v Basic Course Understanding of GBR procedures Slides

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

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

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

I. Training Contents 1. Knowledge of GBR 2. Understanding of Bone Graft Materials 3. Understanding of GBR Membranes 4. Introduction of OSSTEM’s GBR Products www. befrest. com 4

1. Knowledge of GBR OSSTEM GBR Products GBR Membrane Bone Graft Materials 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 Without using an artificial membrane tissue grows faster than bone tissue, so that gingiva infiltrates in the area where bone should regenerate. Membrane A part where bone graft is needed www. befrest. com In case of using an artificial membrane, the membrane prevents alveolar socket from With using an artificial membrane being infiltrated by soft tissue and helps bone regeneration. 5

1. Knowledge of GBR GBR Membrane Bone Graft Materials OSSTEM GBR Products Purpose of 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 Bone graft applies to the area Dental implant can be placed (Difficult to operate the of bone loss into the area of new bone dental implant surgery) www. befrest. com 6

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) Dental implants surgery at the area of bone loss www. befrest. com Bone Graft Covered with Membrane 7 Formed new bone

1. Knowledge of GBR OSSTEM GBR Products GBR Membrane Bone Graft Materials Knowledge of GBR Bone graft is a 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) Normal Bone 2 1 Thickness of Maxillary bone around sinus Bone Graft for the dental Bone Graft 3 An Implant can be put in place implant surgery 4 Dental implant surgery is hampered due to insufficient thickness of bone. Bone graft sinus augmentation surgery. Followed up by implant surgery after bone regeneration. Furthermore, implant surgery and bone graft www. befrest. com can be performed 8 simultaneously

1. Knowledge of GBR GBR Membrane Bone Graft Materials OSSTEM GBR Products The key elements for successful GBR material is grafted. 2. To secure and maintain a space of GBR: obtain a space for GBR. 3. Fixation of membrane: No movement of membrane during a healing period. 4. Anti-bacteria treatment : prevent bacteria from infiltrating into where bone material is grafted. 5. Stability of GBR area: Exposure of membrane after surgery has to be minimized due to concerns of infection 6. Stationariness of GBR: Movement of Bone graft material interrupts osseointegration. 9 www. befrest. com 1. Blockage of growing soft tissue: prevent soft tissue from infiltrating into where bone

1. Knowledge of GBR GBR Membrane Bone Graft Materials Indications of GBR 1. Bone preservation after tooth extraction 2. Alveolar ridge augmentation 3. Maxillary sinus lift surgery 4. Bone regeneration where dental implant is placed www. befrest. com 10 OSSTEM GBR Products

2. Understanding of Bone Graft Materials Knowledge of GBR Membrane Bone Graft Materials 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 11 OSSTEM GBR Products

2. Understanding of Bone Graft Materials GBR Membrane Bone Graft Materials Knowledge of GBR OSSTEM GBR Products The types of bone graft materials Materials Autologous Allograft Xenograft Alloplastic Human Bone (Self-Bone) Human Bone (Other people’s Bones) Derived from an animal such as a bovine bone Synthetic Bone www. befrest. com 12

2. Understanding of Bone Graft Materials Knowledge of GBR Membrane Bone Graft Materials Autologous Characteristics: collected bone from another area of own body such as the 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 13 OSSTEM GBR Products

2. Understanding of Bone Graft Materials Knowledge of GBR Membrane Bone Graft Materials 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 14 OSSTEM GBR Products

2. Understanding of Bone Graft Materials Knowledge of GBR Membrane Bone Graft Materials 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 15 OSSTEM GBR Products

2. Understanding of Bone Graft Materials Knowledge of GBR Membrane Bone Graft Materials 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 16 OSSTEM GBR Products

2. Understanding of Bone Graft Materials Knowledge of GBR Membrane Bone Graft Materials OSSTEM GBR Products 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 17

3. Understanding of GBR Membranes Knowledge of GBR Membranes Bone Graft Materials OSSTEM GBR Products 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 18

3. Understanding of GBR Membranes Knowledge of GBR Membranes Bone Graft Materials OSSTEM GBR Products 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 19

