case studies - biomedical...
TRANSCRIPT
Case studies
BIL
AY
ER
ED
ST
RU
CT
UR
E
Next generation synthetic resorbable membrane Tisseos® is a bi-layered, synthetic, biocompatible and fully resorbable membrane for
Guided Bone Regeneration (GBR) and Guided Tissue Regeneration (GTR) applications.
Bilayered structure for optimal barrier effectSpecially designed bilayered structure prevents (gingival) epithelial tissue ingrowth on one side
(smooth fascia of dense layer) while promoting cell infiltration and guided bone healing on the other (matt fascia with non-woven microfibers).
Synthetic – today’s alternative choice:
• Medical-grade Polylactic-Glycolic Acid provides excellent biocompatibility. A 100% biodegradable polymer, PLGA has a long history of successful use in a variety of medical applications and devices such as resorbable sutures, pins, screws etc, and over many decades
• Unlike bovine or porcine derived membranes, Tisseos® is free from animal derivatives. Our biocompatible synthetic membrane avoids the risk of transmission of animal pathogens.
• Widens treatable patient group: Tisseos® synthetic membranes are suitable for patients who avoid animal by-products for cultural reasons or lifestyle choices.
SY
NT
HE
TIC
RE
SO
RB
AB
LE
PLA4
wk
s8
wk
s1
6 w
ks
26
wk
s The barrier function of Tisseos® membrane remains intact for the
first 4 weeks.
Optimal bone and tissue regeneration are both guaranteed thanks to
the slow, fully controlled resorption over 6 months, avoiding any
need for second stage surgery for membrane removal.
Graph shows the Tisseos® membrane resorption timeover a 6 month period.
Histologie of subcutis implants in rats of thesynthetic PLGA Tisseos® membrane after 4, 8, 16and 26 weeks (Coloration au trichrome deMasson; x100 barre=250 μm).
EA
SY
TO
US
E
• Supple but strong
• Easy to cut
• Tear resistant for tacking and suturing
• Sticks only to bone
• Does not stick to soft tissue or instruments
• Quickly soaks up biological fluids on the micro-fiber side
• Can be used without prior humidification
• Once wet Tisseos® respects the form and shape that you create
• Available in 4 sizes
15x20 15x25 20x30 30x40
Clinical case studyDr. HOORNAERT Alain, Nantes, France
1
Postoperative x-rayPositioning the Tisseos® membrane
Clinical situation after 4 monthsshowing successful vertical and
lateral bone augmentation
Gingival healing after 8 days
Bone regenerationusing Tisseos® membrane and a biomaterial
Initial clinical situation Alveolar ridge after opening of the gingiva
Filling of the bone defect withbiomaterial
Final restorationControl x-ray
Insertion of 2 implants Exposure of implants
Key benefits of Tisseos®
• A major advantage of Tisseos® is its easy surgicalhandling when compared to collagen membranes.When placed on the bone, the microfibre layersoaks up the blood and it attaches easily to thebone.
• The membrane can easily be repositioned on thebone defect for optimal placement to cover thebiomaterial.
• When suturing, the dense layer (smooth side of themembrane) slides easily over the gingival tissuewithout disturbing the bone filling biomaterial.
• Both the dental surgeon and the patient benefitfrom shorter surgical times and improvedoperational comfort.
Clinical case study
Dr. HOORNAERT Alain
Nantes, France
2
Postoperative viewPositioning of Tisseos® membrane
Gingiva healing at 8 days Clinical situation after 4 monthsshowing vertical and horizontal
bone augmentation
Filling of the defect with biomaterialInitial clinical situation Bone crest after opening of the gingiva
Socket preservation and bone ridge augmentationusing Tisseos® membraneand a biomaterial
Placement of covering screws Temporary prostheticsrestoration
CT-scan before surgery(prior to implantation)
Insertion of 3 implants
Alveolar bone resorption after tooth extraction cannotbe avoided. In the anterior maxillary bone, resorption isobserved on the vestibular side and can negativelyimpact the placement of the implant in two ways:
• The axis of the dental implant may be misplaced
• The implant may be visible when smiling
Using a dental membrane allows you to overcome suchproblems.
Why correct vestibular bonedefects?
