botiss mucoderm® Mastering esthetics.

ESTHETIC DENTISTRY

botiss mucoderm®Mastering esthetics.

At a glance

Clinical cases

Summary

What‘s in it for you?

Technical information

Clinical evidence

What customer say

mucoderm®: Benefitting from nature – the safe alternative to autologous soft tissue grafting.

Safe your patients from pain and increase their acceptance with the surgical procedure.¹

At a glance

1 Vincent-Bugnas S, Borie G, Charbit Y. 2018. J Esthet Restor Dent. 30(2):89-95

Excellent biocompatibility and tissue integration

Wide range of indications and surgical techniques

High patient acceptance and less complications

Unlimited availability and constant graft quality

What’s in it for you?

What’s in it for you?

Excellent biocompatibility and tissue integration

• Multi-step cleaning process removes all antigenic components and cells – natural structure of the porcine dermis is preserved

• mucoderm® is well accepted by the host tissue and heals complication free

• Fast revascularization and integration into the surrounding soft tissue

2 Rothamel D, Benner M, Fienitz T et al. 2014. Head Face Med. 27;10:10.

Histology 2 weeks after subcutaneous implantation in rats. Good tissue integration with cell invasion and in-growth of blood vessels (from Rothamel et al. 2014)2

Immunohistochemical staining with transglutaminase showing high vessel density 3 months after implan-tation in a rat model (from D. Rothamel, unpublished Data)

What’s in it for you?

Wide range of indications and surgical techniques

• Easy fixation and application due to high mechanical and volume stability

• mucoderm® can be sutured, pinned and easily cut to the desired shape

• Application also in demanding techniques such as the tunnel technique

• Open and closed healing possible (depending on indication)

2 Rothamel D, Benner M, Fienitz T et al. 2014. Head Face Med. 27;10:10.

Tensile stability allows application also in the tunnel technique

Cutting on alternating sides to expand the length of the matrix

Fixation of the matrix to the periosteum by sutures

What’s in it for you?

High patient acceptance and less complications

• No need for tissue harvesting

• No donor side morbidity, hence less postoperative complications, less pain and faster recovery from surgical intervention¹,³

• Leading to a high patient acceptance for the surgical intervention¹

1 Vincent-Bugnas S, Borie G, Charbit Y. 2018. J Esthet Restor Dent. 30(2):89-95. 3 Nocini PF, Castellani R, Zanotti et al. 2014. J Craniofac Surg. 25(3):799-803.

mucoderm® ѹ Reduced pain &

swelling ѹ Esthetic outcome ѹ Unlimited availability

Autologous tissue ѹ Time consuming

& painful ѹ Limited availability

What’s in it for you?

Unlimited availability and constant graft quality

• Provided sterile, storable at room temperature

• Quality independent of interpatient differences

• Better planning of surgical intervention

• Treatment of extensive defects in one surgery (i.e. treatment of the whole jaw)

• You get what you see – same thickness dry and wet

3 Nocini PF, Castellani R, Zanotti et al. 2014. J Craniofac Surg. 25(3):799-803.

Extensive keratinized tissue augmentation and deepening of the oral vestibule by apically posi-tioning a split palatal flap and grafting with mucoderm® (from Nocini et al. 2014)3

Stable thickness of 1.2 mm – 1.7 mm

Clinical evidence

Recession coverage

Soft tissue thickening

Broadening of attached gingiva

Preclinical and clinical studies indicate: mucoderm® is a valid alternative to autologous soft tissue grafts in many indications.

Clincal evidence

Recession coverage

• Healing was uneventful in all reported studies

• mucoderm® was effective in reducing clinical parameters such as PD, CAL, CRC, MRC, KT

• mucoderm® treatment re-sulted in low morbidity and discomfort

• High color match

• More predictable in maxilla than mandible

Study Design Clinical studies (Case series and RCTs)

Population Overall 58 patients (males and females) with Miller class I-III treated with MCAT+ mucoderm®

Results Mean root coverage following treatment with mucoderm®: 73.2 – 91.0%

Cosgarea 20164

Cieslik- Wegemund et al. 20165

Vincent- Bugnas et al. 20171

Pietruska et al. 20186

Study type Case series RCT Case series RCT

Miller class I, II, III I, II I, II I, II

Mean root coverage (MRC %) 73.20±27.71 91±13 84.35±7.53 53.20±32.17

Maxilla treatment 84.06±21.62 only yes –

Mandible treatment 61.50±29.12 – yes only

Follow-up 12 months 6 months 12 months 12 months

1 Vincent-Bugnas S, Borie G, Charbit Y. 2018. J Esthet Restor Dent. 30(2):89-95. 4 Cosgarea R, Juncar R, Arweiler N et al. 2016. Quintessence Int. 47(9):739-47.5 Cieślik-Wegemund M, Wierucka-Młynarczyk B, Tanasiewicz M et al. 2016. J Periodontol. 87(12):1436-1443.6 Pietruska M, Skurska A, Podlewski Ł et al. 2019. J Clin Periodontol. 46(1):86-95. Epub 2018.

