00:00:00: Hi everybody, welcome to BOTIS Talks.

00:00:02: Today we are with Alessandro Rossi visiting professor from Milan, ITI study club director and an old friend of BOTISS.

00:00:11: How's it going?

00:00:13: Very well thank you.

00:00:15: I'm happy to be here because i think that coming Berlin for me is always very nice.

00:00:21: Yes before talking about all the VIP events what do you remember about this?

00:00:29: that at the beginning I started to work with you, with Drats and many years ago.

00:00:36: And for me it was a pleasure being invited here because in the first time when i came into Berlin there were all your family who were here for me.

00:00:48: so...I immediately felt like a family around me.

00:00:54: I also remember we did, uh...I think with Stroma in Italy.

00:00:57: We were doing this crazy workshops.

00:01:00: Do you remember?

00:01:00: Yes

00:01:02: It was like five-ten minutes' workshop but it wasn't so good preservation or

00:01:07: yes..it was on socket and also on the cerebellum.

00:01:12: Ah right okay yeah that's nice.

00:01:15: But Alessandro we traveled a lot together.

00:01:17: So i brought me couple of pictures.

00:01:19: do they remember these pictures?

00:01:22: Yes, I remember... yes this is Mexico.

00:01:27: Yeah exactly!

00:01:29: Do you remember what we were doing?

00:01:33: We were in Mexico the first time that we go to South Ham because after we also went to Colombia and also to Rio.

00:01:50: I don't know if you were in Rio, but

00:01:54: it

00:01:57: was really nice.

00:02:01: For me is also amazing because we met maybe in the year of two thousand fifteen which one of our first doctors that i talked to and at this time a new zero about their products.

00:02:11: But then they told us the story that Drashen came to you twenty years ago.

00:02:16: Do you remember how did he go?

00:02:20: I remember that he was invited to speak in Croatia, in Opatia.

00:02:26: That is the house of Drazen!

00:02:30: And there it was and they met him.

00:02:32: at beginning the Cerebon was not called Cerebo.

00:02:38: We started working together because... ...I was quite surprised to meet a person who was so interested improve the world of bio-material.

00:02:50: So this for me was very interesting.

00:02:53: Yeah, I mean Drasen Tadich one of our co-founders has basically one thing in mind which is what's next product or solution.

00:03:04: and so you know we went from Cerebon.

00:03:06: that was Jason.

00:03:08: No, very well.

00:03:10: Then over the years we are moving towards the agronomic acid which is our one plus higher in mass craft and then more things have to come drash and it's unstoppable!

00:03:20: So

00:03:21: yeah so later we're gonna see a little bit of products new products together And today my idea was go a little be together into how you see your socket.

00:03:38: Do you do circuit preservation?

00:03:40: You leave it as is, put an implant.

00:03:44: It would be interesting to see from a biological point of view but maybe more importantly for my clinical point-of-view so that also young clinicians following can get an idea what to do.

00:03:56: So the first question will be... Remove the tooth.

00:04:03: What does your diagnosis mean?

00:04:08: socket.

00:04:09: Okay, I think that it's a big question because... It is quite a big problem but i think in the first approach its really very important to look at first to patient Because sometimes we have to look inside into the mouth.

00:04:32: which situation before to extraction?

00:04:36: because we have to check the soft tissue, and all what can be checked before extracting the tooth.

00:04:44: Okay so you analyzed it?

00:04:47: Yes I try to analyze every detail of the presence or absence of the soft tissues quality quantity bone deficiency if present infection.

00:05:01: We can check a lot things before extracting.

00:05:05: Then when we extract I think that we may have many, many different scenarios because Sometimes you may have an intact albiora socket.

00:05:15: Yeah

00:05:16: sometime You may have lost a part of the bone wall Mm-hmm sometimes completely lost off the buccal plate and some time you may also ever three-dimensional defect, so it's completely different what we want to do in this situation.

00:05:36: And for me I think that in this field the rule of the biomaterial and of structure that may prevent bone resorption is really very important.

00:05:49: just in these phases... ARP, so the alveolar rich preservation because I think that may be really a very useful approach.

00:06:04: Okay!

00:06:04: Very good and So you're removing two.

00:06:08: if we have let's say three macro scenarios as mentioned What is there?

00:06:13: If you know roughly the statistics like how many times do encounter us an intact socket?

00:06:19: Is this normal or usual?

00:06:22: also when i find it in taxed socket I Think they will.

00:06:26: maybe another problem that is the thickness of the buccal wall.

