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Understanding of GBR procedures

Basic Course. Understanding of GBR procedures. Slides: 44 Duration: 50 min. www.befrest.com. Concept. Purpose of Training. Key Point. Goal of Training. - To understand GBR procedures and materials. - Understanding of GBR procedures - Understanding of GBR products.

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Understanding of GBR procedures

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  1. Basic Course Understanding of GBR procedures Slides: 44 • Duration: 50 min www.befrest.com

  2. Concept Purpose of Training Key Point Goal of Training - To understand GBRprocedures and materials - Understanding of GBR procedures - Understanding of GBR products • To understand the overall GBRprocedures and materials • To understand and explain OSSTEM’s GBRproducts www.befrest.com

  3. Contents Part I. Training Contents Part II. Quiz Part III. Glossary www.befrest.com

  4. I. Training Contents Knowledge of GBR Understanding of Bone Graft Materials Understanding of GBR Membranes Introduction of OSSTEM’sGBRProducts www.befrest.com

  5. 1. Knowledge of GBR OSSTEM GBR Products GBR Membrane Bone Graft Materials Knowledge of GBR GBR (Guided bone regeneration) GBR,(Guided bone regeneration)is performed to facilitate bone regeneration when bone thickness in a jaw is insufficient for implant placement with using an artificial membrane. In case of not using an artificial membrane, soft tissue grows faster than bone tissue, so that gingiva infiltrates in the area where bone should regenerate. Without using an artificial membrane In case of using an artificial membrane, the membrane prevents alveolar socket from being infiltrated by soft tissue and helps bone regeneration. Membrane A part where bone graft is needed With using an artificial membrane www.befrest.com

  6. 1.Knowledge of GBR OSSTEM GBR Products GBR Membrane Bone Graft Materials Knowledge of GBR Purpose of GBR GBR normally applies to where bone absorption happened or bone ridge get narrow to bring bone augmentation through bone regeneration for stable and successful placement of dental implants. Insufficient alveolar bone (Difficult to operate the dental implant surgery) Bone graft applies to the area of bone loss Dental implant can be placed into the area of new bone www.befrest.com

  7. 1. Knowledge of GBR OSSTEM GBR Products GBR Membrane Bone Graft Materials Knowledge of GBR Dental Implant Surgery with GBR Natural bone loss following tooth extraction in the upper or lower jaw often leaves inadequate bone insufficient for dental implants. To correct this problem, gingiva is lifted away from the ridge to expose the bony defect and the defect is then filled with bone or bone substitute materials. A membrane is then used to contain this bone graft and to prevent unwanted non-bone cells from migrating in. This helps building up the bone ridge and enables placement of dental implant in the area. GBR with The Material of Titanium Membrane(Example 1) Bone Graft Covered with Membrane Formed new bone Dental implants surgery at the area of bone loss www.befrest.com

  8. 1. Knowledge of GBR OSSTEM GBR Products GBR Membrane Bone Graft Materials Knowledge of GBR Bone graft Bone graft isa surgical procedure that replaces missing alveolar bone with a material which is called a bone graft. Bone graft not only replaces missing bone, but helps the successful dental implant surgery by regeneration of alveolar bone. The thickness of the maxillary sinus bone(Example 2) Dental implant surgery is hampered due to insufficient thickness of bone.  Bone graft sinus augmentation surgery. 2 1 NormalBone Thickness of Maxillary bone around sinus Bone Graft for the dental implant surgery 4 Followed up by implant surgery after bone regeneration.  Furthermore, implant surgery and bone graft can be performed simultaneously 3 Bone Graft An Implant can be put in place www.befrest.com

  9. 1. Knowledge of GBR OSSTEM GBR Products GBR Membrane Bone Graft Materials Knowledge of GBR The key elements for successful GBR Blockage of growing soft tissue: prevent soft tissue from infiltrating into where bone material is grafted. To secure and maintain a space of GBR: obtain a space for GBR. Fixation of membrane: No movement of membrane during a healing period. Anti-bacteria treatment : prevent bacteria from infiltrating into where bone material is grafted. Stability of GBR area: Exposure of membrane after surgery has to be minimized due to concerns of infection Stationariness of GBR: Movement of Bone graft material interrupts osseointegration. www.befrest.com

  10. 1. Knowledge of GBR OSSTEM GBR Products GBR Membrane Bone Graft Materials Knowledge of GBR Indications of GBR Bone preservation after tooth extraction Alveolar ridge augmentation Maxillary sinus lift surgery Bone regenerationwhere dental implant is placed www.befrest.com

