mucoderm®

Acellular dermal collagen matrix

 

mmucoderm® is an acellular collagen matrix that offers a safe alternative to autologous soft tissue transplants in a diverse range of soft tissue grafting indications. mucoderm® is derived from porcine dermis that undergoes a multi-step purification process, which removes all non-collagenous proteins and cells as well as potential immunogens, bacteria and viruses. The processing results in a three-dimensional stable matrix, which consists of collagen type I and III with a natural collagen structure that resembles the human connective tissue [1]. After implantation mucoderm® is continuously remodeled into patients own soft tissue.

Scaffold for ingrowing cells and vessels

 

mucoderm® shows a high interconnected porosity and native collagen structure making it an excellent scaffold for ingrowing blood vessels and cells, thus supporting a fast revascularization and tissue integration [5]. Attracted by the signals of activated migrating and proliferating endothelial cells, blood vessels from the surrounding tissue will grow into the matrix. At the same time, fibroblasts adhere and spread onto the matrix. The simultaneous degradation of the matrix and the collagen production of adhering fibroblasts leads to a complete substitution of mucoderm® by the newly formed host tissue within about 6-9 months [3].

CLINICAL APPLICATION

Periimplant soft tissue thickening with mucoderm® and Emdogain®

Dr. Algirdas Puisys, Privat clinic Vilnius, Lituania

Mucosal thickening around bone level implants

Dr. Algirdas Puisys, Privat clinic Vilnius, Lituania

Multiple recession root coverage with the modified coronally advanced tunnel (MCAT)

Dr. Raluca Cosgarea, University of Marburg, Germany and Prof. Dr. Dr. Anton Sculean, University of Bern, Switzerland

PROPERTIES

  • Rapid revascularization and tissue integration
  • Soft tissue regeneration/augmentation without palatal autograft harvesting
  • Complete remodeling into patient’s own tissue in ~6-9 months
  • Can be easily applied and fixed by sutures
  • Can be cut into procedure-specific shapea

UPCOMING EVENTS

Live: Webinar, 16. Oct. 2017

Dr. Peer Wolfgang Kämmerer: Management of periimplant soft tissue with a 3D collagen matrix

Bueons Aires, 26.-27. Oct. 2017

Dr. Massimo Frosecchi: AOA 2017 – Association Odontológica de Argentina

More Events on botiss-academy

INDICATIONS

mucoderm® can be applied as an alternative to autologous soft tissue transplants such as connective tissue graft (CTG) and free gingival graft (FGG) in certain indication in periodontology and implantology. The use of muocderm® is of particular advantage in situations where autologous transplants cannot be harvested in sufficient amount or quality (e.g. in thin biotype, shallow palate or covering of multiple recessions) or if patients are afraid of and do not agree with a tissue harvesting.

Implantology, Periodontology and Oral and CMF

  • Treatment of gingival recessions
  • Soft tissue grafting in combination with GBR/GTR
  • Broadening of attached gingiva (instead of FGG)
  • Closure of extraction sockets (socket seal technique)
  • Thickening of periimplant soft tissue
SPECIFIC DETAILS

SPECIFIC FACTS

Highest safety

The particular, certified multi-stage cleaning process of mucoderm® effectively removes all non-collagenous proteins and cells as well as potential immunogens, bacteria and viruses. Hence, mucoderm® is an absolutely safe and pure collagen type I and III matrix. 
mucoderm® is a medical device regulated according EC-Guidelines. Manufacturing of mucoderm® is subject to a quality control system based on international standards (e.g. EN ISO 13485), and is regularly audited by the notified body and authorities.

Native collagen structure of mucoderm®

mucoderm® is a native collagen matrix, meaning that the natural properties of the original tissue (dermis) are preserved during the production process. This is the basis for its superior handling properties such as tear resistance and dimensional stability. Preservation of the natural structure is also the reason that mucoderm® structure strongly resembles the architecture of the human dermis [1], making the matrix a suitable alternative to autologous gingival transplants.

Bild6

High biocomatibility of mucoderm®

The biocompatibility of mucoderm® was proved by MTT in vitro viability assay testing [5]. Beginning with day six, the MTT viability assay demonstrated a significantly higher viability of gingival fibroblasts, endothelial cells, and osteoblasts on mucoderm® compared to that of the control group (p<0.05).

Tissue integration, revascularization and degradation

mucoderm® is characterized by an open porous collagen structure, visualized by the innovative synchrotron-based X-ray tomography  [2]: Synchrotron-based X-ray tomographic microscopy for visualization of three-dimensional collagen matrices.

mucoderm_synchrotron

Synchrotron-based x-ray image showing the porous structure of mucoderm®

This unique structure makes mucoderm® an ideal scaffold for ingrowth of blood vessels and cells and promotes fast tissue integration and revascularization.
Tissue integration and degradation were analyzed in an animal (rat model) study of Prof. Daniel Rothamel [3]. After only two weeks, mucoderm® shows an extensive ingrowth of blood vessels as well as an inflammation-free healing with superficial cell invasion. In the following four to eight weeks, a continuous degradation with increasing homogeneous cell distribution can be observed. After eight weeks, still 20% of the original matrix volume is available as a scaffold for the formation and reorganization of connective tissue. After twelve weeks, mucoderm® is almost completely replaced by newly formed connective tissue.