00:06:29: That

00:06:30: it's too thin?

00:06:31: Yes,

00:06:32: yes!

00:06:33: So let say an intact socket where you don't do anything or you do minimal is rare... But because one of things I would like to really walk through this socket type.

00:06:43: so lets see if we are lucky today and its intact What do you do?

00:06:51: Do you leave it like this, to use something like a mustatic sponge-like colacone or what is your approach there.

00:06:57: Or place an implant?

00:07:00: first of all I try To look also at the position in which i have strapped the tooth because its really very different.

00:07:08: if we are In the anterior area yeah or If We Are In A posterior Area In The Anterior Where We Have More Esthetics.

00:07:16: I Normally Suggests to be very, very careful because sometimes it's more important to have more step-to-treat the patient.

00:07:31: Also even the patients ask to hurry and find a restoration.

00:07:35: but I think that biology is really very important.

00:07:38: so in many cases they are very important from an aesthetic point of view.

00:07:47: I try to have more steps to treat the patient.

00:07:50: So for example, i use a colaconsponge in order to keep the coagulant stable into their verlo socket and then I really make an evaluation of the patient with cbct after six eight weeks.

00:08:06: so I think that this was just described In the past as an approach staged

00:08:13: exactly

00:08:14: not at the beginning In order to have the best condition of the soft tissue in particular because I think that in this static area This is the most important focus.

00:08:24: So you Analyze it again a six eight weeks and what do you want?

00:08:29: To see.

00:08:30: so if the bone is there If the soft tissues good, then how do you decide what to do

00:08:35: normally?

00:08:35: I analyze the quality or the soft issue And then they profile off the ball Just to understand if I see a concavity If I see that we have lost a lot of the buccal wall, yeah.

00:09:15: really very different from other farms that are in the field of regeneration.

00:09:21: So let's talk about bone and soft tissue separately, so then for some reason after six weeks you have a resorption on the bachal wall or maybe it is not as thick as we would imagine?

00:09:37: I would imagine if you move with some grafting material a membrane or what would you do?

00:09:46: Okay if I have real defect to treat, i normally use a membrane that has long time period of resorption.

00:09:56: Normally i try it with pins and then i usually used biomaterial able to maintain the volume stable.

00:10:07: For example bovine boner, now we have also the bovine bone with a yellow.

00:10:14: It may be very interesting not only from a biological point of view but I think that it's very interesting also From The point of the handling Of the material because the material is very stable Very simple to put the material where we have the defect he stays here.

00:10:36: And this, for a clinician I think that it's really very interesting.

00:10:40: Yeah if we think about one of the latest addition, Cerebon Plus Hire, so Aronic Acid with Cerebone One of the feedbacks from clinicians working on it is really improved handling compared to standard bovine bone.

00:10:59: Do you see any biological effects?

00:11:03: I

00:11:07: think that is not so easy for a clinician to see an immediate change in the biology because with our eyes it's not simple.

00:11:18: Sure, i think that the hyaluronic acid helps a lot healing of the soft tissue but from point of the biology, of the regeneration of the bone.

00:11:31: I think that for a clinician it's not so easy to see what happens.

00:11:34: So Alessandro we need to do our study together?

00:11:35: Yes!

00:11:36: Okay good one thing I should have said... We are done together lots of studies in particular on Mucoderm and will talk about this in a second.

00:11:48: And based on your studies, this is one of the ways that we suggest to use Mukodem in the socket preservation as a sockets ceiling.

00:11:55: But let's go back into the socket.

00:11:58: So if you have an intact socket We might call it to preserve the blood clot.

00:12:05: Yes If there are very aesthetic cases with high expectations from the patient I prefer a staged approach in order to have the more step to treat the patient.

00:12:20: And

00:12:21: if this situation is not so risky from an aesthetic point of view, In some cases I insert immediately the implant and make a post-destructive implant with immediate restoration because now we've seen that it may be very good approach for having stable tissue at end surgery Quite a new approach of the last ten years, but I think that may be very predictable.

00:12:52: Yeah if we have an intent.

00:12:56: So basically you're saying in the aesthetic zone That there's uh You know more demand or more requirements then you go little bit cautious Yes and Then they know less risky area than you try to place an imperfection when you are in.

00:13:12: Because one question i think it's interesting And this is our question at this.

00:13:14: so always here in Congress, so let's say that you do a staged approach maybe in general.

00:13:21: When do and when do you consider increasing the soft tissue or treating the soft issue?

00:13:28: At which stage of the... Stage depressed.