Clinical case study
Drs. BRAY Estelle and L’ENFANT Benoit,
Nantes, France
3
Allogenic bone graftInitial clinical situation
Insertion of 2 implants Prosthetics rehabilitation showing the vertical defect
CT-scans Resorption of the allogenic bone graft
Alveolar ridge after 4 months
Alveolar ridge regenerationfollowing allogenic bonegrafting
using Tisseos® membraneand a biomaterial
Placement of Tisseos® membrane and filling of the defect with a biomaterial
Healing at 8 days
Temporary prosthetics restoration
Resorption of allogenic bone graft is difficult to predict.
Guided bone regeneration using Tisseos® and biomaterialallows you to augment bone vertically in a more predictableway.
Healing at 2 ½ months
Predictable vertical boneregeneration
Clinical case studyDr. MORLOCK Jean-François
Tours, France
4
Healing at 5 daysCovering with Tisseos® membrane
Healing at 28 days
Socket preservationusing Tisseos® membraneand a biomaterial
Clinical situation before tooth extraction
Dental alveole and bone ridge Filling with biomaterial
X-ray at 6 months
Final restoration
Re-entry at 6 months Insertion of 2 implants
Socket preservation
• After tooth extaction, the alveolar bone resorbs, compromising the insertion of implants.
• Filling of the alveole with biomaterial limits the bone resorption.
• Tisseos® membrane covers the biomaterial untilbone healing is complete.
Cilinical case studyDr. HOORNAERT Alain
Nantes, France
5
Filling with biomaterial in the fenestration
Insertion of implant
Covering with Tisseos® membrane
Alveolar ridgeInitial clinical situation Preoperative cone beam scans
Bone augmentation withimmediate implantationusing Tisseos® membrane and a biomaterial
Final restoration
Post-surgical view Healing at 1 month
Key features of Tisseos®
• The insertion of a dental implant for a screw-
retained prosthetic may lead to a vestibular
dehiscence when the maxillary bone profile is not
favorable.
• The use of Tisseos® and a biomaterial at the apex of
the implant allows you to prevent such dehiscence.
• The ease of handling of Tisseos® saves time in such
types of surgery.
X-ray
Clinical case study
Dr. EVANNO Charles,
Liré, France
6
Dehiscence coverageusing Tisseos® membraneand a biomaterial
Alveolar ridge after opening of the gingiva
Implant with exposed turnsInitial clinical situation
Filling with the biomaterial Repositioning of the membrane
Sutures X-ray
Placement of Tisseos® membrane
Palatal insertion
Membrane exposure at day 8
Placement of the cover screwat 1 month
Prosthetics restoration
What to do in case of membrane exposure?
• When filling a large defect, it may be difficult to close thegingival tissue without tension. The membrane may thenbecome exposed during the gingival healing.
• If exposed, Tisseos® membrane maintains its physicalintegrity, prevents leakage of the biomaterial andprevents infection of the site.
• The healing of the gingiva is favoured by the guidedtissue regeneration properties of the Tisseos®membrane.
• After exposure, the gingival tissue will heal and close in2 weeks without losing the barrier effect.
• Mouth wash with antiseptic solution and local applicationof a Chlorhexidine gel are recommended in case ofmembrane exposure.
Gingival healing at day 16
Clinical case study
Dr. THERY Laurent,
La Chapelle sur Erdre, France
7
Insertion of the implant
Filling with biomaterial Positioning of Tisseos® membrane
Initial clinical situation Pre-operative situation
Bone defect
Dehiscence coverageusing Tisseos® membraneand a biomaterial
Gingival healing at 10 daysSuturesResorption of Tisseos® membrane
The opening of the site after 4 months allows visualization
of the complete regeneration of the bone crest over 4
turns of the implant previously exposed, as well as the
complete resorption of the membrane.
Re-entry after 4 months
Clinical case studyDr. THERY Laurent
La Chapelle sur Erdre, France
8
Positioning Tisseos® membrane
Sutures Healing at 10 days
Surgical template Preparation of the graft according to the template
Bone grafting with bonebankand Tisseos® membrane
Grafts in situ
IRS UN, 8 quai Moncousu, 44000 Nantes, FrancePhone : + 33 228 08 00 37 - Fax : + 33 228 08 00 [email protected]
Tisseos® dental membrane is a class III medical device (CE0459) manufactured by Biomedical Tissues.For safe operation, Tisseos® membrane must be used in accordance with the instructions for use. (Legal notice M15B01B 2015-10)
Tisseos® - PL15MD006