  11. 2. Understanding of Bone Graft Materials OSSTEM GBR Products GBR Membrane Bone Graft Materials Knowledge of GBR Conditions of good bone graft materials · The capability of bone regeneration (speed & rate) should be good. · Resistance against infection after graft into body should be good. · No rejection in the body. · A good capability to maintain a volume of bone. · Graft procedure should be simple and convenient. · Price of bone graft materials should be reasonable. www.befrest.com

  12. 2. Understanding of Bone Graft Materials OSSTEM GBR Products GBR Membrane Bone Graft Materials Knowledge of GBR The types of bone graft materials www.befrest.com

  13. 2. Understanding of Bone Graft Materials OSSTEM GBR Products GBR Membrane Bone Graft Materials Knowledge of GBR Autologous Characteristics: collected bone from another area of own body such asthe corner of the jaws or the chin. Advantages: 1) A good capability of bone regeneration. 2) No rejection in the body. Disadvantages: 1)Demands for an extra surgery. 2) Limitations for collected bone quantity. www.befrest.com

  14. 2. Understanding of Bone Graft Materials OSSTEM GBR Products GBR Membrane Bone Graft Materials Knowledge of GBR Allograft Characteristics: derived from human donor. Advantage: 1) A good capability of bone regeneration. Disadvantages: 1)Risk of rejection. 2) The price is expensive than xenograft and alloplastic. www.befrest.com

  15. 2. Understanding of Bone Graft Materials OSSTEM GBR Products GBR Membrane Bone Graft Materials Knowledge of GBR Xenograft Characteristics: derived from animals. Advantages: 1) A good capability to maintain bone volume. 2) Similar to human bone. Disadvantages: 1) Capability of bone induction is lower than Autologous. 2) Risk of rejection. www.befrest.com

  16. 2. Understanding of Bone Graft Materials OSSTEM GBR Products GBR Membrane Bone Graft Materials Knowledge of GBR Alloplastic Characteristics : Synthetic bone graft materials. Advantages: 1) Less risk of infection. 2) Price is cheap. Disadvantage: 1) Capability of bone regeneration is lower than Allograft and Xenograft. www.befrest.com

  17. 2. Understanding of Bone Graft Materials OSSTEM GBR Products GBR Membrane Bone Graft Materials Knowledge of GBR Indications of bone graft materials Autologous: Effective in all cases. Allograft: Effective in the maxillary sinus lift surgery or an exposure of implanted area. Xenograft: Effective in an esthetic part of the maxillary anterior teeth or the preservation of alveolar bone. Alloplastic: Effective in reducing bone absorption through mixing with Autologous or Allograft. - Q-Oss: Effective in the preservation of alveolar bone. - Q-Oss+: Effective in the area of tooth extraction or the maxillary sinus lift surgery. www.befrest.com

  18. 3. Understanding of GBR Membranes OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR The selection of GBR membranes A membrane should be selected based on considering of the inherent advantages and limitations to maximize functional result in suit with each clinical case. www.befrest.com

  19. 3. Understanding of GBR Membranes OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR Characteristics of a good membrane • 1. Tissue adhesion:Membrane must be attached to soft tissue easily. • 2. Blockage of unwanted cells: Enhance ONLY osteoblasts’ proliferation. • 3. Clinical handiness: Convenient and easy to use. • 4. Create a space for ingrowth: Secure and maintain a required space for osseointegration. • 5. Tissue affinity: No inflammatory reaction. The Principle of GBR Epithelial Cells Membrane Original bone www.befrest.com

  20. 3. Understanding of GBR Membrane OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR Types and classification of dental membrane II I • Absorbable • Membrane • Non-Absorbable Membranes ② ③ ① • Collagen • Membrane • PTFE • Membrane • Titanium mesh www.befrest.com

  21. 3. Understanding of GBR Membrane OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR PTFE Membrane Natural polymer Membrane Absorbable Membrane Non-Absorbable Membrane Titanium mesh I Characteristics of Absorbable Membranes • Characteristics • • Absorbable membranes are made of the natural polymers, therefore they are gradually hydrolyzed or enzymatically degraded. • Advantages: • • No needs of second surgery for removal. • • Lower probability of infection even after membrane exposure. www.befrest.com • Disadvantage: • •The materials are not firm enough, then they generally lose strength, collapse into space and lead to a failed reconstruction of volume.