00:13:35: I work from many-many not too many but some years in the field of regeneration And they think if we look also to the history of regeneration We start at the beginning, in the nineties only focusing on the bone.

00:13:54: Then there is a great interest about the soft tissue and I think that this it's good approach because its important also to analyze the soft tissues.

00:14:04: nowadays we see many many clinicians do grafts of the soft issues when they do every type of implant.

00:14:14: I don't think that it's so necessary always to do this.

00:14:19: But, i think... To have a good quality of the soft and the hard tissue is really very important.

00:14:26: And the soft tissues if are thick If they're in high-quality are really a great advantage for us.

00:14:35: Sometimes what we need to increase the soft tissue when I insert the implant, or at the reopening of the implant not only using the connected tissue graft that we know is the go standard for this type surgery but using metrics.

00:14:52: So collagen matrix makes increase in a quite safe.

00:15:01: So when you say this, because then the memories come.

00:15:05: I think what... The first thing that showed me was Mukodar.

00:15:09: Yes

00:15:10: And also about these.

00:15:12: it's very important to speak in a precise way About the type of matrix we use Because the matrices are really completely different.

00:15:30: You know that I use Mukodem from about more than fifteen years, and at the beginning we used Mukoderm everywhere to do everything.

00:15:43: But i think in the socket sealing increase of soft tissue around the implant may be a very good option.

00:15:51: Let's stick on it because conversation brings us naturally as a socket ceiling.

00:16:00: So first of all, let me ask you three rapid questions or You give it to the answer?

00:16:06: Three things that.

00:16:08: so Let's picture this I came to see your don't remember exactly when but certainly Milan arrived in twenty fifteen because there was The year where I visited millions of people in Italy Without knowing so much about the problem and then knew about Mukadar.

00:16:24: What are the three things Three words that come up into your mind when you think about Mukodar.

00:16:32: First of all, handling.

00:16:35: second stability third time of resorption.

00:16:40: let's elaborate.

00:16:41: so handling?

00:16:43: Handling because if we compare this matrix to other type of metrics for example When we have to stabilize the matrix it is very simple To use the mukoden.

00:16:55: The mukodar It quite thick.

00:16:58: But for me, this is an advantage because if I want to make some stitches just to stabilize on the Mucodem it's possible.

00:17:07: It's not a problem!

00:17:14: We wait ten minutes and we leave our matrix in blood or the sine solution.

00:17:25: The matrix becomes very easy to manage, so I think that it's good because its stable And you don't risk destroying the matrix when putting stitches into the matrix.

00:17:43: the approach is very good for this.

00:17:45: Then you mentioned stability of Mukodem, do you mean in a long-term

00:17:51: result?

00:17:52: On one side I meant stability from a simple point of view.

00:17:57: so when we have for example in the socket singing to stabilize the Mukoderm You may use three simple stitches and they stay stable From a biological point of view.

00:18:11: what I have seen sometimes when they make the reopening on some socket Not after too much time You may see them at least more present.

00:18:21: Yeah, and this is very interesting because The effort off their barrier it's really important.

00:18:28: also another important thing When you use the Mucoderm you May avoid to move the soft tissue.

00:18:37: so you know that in the technique that they use for the socket C, I used the Mucoderma exposed.

00:18:44: Yeah okay and in this case it's really a great advantage.

00:18:49: first for the patient because we know that when you have to do release incision We have to move the soft tissue...we may have swelling pain from the patients if we leave everything stable in their proper position.

00:19:03: It is very simple to use Mucodyl.

00:19:05: And

00:19:07: since when you started in Mukulamu, had this idea of using it?

00:19:13: Because that was your idea I think.

00:19:14: Yes!

00:19:15: At the beginning... ...I was searching for a bio-material only to seal the socket because i want to insert a bio material inside the socket and i wanted only to cover the bio material and maintain stable because we know very well nowadays that in the aesthetic area is really important to have a good quality and quantity of soft tissue.

00:19:41: And also the contour on the soft tissues, it's really very important!

00:19:45: So at the beginning I tried using the mucoderm like a punch but this was not so simple... ...and sometimes we had bad results.

00:19:56: For example the healing with the soft tissue is with concavity and not convexity.

00:20:04: We started using the Mucoderma in another approach in order to have more vascularization and more possibility of stabilizing the mucoderm with the stitches.

00:20:15: And this technique seems to give very good results.

00:20:20: when we want to augment the quantity of keratinized tissue, it's obvious that if you don't have keratinised tissue... We cannot create a tissue using a matrix!