Clincal evidence

Soft tissue thickening

mucoderm® leads to a significant increase in peri-implant soft tissue and may serve as an alternative to connective tissue grafting

Study Design Prospective, randomized, examiner-blinded, controlled clinical study

Population Test group: 14 patients, implantation and simultaneous buccal soft tissue augmentation with mucoderm®

Control group: 13 patients, implantation without soft tissue augmentation

Results Significant increase in soft tissue thickness (STTh = 1.06 mm) in the test group 6 months after surgery

Biopsy results showed angiogenesis and mature connective tissue covered by keratinized epithelium

Augmentation of the periimplant soft tissue using mucoderm®. Preparation of split-flap with vertical releasing incisions and fixation of the matrix to the periosteum with resorbable sutures (from Zafiropoulos et al. 2016)7

7 Zafiropoulos GG, Deli G, Hoffmann O et al. 2016. J Indian Soc Periodontol. 20(4):441-445.

Clincal evidence

Broadening of attached gingiva

Vestibuloplasty with mucoderm® and early loading has proven to be a successful treatment option

Study Design Prospective clinical study

Population 39 patients with shallow vestibule and high muscle attachments, use of mucoderm® instead of FGG

1st group (20 patients): dentures mounted 7 days post-op

2nd group (18 patients): dentures mounted 1 month post-op

Results Healing without complications, no pain or discomfort in all patients

Early covering with granulation tissue and sprouting of capillaries

In group 1: 3 months post-op good esthetic outcome with preserved post-surgical vestibular depth and no scaring

Clinical pictures showing situation prior to treatment, mucoderm® fixed to the periosteum during treatment and situation one month after the treatment (from Konstantinova et al. 2015)8

8 Konstantinova D, Djongova E, Arnautska H et al. 2015. IMAB. 21(4):964-968.

Technical information

Native collagen structure

Optimal scaffold function

Visualization of the collagen structure

High biomechanical stability

Three convenient sizes

Technical information

Native collagen structure

• mucoderm® is produced from porcine dermis

• Specific manufacturing process preserves the native collagen structure

• Porcine dermis strongly resembles human dermis regarding collagen structure and arrangement⁹

REM picture of mucoderm® showing the dense collagen network

Pores of the dermis are visible in the final matrix

9 Ge L, Zheng S, Wei H. 2009. Burns. 35(1):46-50.

Technical information

Optimal scaffold function

• mucoderm® shows a dense but porous natural collagen structure

• Homogenous, parallel-aligned fibers serving as guiding structure for cells and blood vessels

• Natural structure facilitates fast cell invasion, revascularization and finally integration and replacement of mucoderm®

Technical information

Visualization of the collagen structure

The native, porous structure makes mucoderm® an excellent scaffold for ingrowing fibroblasts, endothelial cells and blood vessels.¹⁰ Shortly after implantation, revascularization of the matrix starts, fibroblasts adhere and spread onto the matrix. Meanwhile, collagen is produced by the adhering cells, the matrix is gradually degraded and finally replaced by host tissue.¹¹

x-ray tomography

10 Pabst AM, Happe A, Callaway A, Ziebart T et al. 2014. J Periodontal Res. 49(3):371-81.11 Pabst AM, Wagner W, Kasaj A, Gebhardt S et al. 2015. Clin Oral Investig. 19(2):561-4. Epub 2014.

Visualization of the collagen structure of mucoderm® by the innovative synchrotron-based x-ray tomography (from Pabst et al. 2015)11

x-ray tomography

Technical information

High biomechanical stability

• mucoderm® is characterized by high tensile strength

• Optimal mechanical properties after ten to 20 minutes hydration12

• Prolonged hydration showed only minor effects on the biomechanical properties of the collagen matrix12

• mucoderm® can easily be applied, fixed and cut to the needed size

12 Kasaj A, Levin L, Stratul SI, Götz H et al. 2016. Clin Oral Investig. 20(6):1303-15. Epub 2015.

Hydration in blood

Hydration in NaCl

Hydration time [min]U

ltim

ate

stre

ngth

[MPa

] 141210

86420

5 10 20 30 40 60

Technical information

Three convenient sizes

• BO-701520 – 15×20 mm (one matrix)

• BO-702030 – 20×30 mm (one matrix)

• BO-703040 – 30×40 mm (one matrix)

Clinical cases

Dr. Massimo FrosecchiSocket sealing with mucoderm®.