  22. 3. Understanding of GBR Membrane OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR PTFE Membrane Natural polymer Membrane Absorbable Membrane Non-Absorbable Membrane Titanium mesh ① Collagen Absorbable membranes • Characteristics • • Collagen is derived from animals such as cows or pigs • • It takes around between four and fourteen weeks to be absorbed • Advantages: • • No requiring of 2nd surgery. • • The response of cell adhesion and proliferation are very good. www.befrest.com • Disadvantages: • • The materials are not firm enough, then they generally lose strength, collapse into space and lead to a failed reconstruction of volume. • • When bone graft is performed with implant placement simultaneously, then the stability of implant weakens.

  23. 3. Understanding of GBR Membrane OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR PTFE Membrane Natural polymer Membrane Absorbable Membrane Non-Absorbable Membrane Titanium mesh II Characteristics of Non-Absorbable Membranes • Characteristics • • Excellent maintenance of the space for a sufficient period of bone regeneration compared with an absorbable membrane. • Advantages: • • Handy to use clinically. • •Excellent results of space maintenance. • Disadvantages: • • Second surgery is inevitable for removal. • • Probability of infection from bacteria. www.befrest.com

  24. 3. Understanding of GBR Membrane OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR PTFE Membrane Natural polymer Membrane Absorbable Membrane Non-Absorbable Membrane Titanium mesh ② PTFE Membrane • Characteristics • • It is made of expandedpolytetraflouroethylene(PTFE). • Advantages: • • Handy to use clinically. • •Excellent results of space maintenance. • Disadvantages: • • Second surgery is inevitable for removal. • • Probability of infection from bacteria. www.befrest.com

  25. 3. Understanding of GBR Membrane OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR PTFE Membrane Natural polymer Membrane Absorbable Membrane Non-Absorbable Membrane Titanium mesh ③ Titanium mesh • Characteristics • • Titanium mesh has high rigidity, low density, despite low weight and also an excellent resistance of corrosion. • Advantages: • • Excellent results of blood supply. • • Rigidity provides extensive space maintenance. • • Applicable to vertical ridge augmentation. • Disadvantages: • • When using it for the first time, it is not easy to manipulate compared with an absorbable membrane. • • Second surgery is inevitable for removal. www.befrest.com

  26. 4. Introduce OSSTEM’s GBR Products OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR OSSTEM’s GBR Products www.befrest.com • Bone Graft • Membranes • Xenograft • A-Oss • Allograft • SureOss, • CANOSS, • OsteOss, • Ingross, • Genesis, • SureFuse II, • ExFuse II, • Bellafuse • Alloplastic • Q-Oss, • Q-Oss+ • Absorbable • OssGuide, • Cytoplast RTM Collagen, • AtoloCare, • CllaDerm • Non-Absorbable • Non-Absorbable • Cytoplast TXT, • Cytoplast Ti • Non-Absorbable • SmartBuilder ⑤ ② ③ ④ ⑥ ①

  27. 4. Introduce OSSTEM’s GBR Products OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR Alloplastic(Q-Oss, Q-Oss+) PTFEmembrane (Cytoplast) Xenograft(A-Oss) Allograft (SureOss) Collagen membrane (Oss-Guide) Titanium mesh (SmartBuilder) ① Allograft(SureOss) • Characteristics: • 1. SureOss is a type of allograft bone material as a human bone, and has a good capability of bone regeneration. • 2. It has a long history of clinical data. • 3. It is the most common allograft product in Korea. www.befrest.com

  28. 4. Introduce OSSTEM’s GBR Products OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR Alloplastic(Q-Oss, Q-Oss+) PTFEmembrane (Cytoplast) Xenograft(A-Oss) Allograft (SureOss) Collagen membrane (Oss-Guide) Titanium mesh (SmartBuilder) ① Allograft(SureOss, SureOss-D, CANOSS) CANOSS Freeze Dried Bone Allograft (FDBA) Cancellous bone SureOss Freeze Dried Bone Allograft (FDBA) Cortical bone SureOss-D Demineralized Freeze Dried Bone Allograft(DFDBA) Cortical bone Freeze Dried: A method of drying the frozen material that transforms to vapor by the low pressure. Demineralized Freeze Dried: DFD is a product that inorganic substance (mineral) is removed. Cortical bone: Compact bone. Cancellous bone: Spongy bone . www.befrest.com

  29. 4. Introduce OSSTEM’s GBR Products OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR PTFEmembrane (Cytoplast) Alloplastic(Q-Oss, Q-Oss+) Xenograft(A-Oss) Allograft (SureOss) Collagen membrane (Oss-Guide) Titanium mesh (SmartBuilder) ① Allograft(OsteOss, INGROSS, Genesis) OsteOss FDBA Cortical + Cancellous bone Genesis FDBA Block bone INGROSS FDBA+ DFDBA Cortical bone Freeze Dried: A method of drying the frozen material that transforms to vapor by the low pressure. Demineralized Freeze Dried: DFD is a product that inorganic substance (mineral) is removed. Cortical bone: Compact bone. Cancellous bone: Spongy bone . www.befrest.com