00:20:32: This is quite clear.

00:20:34: So but If we do have some keratinize tissues more than would work as an amplifier.

00:20:39: Yes, sure!

00:20:42: We have many evidence about it because we've seen the creation of a real wall in New Genjiva.

00:20:54: Since we are focusing on this let's also put people who never tried this.

00:21:00: So let's imagine that, you know we removed the tooth.

00:21:03: You decide because it analyzed a soft tissue and bone situation to use bovine bone in the socket And you're gonna do socket sealing.

00:21:12: so Let us assume they put the bone there which I assume is the first thing you do?

00:21:17: Then what are you doing Mukudan?

00:21:20: Yes.

00:21:21: How long do you hydrate it?

00:21:23: About at minimum ten minutes, because this is really very important.

00:21:27: Do

00:21:28: you have it in sideline or other things?

00:21:32: Normally our sideline solution for all blood of the patient.

00:21:35: Then at this point Mukudam after ten minute is easy to handle.

00:21:40: And then what do we apply?

00:21:43: We've done quite a protocol to use in a very safe way the Mucoderm.

00:21:48: So we normally leave only one third of the mucoderma exposed.

00:21:55: if you want to leave it as opposed and then other two thirds, We have put under the flap... Under the palatal and buccal flap In order to have best stability And the best vascularization from beginning.

00:22:08: This is really important!

00:22:10: It's always good for every type of

00:22:14: craft Perfect.

00:22:15: This is exactly what we are.

00:22:18: When you talk to clinicians, they show in your study and we're talking about leaving Mukulam.

00:22:22: about thirty percent in this indication So that allows for the rest of two-thirds for vascularization does.

00:22:30: but then how Is it healing?

00:22:31: In the first let's say weeks

00:22:33: at the beginning I was Curious to see what happened.

00:22:37: so all the patients with treatin our clinic come To make controls after three ten, fifteen and thirty days just to see what happened.

00:22:50: And it's interesting that you can slowly become completely integrated into the soft tissue.

00:23:00: You may see a real migration of this soft tissue.

00:23:03: I don't know honestly if the immigration is over the move or also inside.

00:23:12: But I think that the most important thing is, we have a matrix which maintains the biomaterial in its proper position first of all and then it doesn't have any dispersion from the biomaterials to the mouth.

00:23:24: The patient's soft tissue is healed very safe without infection.

00:23:35: so this is just quite good goal

00:23:41: this approach also in the aesthetic zone.

00:23:44: Yes, I use these in the esthetic zone particularly because it's there where i want to have more soft tissue in terms of quality thickness and quantity.

00:24:00: then you know very well when we talk about matrices and substitutes one of them.

00:24:05: first question is yes but conetition graphed Does it mix?

00:24:13: So what is the reason why you, in your cases decide to go to a matrix like Mucador.

00:24:23: Yes we know that connected tissue grafts are the go standard but connective tissue graft have also morbidity.

00:24:32: so we have to take that soft tissue from patient In this case I only open and then how much more quality I want.

00:24:43: So, also if we look to the patient's interest it is quite interesting that in this type of defect they have the same effect on a soft tissue taken from the patients.

00:25:02: If i had to choose for myself then i would choose material not for them.

00:25:07: Is there any case where you say ok?

00:25:09: In these cases the tissue from the patient.

00:25:13: Only in cases where I don't have any quantity of keratinized soft tissue, only this case.

00:25:22: Otherwise, mucodamide is a good alternative?

00:25:24: Yes for me yes and also because we've seen that recreated normal convexity on the soft tissue in the synthetic area.

00:25:32: We had many-many cases about it And if you look at some publications The increase of the thickness is very important, because we know now it's very well that if you have a good seal on the soft tissue around your implant.

00:25:49: We are stable results in years and this is really important for me Because as you can see here at the market we have biomaterial that arrive And one wants to see what happens after five years.

00:26:06: Because at the beginning everything is worthwhile, but after five or ten years it's different.

00:26:12: You

00:26:13: start having some serious follow-up.

00:26:16: Oh yes because about Mucoder we have a follow up of more than twelve years In some cases.

00:26:23: I think that The first thing to do with Mucoder was We started in two thousand eleven.

00:26:33: so its quite.

00:26:35: we are near to the fifteen year follow-up.

00:26:39: Nice,

00:26:39: okay and this is

00:26:41: interesting!

00:26:41: Good so the socket ceiling.

00:26:43: yeah your baby that's where it comes from.