Dr. Algirdas PuiŠys Mucosal thickening around bone level implants.

Dr. Attila HorváthWidening of the peri-implant keratinized mucosa.

Prof. Dr. G. Zucchelli and Dr. M. StefaniniMultiple recession coverage with mucoderm® and Straumann® Emdogain®.

Clinical cases

Prof. Dr. G. Zucchelli & Dr. M. Stefanini

1 – Initial clinical situation

5 – Amelogenins on the exposed root surfaces

9 – Occlusal view after flap closure: note complete absence of bleeding

2 – Flap design: Coronally advanced envelope flap for multiple gingival recessions

6 – After de-epithelization of the anatomic papilla

10 – Coronally advanced flap closure: note that matrix is completely covered by the flap

3 – Flap elevation: with split-full-split approach

7 – mucoderm® fixation

11 – year follow-up

4 – EDTA gel application on the exposed root surfaces

8 – Occlusal view of the sutured matrix

12 – 4 years follow-up

Multiple recession coverage with mucoderm® and Straumann® Emdogain®

Clinical cases

Dr. Algirdas PuiŠys

1 – Full-thickness flap preparation buccally and lingually

5 – The margins of the flap are adapted and sutured leaving the abutment open

9 – Final restoration 5 months post-operative

2 – Bone preparation for Straumann® Bone Level Implant

6 – Situation 1 week after surgery and after suture removal

10 – Stable clinical situation after 5 years

3 – Implant insertion and contour-ing of crestal bone with straight handpiece

7 – Wider healing abutment after 4 months

4 – Rehydrated mucoderm® perforated and pulled over the healing cap

8 – Smooth emergence profile visible after removal of the healing abutment

Mucosal thickening around Straumann® Bone Level Implants

Clinical cases

Dr. Attila Horváth

1 – Lack of sufficient keratinized mucosa following extensive horizontal ridge augmentation

5 – Initial wound healing

9 – Newly formed keratinized mucosa 6 months post-operative

10 – Stable keratinized mucosa after 6 years

2 – Split-thickness flap preparation and apical positioning of the mobile mucosa

6 – Uneventful wound healing

3 – Hydration of mucoderm® in sterile saline solution and cut to size

7 – Following graft maturation, placement of Straumann® SLActive® implants

4 – mucoderm® immobilized with deep periosteal anchoring sling and superficial mattress sutures

8 – Sufficient keratinized mucosa and deeper vestibule

Widening of the peri-implant keratinized mucosa

Clinical cases

Dr. Massimo Frosecchi

1 – X-ray showing endodontic failure of the molar

5 – Planning of implant positioning

9 – Lithium disilicate crown placement and final setting

2 – Atraumatic tooth extraction

6 – Implant placement

10 – Lateral view 11 – Final X-ray control

3 – Blood clot stabilization with mucoderm®

7 – Osseointegration and soft tissue healing after 45 days

4 – Healing situation at 2 months

8 – Final Zirconia abutment

Socket sealing with mucoderm®

What custo-mers say

Prof. Dr. Anton Sculean“In many cases I use mucoderm® as an alternative for a connective tissue graft.”

Prof. Dr. Giovanni Zucchelli“The adjunctive use of mucoderm® and Emdogain® to the coronally advanced flap allows …”

What customers say

Prof. Dr. Adrian Kasaj“ Based on my clinical experience and research, I have found out that …”

What customers say

Clinician statement: Prof. Dr. Adrian Kasaj

Based on my clinical experience and research, I have found out that the mucoderm® matrix is a viable, highly safe and patient-friendly alternative to palatal donor tissue in root coverage procedures. The accomplished root coverage and thickening of the marginal tissue is characterized by a natural and aesthetic appearance meeting the expectations of the patients.

What customers say

Clinician statement: Prof. Dr. Anton Sculean

In many cases I use mucoderm® as an alternative for a connective tissue graft. Due to its high biocompatibility and excellent mechanical properties, mucoderm® is perfectly suitable for the tunneling procedure. Moreover, it serves as an ideal carrier for biologic active substances, such as Emdogain® or other growth factors.

What customers say

Clinician statement: Prof. Dr. Giovanni Zucchelli

The adjunctive use of mucoderm® and Emdogain® to the coronally advanced flap allows to increase soft tissue thickness and improve the quality of attachment between the soft tissue and the root. Both of these factors are critical for the long-term stability of the root coverage outcome.

Summary

• mucoderm® shows a native collagen structure that strongly resembles human dermis

• Developed for soft tissue regeneration without the need for (palatal) tissue harvesting

• Can be used in a wide range of indications in open as well as closed healing

• Allows easy handling and fixation due to high biomechanical stability

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