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

3. Understanding of GBR Membrane Knowledge of GBR Absorbable Membrane I GBR Membranes Bone Graft Materials Natural polymer Membrane Non-Absorbable Membrane OSSTEM GBR Products PTFE Membrane Characteristics of Absorbable Membranes Characteristics www. befrest. com • 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. Disadvantage: • The materials are not firm enough, then they generally lose strength, collapse into space and lead to a failed reconstruction of volume. 21 Titanium mesh

3. Understanding of GBR Membrane Knowledge of GBR Absorbable Membrane ① GBR Membranes Bone Graft Materials Natural polymer Membrane Non-Absorbable Membrane PTFE Membrane Collagen Absorbable membranes Characteristics • Collagen is derived from animals such as cows or pigs www. befrest. com • It takes around between four and fourteen weeks to be absorbed Advantages: • No requiring of 2 nd surgery. • The response of cell adhesion and proliferation are very good. 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. 22 OSSTEM GBR Products Titanium mesh

3. Understanding of GBR Membrane Absorbable Membrane II GBR Membranes Bone Graft Materials Knowledge of GBR Natural polymer Membrane Non-Absorbable Membrane PTFE Membrane 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 23 OSSTEM GBR Products Titanium mesh

3. Understanding of GBR Membrane Absorbable Membrane GBR Membranes Bone Graft Materials Knowledge of GBR Natural polymer Membrane ② Non-Absorbable Membrane PTFE Membrane Characteristics • It is made of expanded polytetraflouroethylene(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 24 PTFE Membrane OSSTEM GBR Products Titanium mesh

3. Understanding of GBR Membrane Absorbable Membrane GBR Membranes Bone Graft Materials Knowledge of GBR Natural polymer Membrane ③ Non-Absorbable Membrane 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 25 PTFE Membrane OSSTEM GBR Products Titanium mesh

www. befrest. com 4. Introduce OSSTEM’s GBR Products OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR OSSTEM’s GBR Products Bone Graft Membranes Allograft Xenograft Alloplastic Absorbable Sure. Oss, CANOSS, Oste. Oss, Ingross, Genesis, Sure. Fuse II, Ex. Fuse II, Bellafuse A-Oss Q-Oss, Q-Oss+ Oss. Guide, ① ② Non-Absorbable Cytoplast RTM Collagen, Atolo. Care, Clla. Derm ③ ④ 26 Non. Absorbable Cytoplast TXT, Cytoplast Ti Smart. Builder ⑤ ⑥

4. Introduce OSSTEM’s GBR Products Allograft (Sure. Oss) Xenograft (A-Oss) ① Alloplastic(Q-Oss, Q-Oss+) Collagen membrane (Oss -Guide) Allograft (Sure. Oss) Characteristics: 1. Sure. Oss 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 OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR 27 PTFE membrane (Cytoplast) Titanium mesh (Smart. Builder)

4. Introduce OSSTEM’s GBR Products Allograft (Sure. Oss) Xenograft (A-Oss) ① OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR Alloplastic(Q-Oss, Q-Oss+) Collagen membrane (Oss-Guide) PTFE membrane (Cytoplast) Titanium mesh (Smart. Builder) Allograft (Sure. Oss, Sure. Oss-D, CANOSS) Sure. Oss-D CANOSS Freeze Dried Bone Allograft Demineralized Freeze Dried Bone Allograft (FDBA) Cortical bone Bone Allograft(DFDBA) Cortical bone (FDBA) Cancellous 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. www. befrest. com Cortical bone: Compact bone. Cancellous bone: Spongy bone. 28

4. Introduce OSSTEM’s GBR Products Allograft (Sure. Oss) Xenograft (A-Oss) ① Alloplastic(Q-Oss, Q-Oss+) OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR Collagen membrane (Oss. Guide) PTFE membrane (Cytoplast) Titanium mesh (Smart. Builder) Allograft (Oste. Oss, INGROSS, Genesis) Oste. Oss INGROSS Genesis FDBA Cortical + Cancellous bone FDBA + DFDBA Cortical bone FDBA Block 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. 29 www. befrest. com