 


mucoderm-histo1_small

mucoderm® demonstrates a very good  tissue integration and initial cell invasion
after two-week healing time

mucoderm-histo2_small

Complete remodeling of mucoderm® and inflammation-free connective tissue are observed in vivo after 12 weeks


Exposure of mucoderm®
  • mucoderm® should only be left for open healing, if a revitalization from the surrounding or underlying wound bed is ensured. Exposure should always be avoided when used in recession coverage.
  • Open healing is feasible in the case of a vestibuloplasty, if mucoderm® is sutured to the periosteum. In this case mucoderm® should be closely fixed to the periosteum. This facilitates an increase in the width of the attached gingiva but not in the thickening of the tissue.
  • Open healing is also possible if only minor parts of the matrix are exposed and revascularization is ensured by the surrounding margins of the flap or by the underlying periosteum.
  • Please note that the degradation time depends on the extent of the exposure and will be faster due to bacterial decontamination and resorption.
Rehydration protocol

mucoderm_rehydrationmucoderm® should always be applied after rehydration (in sterile saline, defect blood, or platelet concentrates).  Rehydration should be performed in a sterile saline solution or blood for five to 20 minutes, depending on the technique used and the desired flexibility of the matrix. The flexibility of the mucoderm® graft increases with rehydration time. The rehydration protocol and its influence on the biomechanical properties of mucoderm® were analyzed in a study of Prof Dr. Adrian Kasaj  [4].

Trimming of mucoderm®

Size and shape of the matrix should be adapted to the size of the defect. After rehydration, mucoderm® can be easily trimmed to the desired size with a scalpel or scissors. Cutting or rounding the edges of a mucoderm® matrix that has been briefly rehydrated can prevent the perforation of the gingival tissue during the flap closure. For the coverage of multi-recession defects, the surface of mucoderm® can be extended by cutting the matrix on alternating sides (mesh-graft technique) and pulling it.

mucoderm_trimming

mucoderm® trimmed for application with the mesh-graft technique

Fixation of mucoderm®

Following application, mucoderm® should always be stabilized to avoid micro movements and ensure undisturbed revitalization, e.g. ingrowth of vessels and cells.
When preparing a split flap, mucoderm® should be sutured to the intact periosteum to ensure close contact between the matrix and the periosteal wound bed. Single button or cross sutures may be used; the use of resorbable sutures is recommended.

Flap preparation for recession coverage

mucoderm® can be used in combination with all mucogingival surgical techniques, including coronally advanced flap and tunnel techniques. Notably, the classical coronally advanced flap or the modified coronally advanced flap ensure a good view on the prepared donor bed and facilitate the coronal repositioning of the flap over the matrix.
Advanced flaps need to be sufficiently mobilized to avoid tension of the soft tissue: When applying mucoderm® for recession coverage, special attention must be paid to achieve sufficient flap mobilization and tension-free closure.
A proper vascular supply from the prepared flap[6] is critical to achieve an appropriate revascularization of the mucoderm® matrix. In particular, split flaps must be sufficiently thick to ensure revitalization of the matrix and the integration into the patient’s own connective tissue.

Post-operative care

After surgery it is necessary to avoid any mechanical trauma of the treated site. Patients should be instructed not to brush their teeth at the respective side for the four weeks following surgery. Plaque prevention can be achieved by mouth rinsing with a 0.2% chlorhexidine solution. Post-operatively, the patient should be recalled weekly for plaque control and healing evaluation.

Let us know YOUR COUNTRY and we will provide you with
YOUR right local
CONTACT PERSON!

Email to product-management@botiss.com!

Product Specifications

Art.-No.SizeContent
70152015 × 20 mm1 × matrix
70203020 × 30 mm1 × matrix
70304030 × 40 mm1 × matrix
710210Ø 10 mm1 × punch
LITERATURE

[1] Ramachandra SS, Rana R, Reetika S, Jithendra KD. Options to avoid the surgical site: a review of literature. Cell Tissue Bank Bank 2014, 15(3): 297-305.
[2] Pabst AM, Wagner W, Kasaj A, Gebhardt S, Ackermann M, Astolfo A, Marone F, Haberthür D, Enzmann F, Konerding M A. Synchrotronbased X-ray tomographic microscopy for visualization of three-dimensional collagen matrices. Clin Oral Investig 2015, 19(2):561-4.
[3] Rothamel D, Benner M, Fienitz T, Happe A, Kreppel M, Nickenig HJ and Zöller JE Biodegradation pattern and tissue integration of native and cross-linked porcine collagen soft tissue augmentation matrices – an experimental study in the rat. Head and Face 2014, 10:10.
[4] Kasaj A, Levin L, Stratul SI, Götz H, Schlee M, Rütters CB, Konerding MA, Ackermann M, Willershausen B, Pabst AM.The influence of various rehydration protocols on biomechanical properties of different acellular tissue matrices. Clin Oral Invest. 2015.
[5] Pabst AM, Happe A, Callaway A, Ziebart T, Stratul SI, Ackermann M, Konerding MA, Willershausen B, Kasaj A. In vitro and in vivo characterization of porcine acellular dermal matrix for gingival augmentation procedures. Periodont Res. 2014, 49(3): 37-81
[6] Mörmann W, Ciancio SG. Blood supply of human gingiva following periodontal surgery. A fluorescein angiographic study. J Periodontol. 1977 Nov;48(11):681-92