00:26:47: let's talk about bone graft.

00:26:49: in part you as mentioned before using mucodamil place a bovine bone there can tell us why.

00:27:01: which bovine If you prefer the collagen version or maybe the Cerebon Plus with bionic acid, Or there's a reason to use one of them.

00:27:12: What can we tell us?

00:27:16: You make always very big questions because it is not so easy To answer easily.

00:27:24: I think that at the beginning In some cases in the past when We lost the buccal plate I insert only the mucoderm on The buccal aspect there in order to recreate and to have a barrier on this side And For some region for example, the premolar region.

00:27:48: This type of approach was really very good because we increase the soft tissue and they've seen also a Spontaneous bone regeneration of the obelisk often really very Good.

00:27:58: i think that may be a similar result now day We may have using the shield technique.

00:28:09: that is Another good option from my clinical point of view.

00:28:14: I don't Have so much experience with this but they have seen something very Very interesting because it's very easy to handle also the magnesium membrane And So, I think there maybe a good option to treat these type of situation.

00:28:31: regarding the bone into the alveolar socket, I think that nowadays we know very well that the best bone is the one that naturally grows in to the alvaolar socket.

00:28:43: So the best option should be to have something inside without any type of granules that we know during their year remains also a little bit part inside of an alveola socket.

00:28:57: so all cases which i have defect in which I'm quite sure that the normal bone regeneration alone is able to fill all sockets, i don't put anything inside or only the colacon.

00:29:16: That's one of my favorite biomaterials for this type of surgery.

00:29:23: Well...I want be sure that volume remains stable.

00:29:31: And so I want to reduce the physiologic contraction of the alveolar socket, and insert by material.

00:29:41: Nowadays i'm only using two type of bi-material bovine born with collagen or bovine bone with hyaluronic acid.

00:29:49: Yeah!

00:29:49: I

00:29:50: have an interest in the point of moocoderm and shield because You are also known as Mr.

00:30:00: Mukudam in Italy!

00:30:02: I called you, Mr.Mukudam.

00:30:04: So initially when shield was not available so we were using mukudam too.

00:30:09: let's say Use it a membrane When you have a missing bucket wall and then would use either nothing collocone or the bovine bone.

00:30:20: And now...you tried to shield this well?

00:30:23: Yes What can tell us?

00:30:26: Also in this case, it's very important the handling because sometimes is not so easy to insert the mucoderm between the flap and bone.

00:30:36: Shields are more simple things that you have only to insert your shielding to stabilize a little.

00:30:44: but I think for the clinic or surgery of every day they're quite an advantage.

00:30:53: Yeah, I mean for us Shield is certainly one of the best innovation.

00:30:59: Both this is the only company in the dental field providing a metal that resorts so magnesium and particularly for Shield.

00:31:09: from our point-of-view it's nice to confirm the advantages because Shield is so rigid as a metal, then it's easy to be placed between the back of wall.

00:31:22: Very easy thing!

00:31:23: Yeah but this is an interesting point because before you were saying that if your back-of-wall was missing and sometimes you might do a staged approach... You would very cautious in placing an implant.

00:31:37: Do you think having shields that create immediately a barrier there opens up for the possibility of placing implants immediately?

00:31:45: in more cases.

00:31:48: I think that this may be a possibility, because if we are sure the wall is stable... We can insert an implant.

00:31:56: but i think very important criteria are always the soft tissue Because If shield it's able to recreate bone But also to maintain proper position of the soft tissues ...we might say ok Yeah!

00:32:17: The soft tissue are not so stable.

00:32:20: So for example, after six months we have a concavity and non-teconvexity in the canine region.

00:32:29: I think that to analyze again use of shield because you know it's an aesthetic area.

00:32:36: We need perfect condition on the soft tissue.

00:32:40: If there is reduction of bone we may have a deficiency from an aesthetic point of view.

00:32:46: and so, to treat this type of deficiency.

00:32:48: How do you treat these types?

00:32:50: But I think that it's very interesting because on one side also in the past when we make the VIP event... ...I made the future trends with drudging Because some cases i use the Mukoderm as membrane.

00:33:06: Yeah!

00:33:07: Because With ONE thing We can create soft tissue And we may also have an effect of barrier.

00:33:16: So with one product, two after

00:33:19: it

00:33:20: and this is very important.

00:33:21: so let's talk about This one because these are something I think It's a bit underrated to be mucodam.

00:33:27: some mucidum has a barry affect this for sure Because We've seen that use it in.

