sooner than 10 to 30 minutes.

The doctor may wish to use a bone veneer such as PentOS OI™ Flex instead. They could affix it in place, carefully and 'lag' with screws to reduce pressure and cracking, and have it act as a 'dam'; fill in the resulting void with regular bone graft material such as Raptos®, cover with a Neomem® membrane would work as you have structure at both ends; wall at one end and PentOS OI™ Flex at the other). You would have to be conscious of adequate blood flow to the grafted site, passive flap and membrane coverage and absolutely NO micromovement of the graft or PentOS OI™ Flex. Average healing time is also six months or more using this procedure.

You can use PentOS OI™ Flex in the same way as you would use a titanium mesh. Hydrate the PentOS OI™ Flex and then fixate the veneer graft with titanium screws. The difference between titanium mesh and PentOS OI™ Flex , other than one being bone and the other titanium is that the PentOS OI™ Flex will be remodeled into a new orbital floor wall.

Composition of our ridge / socket preservation bone graft plug. PreservaRidge™ Plug material source: Synthetic Carbonate Apatite & Bovine Type I Collagen PreservaRidge™ Plug is a synthetic plug that mimics natural bone and is made of approximately 80% mineral particles combined with 20% Type I collagen from bovine Achilles tendon. It is specifically designed for use in post extraction treatment to help maintain ridge height and width. Definition of carbonate-apatite: apatite containing a considerable amount of carbonate, such as: a: apatite in which the calcium phosphate carbonate predominates over other components b: calcium phosphate carbonate

When filling the void, following an extraction site, using PreservaRidge™ Plug, it is best to achieve primary closure if possible. The use of a membrane is left to the clinicians discretion.

When filling the void, following an extraction site, using PreservaRidge™ Plug, it is best to achieve primary closure if possible. The use of a membrane is left to the clinicians discretion.

No, Raptos® is available in vials, wide-mouth round bottom jars and syringes. Raptos® is available in cortical, cortico-cancellous blend, cancellous, demineralised and Premium Blend ( 70% mineralised cortical and 30% de-mineralised cortical.). It is available in vials for the following: Cortical, Cortical-Cancellous, Cancellous, Demineralised Cortical and the Premium Blend. It is available in jars (where you can actually mix and hydrate the product) in: Cortical, Cortical-Cancellous and Cancellous. It is available in syringes in Cortical, Cortical-Cancellous, Cancellous, Demineralised Cortical and Premium Blend. Please refer to the Product page for information on particle sizes.

Raptos® allograft irradiated bone particulates offers a natural scaffold for bone regeneration. The Cortico-cancellous Raptos® bone comes from sections of the ilium which are ground into several particulate sizes. The blend of cortical and cancellous that results from this process gives this product the structure of cortical, with the open scaffolding for bone to grow into offered by cancellous. The Raptos® Premium Blend is Cortical Mineralized/Demineralized blend combines two of the most popular allograft particles used in dentistry, all in a single vial.

The advantage of using Raptos® jars is that it can be mixed with blood/other bone/saline directly in the jar versus the Raptos® Vial, which has to be removed and placed into a bone well or mixing dish.

Raptos® as a standalone product, but also used as a graft extender. Yes, Raptos® can be mixed with different grafts, such as C-Blast Putty™, if you are looking to augment the graft or to help contain the grafts on site. It also can be mixed with antibiotics if needed.

History of each donor and sterilization protocol. Each donor used to produce Raptos® is thoroughly evaluated using medical/social history questions, medical records, blood tests, culture results, physical examination and autopsy reports (when performed). This process is used to ensure the donor is suitable for donation by allowing to recognize and exclude potential diseases or medical conditions that are unacceptable. Specific lab tests are performed for Syphilis, Hepatitis B and C, HIV and other viruses. All of the donor chart information is evaluated by individuals trained in tissue banking prior to processing the tissue. Tissue grafts are rinsed and soaked in various solutions to minimize transmission of bacteria and viruses. Processing and packaging of the tissue are performed using an aseptic technique and occur in a clean room. As an added margin of safety, a low dose gamma irradiation after final packaging of the musculoskeletal grafts is utilized.