  30. 4. Introduce OSSTEM’s GBR Products OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR Alloplastic(Q-Oss, Q-Oss+) PTFEmembrane (Cytoplast) Xenograft(A-Oss) Allograft (SureOss) Collagen membrane (Oss-Guide) Titanium mesh (SmartBuilder) ① Allograft(SureFuse II, ExFuse II, BellaFuse) SureFuse II DFDBA Cortical + CMC Carrier BellaFuse DFDBA Sheet(Gelatin carrier) type ExFuse II DFDBA Cancellous + CMC Carrier Freeze Dried: A method of drying the frozen material that transforms to vapor by the low pressure. Demineralized Freeze Dried: DFD is a product that inorganic substance (mineral) is removed. Cortical bone: Compact bone. Cancellous bone: Spongy bone . www.befrest.com

  31. 4. Introduce OSSTEM’s GBR Products OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR PTFEmembrane (Cytoplast) Alloplastic(Q-Oss, Q-Oss+) Xenograft(A-Oss) Allograft (SureOss) Collagen membrane (Oss-Guide) Titanium mesh (SmartBuilder) ② Xenograft (A-Oss) • Characteristics of A-Oss • 1. Similar to human bone structure. • 2. Excellent formation of new bone with significantly good blood wettability. • 3. Excellent volume maintenance. www.befrest.com

  32. 4. Introduce OSSTEM’s GBR Products OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR Alloplastic(Q-Oss, Q-Oss+) PTFEmembrane (Cytoplast) Xenograft(A-Oss) Allograft (SureOss) Collagen membrane (Oss-Guide) Titanium mesh (SmartBuilder) ③ Alloplastic(Q-Oss / Q-Oss+) • Characteristics of Q-Oss, Q-Oss+ • 1. Excellent pore structure for bone regeneration. • 2. Excellent formation of new bone with significantly good blood wettability. • 3. Divided usage for disparate indications. • Additional Information: Q-OssandQ-Oss+ consist of HA (slow ossification) and β-TCP(fast ossification) • Q-Oss : High ratio of HA Excellent volume maintenance. • Q-Oss+: High ratio of β-TCP  Rapid bone regeneration www.befrest.com

  33. 4. Introduce OSSTEM’s GBR Products OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR PTFEmembrane (Cytoplast) Alloplastic(Q-Oss, Q-Oss+) Xenograft(A-Oss) Allograft (SureOss) Titanium mesh (SmartBuilder) Collagen membrane (Oss-Guide) ④ Absorbable Membranes(Collagen Membranes) • Characteristics of OssGuide • 1. Material derives from porcine collagen • 2. Handy to use with excellent adhesion and attachment • 3. Absorbable Collagen Membrane for GBR • Characteristics of Cytoplast RTM Collagen • 1. Material derives from bovine collagen • 2. Long term sustainability(26~38W) • 3. Absorbable Collagen Membrane for GBR • RTM (Resorbable Tissue Matrix) www.befrest.com

  34. 4. Introduce OSSTEM’s GBR Products OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR PTFEmembrane (Cytoplast) Alloplastic(Q-Oss, Q-Oss+) Xenograft(A-Oss) Allograft (SureOss) Collagen membrane (Oss-Guide) Titanium mesh (SmartBuilder) ④ Absorbable Membranes (Collagen Membranes) • Characteristics of AteloCare • 1. Material derives from porcine collagen. • 2. Excellent results in hemostasis. • 3. Prevent perforation of membrane in the maxillary sinus lift surgery. • Characteristics of CollaDerm • 1. Material derives from porcine collagen. • 2. Used to stanch after extraction of wisdom teeth. • 3. Prevent the collapse of soft tissue. www.befrest.com

  35. 4. Introduce OSSTEM’s GBR Products OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR PTFEmembrane (Cytoplast) Alloplastic(Q-Oss, Q-Oss+) Xenograft(A-Oss) Allograft (SureOss) Titanium mesh (SmartBuilder) Collagen membrane (Oss-Guide ⑤ Non-Absorbable Membranes –(PTFEMembranes) • Characteristics of Cytoplast TXT • 1. Non-absorbable membrane. • 2. Minimize the risk of bacterial infection. • 3. Excellent biocompatibility. • Characteristics of Cytoplast Ti • 1. Fixation-reinforced non-absorbable titanium membrane. • 2. Minimize the risk of bacterial infection. • 3. Excellentbiocompatibility. www.befrest.com

