Less Stress, More Bone With Regenerative Biomaterials
Bone substitute and regeneration materials from Geistlich align biologically with human tissue to promote better bone growth for more stable, successful implants
Mention the term “tension-free” and one assumes we’re talking “stress-free” as well. But in the world of bone augmentation to prepare patients for dental implants, the 2 terms are definitely not interchangeable—and achieving a tension-free closure during bone regeneration procedures is far from being free of stress. To lessen the stress that’s always part of this critical and complex component of bone augmentation, it’s beneficial if clinicians can be confident that the biomaterials being used will perform effectively. Avoiding subpar materials is a critical factor for procedural success, and because of this, Tamir Wardany, DDS, ABOI, relies on a line of bone regeneration products from Geistlich.
Dr. Wardany holds Diplomate status with the American Board of Oral Implantology and has dedicated almost 2 decades to extensive training in dental implant surgery and its associated procedures, including complex bone augmentation and sinus augmentation. His Sacramento, CA, practice focuses on the surgical aspects of implant dentistry, along with ridge and sinus augmentation surgeries, and he has been using Geistlich materials and performing several specific techniques—including a tension-free primary closure—for more than a dozen years.
“Geistlich materials are not chemically treated in ways that can lead to inflammation, so there’s more natural healing. Geistlich aligns itself with biology and with bone regeneration—taking sterilized materials that have no life in them and creating a process where the biology of the body is now working with that material. The Geistlich products are in excellent alignment with that biological process,” Dr. Wardany explained.
While not necessary in all extraction cases, Dr. Wardany believes many patients can benefit from grafting—either ridge augmentation or preservation—before implant surgery due to the inevitable bone loss that occurs naturally with age progression.
“Not only do I feel patients should have a bone graft at the time of the extraction just to ensure that we can maintain the ridge for the initial placement, but many times, I’m placing additional bone around the implant to make sure there’s good bone insulation for years to come,” Dr. Wardany explained.
First, a Look at Bone Augmentation
For augmentation—grafting outside the existing wall of the ridge—Dr. Wardany reaches for Geistlich Bio-Oss, a xenogeneic bone substitute derived from bovine bone. Bio-Oss displays excellent hydrophilic properties that promote rapid and complete hydration, along with superior handling properties.
“Typically, I’ll use Bio-Oss mixed with autogenous bone, which is bone that I’ve harvested from the patient’s jaw,” Dr. Wardany explained. “I’ll make a 50/50 mix to layer up against the existing ridge to make a thicker zone of the grafted material. It’s usually been some time since the extraction, so the healing process where growth factors are secreted is essentially complete. Since I have the patient’s bone in the mix, I have another source of growth factors that can start a more predictable bone regeneration process.”
Next, Dr. Wardany uses Geistlich Bio-Gide on top of the bone prior to closing the flap to contain bone particles. Bio-Gide is a porcine, resorbable collagen membrane with excellent tissue integration and wound stabilization, which prevents soft tissue from invading the graft too early, while allowing nutrients and growth factors from the periosteum to migrate into the graft. A bilayered, biocompatible membrane, Bio-Gide has excellent hydrophilicity for adhesion to the graft and surrounding bone, is easily trimmable, and displays high tensile strength to prevent tearing.
Next Step: A Tension-Free Primary Closure
“Over the membrane, we have to stretch the patient’s gum tissue, or the flap. We make the flap by making an incision down the middle of the ridge and we push one half of the flap to the buccal and one half to the lingual. The concept of ‘tension-free’ means that we don’t want to have to pull both sides of the flap or suture them too tightly—we want it to come together passively, without tension, so it will stay sutured more predictably,” Dr. Wardany explained.
Now, a Glimpse at Ridge Preservation
Dr. Wardany performs ridge preservation on patients with healed extractions who are planning to have implants in the coming months, but who need more bone in the socket. This “socket” graft is the most common type of grafting and for this procedure, Dr. Wardany reaches for either Geistlich Bio-Oss Collagen or Geistlich vallomix to complete the job.
With exceptional handling and ease of use, Bio-Oss Collagen improves the pocket depth and clinical attachment level while promoting rapid vascularization and faster epithelial and bone regeneration. “I love the handling and long-term results for certain ridge preservation procedures,” he said. “It works phenomenally when grafting the gap around an immediate implant. The combination of Bio-Oss Collagen and Geistlich’s native collagen membrane is magic!”
Geistlich vallomix is the first xenogeneic/allogeneic validated bone substitute. Designed to ensure vital bone after 18-20 weeks, vallomix is a demineralized bone matrix with a pore structure that enhances its hydrophilic properties.
“Vallomix is an allograft and xenograft mix, which tends to become solid faster, so it’s my choice for everyday, run-of-the-mill extractions where I’m going to extract the tooth and place the implant in about 4 months,” Dr. Wardany shared.
As a final step, Dr. Wardany covers the graft with Geistlich Mucograft, a collagen matrix that promotes soft tissue cell ingrowth and favorable integration of the matrix with the surrounding tissues. Providing superior hydrophilicity, Mucograft encourages immediate blood clot stabilization and faster healing.
“Mucograft heals well and yields a better keratinized tissue over the graft site. A thicker keratinized tissue leads to a better future implant,” Dr. Wardany said. “Geistlich materials allow for angiogenesis and a vasculature within the graft much better than other materials that have been chemically treated or not manufactured in this way.”