Acquisition of bone to produce the Raptos® bone particulate. For the manufacture of Raptos®, only donors that meet or exceed FDA & AATB eligibility requirements are accepted. All donors are recovered within the United States, over 6,000 donors recovered in 2016.

It is important to rebuild or preserve the ridge when placing an implant because, before loading, there can be bone loss that can make it difficult to place the implant. Raptos® Particulates is a good choice as it gives time for the bone to remodel and for the ridge to rebuild.

Putties are versatile grafting solutions and allow dental surgeons to incorporate other bone types. An autogenous bone, a xenograft or particulate Raptos® bone can be added to putties allowing the granules to be contained and it also allows for easier placement.

Raptos® tissue grafts are rinsed and soaked in various solutions to minimize transmission of bacteria and viruses. Processing and packaging of the tissue are performed using an aseptic technique and occur in a clean room. As an added margin of safety, a low dose gamma irradiation after final packaging of the musculoskeletal grafts is utilized.

The time for remodeling to host bone really depends on the patient (age, health, etc.). The next major factor is the type of bone used. First, the demineralization of Raptos® cortical bone allows for faster remodeling versus mineralized cortical bone. If we compare cancellous Raptos® bone to cortical bone though the porosity, this becomes significant. Cancellous is 80% porous and cortical is only 10%. The increase in porosity allows for faster remodeling in the Cancellous Raptos®

Yes. While it is an additional cost at the outset, in the long run it will be beneficial to the patient to preserve the socket or ridge. If products such as Raptos®, DBM putties are used when the tooth is removed, more costly separate bone grafting procedures can be avoided in the future.

Bone graft materials such as Raptos® or DBM Putties, are highly purified and go through a highly controlled processing and sterilization procedure to remove any impurities. At the end of this process, every batch has to pass rigorous testing for purity and sterility.

An autograft can result in harvest site patient morbidity and complications, so it is sometimes best to use an allograft such as Raptos® or PentOS OI™ Putty. If you have a patient who will have trouble healing, or one that does not want to deal with secondary site discomfort, an allograft is a good option.

Dense structures show up on X-Rays. Depending on the composition of a bone graft it can range from totally radiolucent (does not show) to somewhat radiopaque. Due to the cortical bone structure around the graft site Raptos® typically does not show up on an X-Ray, however when the bone has consolidated, the new bone will show on the X-Ray. Radiolucent – Refers to structures that are less dense and permit the X-Ray beam to pass through them. Radiopaque structures appear light or white in a radiographic image. Cortical bone is 10% porous on average whereas cancellous bone is 80% porous. Cortical bone graft is easier to see on an X-Ray. Demineralized bone is virtually invisible to X-Rays

Your question about how long before placing an implant in a molar grafted with Raptos® depends on the volume of material used to graft the socket. The more volume of graft used extends healing time. Generally, in a contained socket, most clients are placing implants within five months with good initial stability. The use of the Penguin devices could help you decide if your implant is ready to load.

Citagenix has an extensive product offering and we therefore have an option for your patient. You can offer Eclipse™, a 100% synthetic bone substitute that completely transforms to natural bone. It is made of hydroxyapatite (HA) and tricalcium phosphate (TCP) (20% HA, 80% TCP).

Safety information on our Acellular Human Dermis Membrane. It is important to note that all tissues have been collected, processed, stored and distributed according to the Current Standards for Tissue Banking of the American Association of Tissue Banks (AATB), and Food and Drug Administration (FDA) Regulations and Ministry of Food and Drug Safety (MFDS) Regulations. Neoderm ADM is decellularized to remove cellular components and to preserve the biologic properties that promote revascularization and repair. It is minimally processed to remove epidermal and dermal cells, while preserving the extracellular matrix of the dermis. Neoderm ADM is sterilized with ethylene oxide gas (EO gas) after processing and packaging.