  36. 4. Introduce OSSTEM’s GBR Products OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR PTFEmembrane (Cytoplast) Alloplastic(Q-Oss, Q-Oss+) Xenograft(A-Oss) Allograft (SureOss) Titanium mesh (SmartBuilder) Collagen membrane (Oss-Guide) ⑥ Non-Absorbable Membranes (Titanium Membrane) • Characteristics of SmartBuilder • 1. Minimize gingiva exposure. • 2. Handy to use without bending or trimming. • 3. Excellent attachment. Existing Titanium mesh SMARTbuilder www.befrest.com

  37. II. Quiz www.befrest.com

  38. II. Quiz Which surgery applies an artificial membrane to facilitate bone regeneration when the bone thickness in the jaw is insufficient for implant placement? ① Maxillary sinus life surgery② Guided Bone Regeneration(GBR)③ Dental implant surgery ④ Soft tissue regeneration √ 2. What is a surgical procedure that replaces missing alveolar bone with bone material? ① Bone graft ② Dental implant surgery ③ Soft tissue regeneration ④ Scaling √ 3. Choose all correct indications of GBR? (4 answers) ① Preserve bone after tooth extraction ② Alveolar ridge augmentation ③ Maxillary sinus lift surgery ④ Bone regeneration around placed dental implant ⑤ Transplantation of teeth √ √ √ √ www.befrest.com

  39. II. Quiz 4. Choose all correct conditions of good bone graft materials? (4 answers) ① The capability of bone regeneration(speed & rate) should be good. ② The resistance to infection should be good. ③ No rejection in the body. ④ A good capability to maintain a volume of bone. ⑤ The bone graft materials should be expensive. √ √ √ √ 5. Choose all correct matching between bone types and bone graft materials. ① Autologous– Human bone(Self bone) ② Allograft– Human bone(Other people’s bones) ③ Xenograft– Mixed bone with more than two animals’ bones ④ Alloplastic– Synthetic bone www.befrest.com √ √ √ 6. Choose all correct bone graft indications? ① Autologous– Effective in all cases ② Allograft– Effective in the maxillary sinus lift surgery or exposure of placed dental implant ③ Xenograft– Effective in an esthetic part on the maxillary anterior teeth or preservation of alveolar bone ④ Alloplastic– Never mix with others, used independently. √ √ √

  40. II. Quiz 7. Choose all correct elements of good membrane? ① Create space for ingrowth. ② Block unwanted cells. ③ Block an external impact. ④ Membrane materials should be strong and hard. √ √ √ 8. Choose all correct characteristics of absorbable membranes ? ① They are made of the natural polymers and gradually hydrolyzed or enzymatically degraded. ② Decompose at certain temperatures. ③ Minimize bacteria infection when membrane is exposed. ④ The materials are not firm enough, then normally lose strength, collapse into space. www.befrest.com √ √ √ 9. Choose all correct characteristics of Non-absorbable membranes? ① Better maintenance of space than absorbable membrane for a sufficient period of bone regeneration. ② Handy to use. ③ Excellent maintenance of space. ④ No needs of second surgery for removal. √ √ √

  41. II. Quiz 10. Choose all correct matching between bone types and OSSTEM products? ① Allograft– SureOss ② Xenograft– Bio-Oss ③ Alloplactic– Q-Oss ④ Absorbable membrane– OssGuide ⑤ Titanium mesh– SmartBuider √ √ √ √ www.befrest.com 11. What is the material of A-Oss product? ① TCP② Human bone③ Collagen ④ porcine⑤ bovine √ 12. Which non-absorbable membrane is used to regenerate periodontal tissue and promote bone formation where natural bone defect has occurred and is designed as 3Dpre-formed titanium membrane? ① SmartBuilder ② TS CA ③ A-Oss ④ Q-Oss ⑤ SureOss √

  42. III. Glossary www.befrest.com

  43. III. Glossary • GBR : Guided Bone Regeneration. • Bone graft : A surgical procedure performed to restore absorbed bone with using bone graft materials. • Membrane : A material used in GBR surgery to prevent epithelium. • PTFE membrane: It is made of expandedpolytetraflouroethylene (PTFE). • Freeze Dried: A method of drying the frozen material that transforms to vapor by the low pressure. • Demineralized Freeze Dried: DFD is a product that inorganic substance (mineral) is removed. • Cortical bone: Compact bone, Hard bone. • Cancellous bone : Spongy bone, Soft bone.; www.befrest.com

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