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Geistlich Fibro-Gide®

A breakthrough in soft-tissue regeneration

04.05.2018
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Soft tissue augmentation without using grafts from the palate – the new collagen matrix Geistlich Fibro-Gide® makes it possible.

PD Dr Daniel Thoma | Switzerland

Although connective tissue grafts are the gold standard when it comes to soft tissue augmentation their use is associated with several issues such as anatomical restrictions1-3 or pain and numbness at the donor site4,5. Patients and clinicians have long awaited a soft tissue substitute that avoids these problems and still delivers clinical performance comparable to autologous transplants.
The new 3-D stable, collagen matrix Geistlich Fibro-Gide® was launched in 2017. Before this, the biomaterial has been tested over ten-years in numerous in vitro, preclinical and clinical models that demonstrated:

  • Favorable mechanical properties and biological attributes enabling the ingrowth of human fibroblasts6
  • Favorable tissue integration and support to angiogenesis7
  • Non inferiority to the gold standard autologous graft in terms of 2- and 3-D linear and volumetric gains8,9

In a recent randomized controlled clinical trial Geistlich Fibro-Gide® was evaluated for mucosal thickness augmentation around dental implants.10 (Figs. 1-12) Geistlich Fibro-Gide® produced a volume increase non-inferior to autologous transplants and with relative stability over a three-month period. Apart from these favorable mechanical and biological attributes, patient morbidity was reduced when using Geistlich Fibro-Gide® compared with traditional connective tissue grafts.

 

Developing concept

Given the benefits of Geistlich Fibro-Gide® and based on current knowledge and experience, clinicians are now able to offer a choice when an increase in mucosal thickness is desired. Geistlich Fibro-Gide® is suitable for the following indications:

  • Delayed implant placement with concomitant soft tissue augmentation (simultaneous approach)
  • Delayed soft tissue augmentation at implant sites in conjunction with or prior to abutment connection
  • Soft tissue augmentation of pontic sites


The Clinical tips: flap technique

The coronally advanced flap is preferred when dealing with thin mucosal tissue (thin biotype), since the preparation of a tunnel is likely to cause perforations or tearing of the gingiva. The coronally advanced flap is also recommended when a greater amount of coronal advancement is planned and if the scalloped nature of the free gingiva is absent – flatly contoured gingival zenith, such as in the lower anterior region.
The tunneling technique is ideal when working with a thick biotype, highly scalloped free gingiva and suitable keratinized tissue. The tunneling technique should also be considered if esthetics are critical and a mild to moderate coronal advancement is anticipated. One of the key factors for success is the proficiency of the periodontal surgeon.


Connective tissue graft vs. biomaterial

Connective tissue grafts help create keratinized gingiva, based on a study of tissue specificity by Karring and co-workers.3 In this epithelial differentiation study, Karring was able to demonstrate that free grafts harvested from the palate produced keratinized gingiva, whereas grafts transplanted from the non-keratinized alveolar mucosa produced alveolar mucosa.4

Advantages of connective tissue grafts include plasmatic circulation (capillary beds within the grafts) that help with high graft survival, outstanding color match after healing and dimensional stability. Disadvantages include patient morbidity, e.g. bleeding, delayed healing and pain, along with the secondary graft harvest sites. (Figs. 1, 2)

Accordingly, clinicians have been interested in developing a graft substitute. Such biomaterials not only avoid connective tissue graft harvest and associated morbidity but also provide unlimited supply with consistent quality. Working with such biomaterials, complete primary closure with a tension-free flap is recommended. Ideal biomaterials should act as scaffolding to promote ingrowth and regeneration by host cells, while remaining dimensionally stable. (Fig. 3)

PD Dr Daniel Thoma

PD Dr Daniel Thoma | Switzerland

Head of Academic Unit
Clinic of Fixed and Removable
Prosthodontics and Dental Material Science
Center for Dental Medicine
University of Zurich

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