Composition and origin of Acellular Dermal Matrices. The most common sites of harvest for dermis grafts are the buttocks and inner thigh or back. The dermis is a connective tissue layer sandwiched between the epidermis and subcutaneous tissue. The dermis is a fibrous structure composed of collagen, elastic tissue, and other extracellular components. A dermis graft is a surgical procedure in which a piece of dermis is transplanted from a deceased human donor, processed and transplanted to another. Acellular dermal matrix (ADM) is a soft connective tissue graft generated by a decellularization process that preserves the intact extracellular skin matrix. Upon implantation, this structure serves as a scaffold for donor-side cells to facilitate subsequent incorporation and revascularization. Our version is known as Neoderm ADM.

Things to know and steps to follow before using Neoderm ADM. It is quite easy to prepare Neoderm ADM for use, there are just a few steps to follow one by one. Warm saline solution(37°C) may reduce the time required for rehydration. Nevertheless, do not heat saline above 37°C. When rehydrating multiple pieces, ensure the pieces are not overlapping or clumping together as this may delay the process. Use multiple dishes, if necessary. Fully submerge Neoderm ADM by weighing it down, e.g., with sterile forceps. Using a sterile gloved hand or forceps, remove and discard the paper backing (the 10x10 size is backing free) once it separates from the tissue. Neoderm ADM is fully rehydrated when it is soft and pliable throughout. Neoderm ADM will appear to be of uneven thickness and have a mottled appearance if it is not fully rehydrated. Once Neoderm ADM is removed from the packaging, it should be rehydrated within 24 hours and can be stored up to 4 hours prior to use. Neoderm ADM has an up/down side. The down side (dermal) has a paper backing meant to protect the absorbent characteristics of the dermal matrix. After hydrating for at least 10 minutes in sterile saline, remove the paper backing and place this dermal side onto the wound bed. You should see a rapid absorption of blood from the wound bed into the dermal side as an indication that the correct side is in the ideal orientation.

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.1 Instructions for Use. Geistlich Fibro-Gide®. Geistlich Pharma AG, Wolhusen, Switzerland.

Geistlich Fibro-Gide® is an alternative to autologous connective tissue grafts (CTG) for soft tissue volume augmentation around dental implants and natural teeth.1,2 Geistlich Fibro-Gide® obviously has the advantage of reducing patient morbidity since there is no additional harvest site. Furthermore, there is minimal risk of necrosis when using Geistlich Fibro-Gide® compared to CTG.3 Thoma DS et al. J Clin Periodontal 2016. Zeltner M et al. J Clin Periodontal 2017. Data on file. Geistlich Pharma AG, Wolhusen, Switzerland.

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.1,2 Geistlich Fibro-Gide® can be cut and trimmed both in a dry or wet state, using scissors and/or a scalpel.1,2 The scalpel is recommended for dry handling.1,2 Using a scalpel will help to obtain smooth edges and tapers for improved wound adaptation and precise fit of the matrix.1,2 Instructions for Use. Geistlich Pharma AG, Wolhusen, Switzerland. Data on file. Geistlich Pharma AG, Wolhusen, Switzerland.

Geistlich Mucograft® = Compact and spongy layer Geistlich Fibro-Gide® = Porous layer Geistlich Mucograft® = Reconstituted collagen: No cross-linking Geistlich Fibro-Gide® = Reconstituted collagen: Smart cross-linking Geistlich Mucograft® = Reduced volume stability Geistlich Fibro-Gide® = Good volume stability Geistlich Mucograft® = Open-healing & submerged healing Geistlich Fibro-Gide® = Submerged healing only Geistlich Mucograft® Treatment Option: Gain of keratinized tissue Socket Seal Vestibuloplasty Recession Coverage Geistlich Fibro-Gide® Treatment Option: Soft-tissue volume augmentation around dental implants and natural teeth, and under pontics Recession Coverage

The compact structure should face outward, away from underlying bone, with the spongeous structure facing the bone or soft-tissue wound bed. No clinical or comparative data is available regarding the performance of Geistlich Mucograft® when placed with the compact structure facing the bone or soft-tissue wound bed.