4. Introduce OSSTEM’s GBR Products Allograft (Sure. Oss) ① Xenograft (A-Oss) Alloplastic(Q-Oss, Q-Oss+) OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR Collagen membrane (Oss. Guide) PTFE membrane (Cytoplast) Titanium mesh (Smart. Builder) Allograft (Sure. Fuse II, Ex. Fuse II, Bella. Fuse) Sure. Fuse II Ex. Fuse II Bella. Fuse DFDBA Cortical + CMC Carrier DFDBA Cancellous + CMC Carrier DFDBA Sheet(Gelatin carrier) type 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. 30 www. befrest. com

4. Introduce OSSTEM’s GBR Products Allograft (Sure. Oss) Xenograft (A-Oss) ② Alloplastic(Q-Oss, Q-Oss+) Collagen membrane (Oss. Guide) 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 OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR 31 PTFE membrane (Cytoplast) Titanium mesh (Smart. Builder)

4. Introduce OSSTEM’s GBR Products Allograft (Sure. Oss) ③ Xenograft (A-Oss) OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR Alloplastic(Q-Oss, Q-Oss+) Collagen membrane (Oss-Guide) PTFE membrane (Cytoplast) Titanium mesh (Smart. Builder) 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-Oss and Q-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 32 www. befrest. com

4. Introduce OSSTEM’s GBR Products Allograft (Sure. Oss) ④ Xenograft (A-Oss) OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR Alloplastic(Q-Oss, Q-Oss+) Collagen membrane (Oss-Guide) PTFE membrane (Cytoplast) Titanium mesh (Smart. Builder) Absorbable Membranes (Collagen Membranes) Characteristics of Oss. Guide 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 (26~38 W) 3. Absorbable Collagen Membrane for GBR RTM (Resorbable Tissue Matrix) 33 www. befrest. com

4. Introduce OSSTEM’s GBR Products Allograft (Sure. Oss) ④ Xenograft (A-Oss) Alloplastic(Q-Oss, Q-Oss+) OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR Collagen membrane (Oss. Guide) PTFE membrane (Cytoplast) Absorbable Membranes (Collagen Membranes) Characteristics of Atelo. Care 1. Material derives from porcine collagen. 2. Excellent results in hemostasis. 3. Prevent perforation of membrane in the maxillary sinus lift surgery. Characteristics of Colla. Derm 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 34 Titanium mesh (Smart. Builder)

4. Introduce OSSTEM’s GBR Products Allograft (Sure. Oss) ⑤ Xenograft (A-Oss) OSSTEM GBR Products GBR Membranes Bone Graft Materials Knowledge of GBR Alloplastic(Q-Oss, Q-Oss+) Collagen membrane (Oss-Guide PTFE membrane (Cytoplast) Non-Absorbable Membranes –(PTFE Membranes) 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. Excellent biocompatibility. www. befrest. com 35 Titanium mesh (Smart. Builder)

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

II. Quiz www. befrest. com 37

II. Quiz 1. 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 surgery ② 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 38

II. Quiz 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 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. 39 www. befrest. com 4. Choose all correct conditions of good bone graft materials? (4 answers)

II. Quiz 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. √ 9. Choose all correct characteristics of Non-absorbable membranes? www. befrest. com 7. Choose all correct elements of good membrane? √ 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. 40

II. Quiz 10. Choose all correct matching between bone types and OSSTEM products? ② Xenograft – Bio-Oss √ ③ Alloplactic – Q-Oss √④ Absorbable membrane – Oss. Guide √⑤ Titanium mesh – Smart. Buider 11. What is the material of A-Oss product? ① TCP ② Human bone ③ Collagen ④ porcine √ ⑤ 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 3 D pre-formed titanium membrane? √ ① Smart. Builder ② TS CA ③ A-Oss ④ Q-Oss ⑤ Sure. Oss 41 www. befrest. com ① Allograft – Sure. Oss √

III. Glossary www. befrest. com 42

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