No. Geistlich Mucograft® has limited elongation properties and should always be sutured tension-free.

Geistlich recommends handling and applying the material dry, as it is easy to trim and pre-suture.

Geistlich Mucograft® is ready to be applied directly to the defect and does not need treatment or hydration prior to application. Due to its excellent hydrophilicity, the matrix will hydrate quickly with the patient’s blood after placement in the defect.

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

Geistlich Mucograft® Seal consists of porcine collagen and is specifically designed for soft-tissue regeneration. The matrix is built up of a compact macro-structure that gives stability while allowing open healing, and a spongy micro-structure that supports blood clot stabilization and ingrowth of soft-tissue cells.

Why you should use a barrier membrane Neomem® acts as a barrier to prevent the epithelial cells from growing into the bone graft. By not placing a membrane, your bone graft can be exposed to tissue growth, bacteria and food.

Suturing technique for socket preservation using Neomem® Xac. There are many different suturing techniques. We cannot recommend one over the other. However, in socket preservation procedures, it seems as if many clinicians seem to prefer a reverse figure eight type of suture technique. The reverse technique refers to the movement of the suture needle from inside the socket to the outside. This aids in membrane retention. In terms of suture material Biotex PTFE (4.0 or 5.0) is mostly used due to the monofilament nature, which eliminates bacterial wicking.

The Neomem® Xac manufacturing process The process to manufacture Neomem® Xac is centered on tightly controlled procedures focused on: Best in class procedure, driven by internal research and peer reviewed studies Minimal manipulation to retain optimal regenerative capacity native to tissue Exhaustive post-processing rinsing to effectively eliminate processing reagents Independent, contracted tissue recovery agencies follow strict protocols in accordance with FDA regulations and AATB standards. Serological and microbiological testing is performed at an independent, CLIA certified, FDA registered laboratory against standards that exceed the requirements of the FDA and AATB. Final donor eligibility is determined by a licensed medical director following review of all infectious disease testing, the uniform donor risk assessment interview and all relevant medical records. Placental membranes are recovered from caesarean section procedures and shipped to the manufacturer overnight in validated coolers. The membranes are processed fresh upon receipt and never frozen. The membrane is subjected to a proprietary series of mild aqueous rinses to disinfect and clean the tissue in ISO Class 6 clean rooms without the use of harsh chemicals. Once rinsed, the tissue is dehydrated, cut to size, packaged in foil and Tyvek pouches. Finished grafts are evaluated by dedicated quality control technicians and subjected to terminal sterilization via low dose e-beam irradiation to a sterility assurance level of 10-6. Every step of the process is completed in accordance with current Good Tissue Practices (cGTP), AATB standards and AORN aseptic technique. All processes are validated against appropriate ISO standards. Finally, a comprehensive review of the infectious disease testing, processing records, labeling documentation, and medical records are completed by a dedicated quality associate prior to the tissue being released for distribution.

No, there is no orientation. Neomem® Xac amnion-chorion membrane, as well as all others we have seen in dentistry, do NOT have any orientation, as they are deepithelialized. They can be placed up or down, folded, and/or layered, without any concern.

Amnion-chorion membranes generally resorb in 8 to 12 weeks. If the membranes are left exposed, this absorption profile will obviously differ, but given the many factors that could impact an exposed membrane, it is not possible to give a precise resorption profile for an exposed membrane. However, Neomem® Xac amnion-chorion membranes have proven to behave exceptionally well under exposure.

Comparison between Neomem® and Neomem® FlexPlus The main difference between the two is that one is derived from highly purified type I collagen fibres from bovine Achilles tendon. The other is a single layer collagen membrane derived from porcine peritoneum. Neomem® may be too stiff in some instances, with too much memory that causes it to spring back. Neomem® FlexPlus is supple and drapy ensuring that it drapes over the ridge easily.

Guidelines after using Neomem® Xac If the membrane is exposed to the oral environment, then for 3 days post-op please instruct the patient to avoid overly aggressive rinsing or swishing with any solution to avoid dislodgement of the membrane. After 3 days, gentle rinsing with salt water is recommended for the next 7 days. The patient should not use any oral rinses 10 days post-op. This includes antiseptics; chlorhexidine (Peridex®), chlorhexidine without alcohol, and other common oral rinses. Oral rinses can adversely impact the health of gingival cells, and chlorhexidine specifically may adversely impact the membrane. After 10 days post-op, the patient may begin using an oral rinse for plaque control.

The OpenTex® TR Membrane may be shaped or cut to your preferred size. OpenTex® TR membrane and the titanium can be trimmed to the required size. It will be important to verify that the edges of the titanium are smooth after trimming them. You want to make sure that there are no sharp edges so it as to not puncture through the flap of tissue.

Features of OpenTex® Unlike traditional membranes, the soft tissue attaches, but does not grow through the membrane with OpenTex®. The exposed membrane also allows for non-surgical removal therefore no anesthesia is required.

Positioning of the PTFE OpenTex® and OpenTex® TR membranes The regular OpenTex® membranes can be placed either side up but for the Titanium reinforced version, OpenTex® TR, it is preferable to place down the dark side of the titanium over the bone.

Geistlich Bio-Gide® can be used submerged or in an open healing situation1 depending on the surgeon's preference. The advantages of the secondary intention healing of Geistlich Bio-Gide® include the ability to perform a flapless surgery and the preservation of the mucogingival line. References: Cardaropoli D, et al.: Int J Periodontics Restorative Dent 2012, 32(4): 421-30.

Geistlich Bio-Gide® is a membrane with a unique bilayer structure. It combines optimal bone formation with complication-free wound healing and predictable outcomes. The native collagen of Geistlich Bio-Gide® leads to significantly less soft tissue dehiscences compared to artificially cross-linked membranes.1 A significant number of scientific publications and proven long-term clinical success support the safety and efficacy of Geistlich Bio-Gide®.

No. Autoclaving or hot-air sterilization irreversibly destroys the collagen structure. The physical properties of the membrane are changed and the consistency of the product becomes like parchment paper. In addition the product is not approved for re-sterilization and therefore may not be used.

Geistlich Bio-Gide® Compressed has a smoother surface, a firmer feel and is easier to cut compared to Geistlich Bio-Gide®. It offers an alternative handling for clinicians who prefer a firmer membrane.

The bilayer structure of Geistlich Bio-Gide® Compressed has a compact, porous surface that exhibits higher cell occlusiveness than the rough, porous layer which prevents the downgrowth of epithelial cells. If the membrane is applied with the porous surface placed toward the soft-tissue, integration of the bone cells may take place more slowly, however the membrane does not need to be removed.

The surface of Geistlich Bio-Gide® Perio has been made firmer when dry to facilitate periodontal applications. Second, the outer blister pack of Geistlich Bio-Gide® Perio includes four sterile water repellent templates. These can be placed repeatedly in the region of the defect to allow customization of the template before trimming the membrane to the precise shape.

Geistlich Bio-Gide® Shape shares the same biological properties but is pre-cut to reduce preparation time, facilitate easier handling and specifically designed for non-intact extraction sockets.

Place the membrane without pre-wetting within the extraction socket. The long wing of the Geistlich Bio-Gide® Shape should be placed to cover the bony defect of the socket with the dense surface facing towards the soft-tissue and the rough side facing 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/palatally in-between the soft-tissue and bone wall.

The membrane can be placed inside the alveolus for a less invasive surgical procedure but can also be placed outside, between the bone and the soft-tissue. The long wing of the Geistlich Bio-Gide® Shape should cover the bony defect of the socket, if present, with the dense surface facing towards the soft-tissue, and the rough side facing the defect.