00:33:32: so What do you mean exactly?

00:33:36: on One side the its Very good because we have the possibility, as I told you before to recreate the soft tissue and to have the effort of the barrier.

00:33:48: On the other side that problem is the handling when use the Mucoderm as a membrane because if want to stabilize for example with pin it's very thick so its not easy to use the pin.

00:34:02: some colleague used this screw but then Sometimes it's better to remove the screw because, uh... The patient may feel this screw under the sub-tissue.

00:34:14: Yeah for sure okay.

00:34:15: So I think that on one side Maybe a very good approach in order to have the recreation of two type of tissue.

00:34:27: On the other side the handling is not so easy Because if you do the effect or barrier and also closing of the ambiolus socket to stabilize very well the mucoderm.

00:34:38: That's why when we talk about this indication, We always make clear that Mucoder is one point five millimeters on average Which means it's ideal for certain indication.

00:34:49: as a membrane you need To have a little bit of manualities too messing up and that's why This Is an important point.

00:34:57: because of course then you have to

00:34:59: close the flap.

00:35:01: But going back To the bone, I want to do a little digression because you had the first Italian clinician to use cerebone.

00:35:11: Because as we were saying twenty years very likely... Twenty years ago or so Drashen was coming through with the sub-case to show us the biomaterials for you and Chepasco.

00:35:24: So how did they convince you?

00:35:28: And what is the result of cerebone in socket but also other indications after twenty years now?

00:35:38: You know glasses, okay.

00:35:40: We need the glasses when we want to see very well what happened.

00:35:45: as a clinician I can only see the macro structure of your biomaterial.

00:35:51: where i met Razen...I met a person that was able to see at the micro-structure.

00:36:00: And this for me, it's really very important because what we need is to know What happened inside the granules of the primatism.

00:36:08: and when I spoke in the first time with Razen.

00:36:11: I spoke with a person that i understand immediately The nose Of what?

00:36:16: Well...I was asking for Because sometimes When you speak With other persons That have Other products No one says You Why I make these type of granules, why?

00:36:31: I made this treatment off-temperature for example.

00:36:35: And so i think that also to have a person that... ...I'm sure they've analyzed all these critical aspects is really very important.

00:36:45: and the result we have because nowadays we have about sinus lift with fifteen or twenty years follow up We had a very stable situation.

00:36:58: the material ever give us problem of infection or other thing.

00:37:05: We use alone in the sinus graft because we have done also protocol with only cerebal in the sinus graft and result nowadays are stable.

00:37:17: so I think that This may be a great goal.

00:37:20: For you is good for us,

00:37:23: but also for

00:37:24: everybody.

00:37:25: so that's why I mean one of the reasons we wanted to develop a new bone, a bovine bone it exactly to maximize stability and have the kind of result here talking about.

00:37:40: But now this was twenty years ago Now in year.

00:37:46: So we know each other since a little bit.

00:37:48: And, we are moving into bio-functionalized Cerebon and other biomaterials for example with the Euronic Acid.

00:37:56: so... We're moving in to using our euronic acid also for Colocone like Hyacone or Color Fleece, Hirefleece Jason Ultimate etc.

00:38:06: What is your take on this direction?

00:38:09: what do you think about the biofunctionalization of successful platforms?

00:38:15: You know that We are testing all this material.

00:38:19: Yes, okay?

00:38:23: And on one side I think that the Yaluronic acid is sure a good advantage in order of the healing and soft tissue may be also a very advantage for some casings but prefer to use Cerebon without your rolling acid in the sinus lift, because sometimes we have too much blood and the biomaterials become unstable.

00:38:55: So it's very good when I make Cerebone Plus Regeneration with Jason for the fact of the Maxilla if I have to increase the volume in the sausage, very good in the Sausage technique for me.

00:39:13: And as a member what do you use?

00:39:15: Normally nowadays i used normal jason one because we tried to test the jason with yellow ronich acid and on one side there may be a better option but it becomes not so easy.

00:39:35: In Italy, we say scivolosa.

00:39:37: It's squishy.

00:39:41: Slippery!

00:39:44: Very good.

00:39:46: So about the sausage that can come curious... ...about the uses of the standard Jason?

00:39:51: Why do you think standard Jason is a good memory for sausages?

00:39:57: First of all it's very easy to stabilize with the pin.

00:40:02: It was very strong.

00:40:05: It's a strong membrane.

00:40:07: So when you insert the biomateria under the membrane, You don't have any fear of lacheration or problem about this.

00:40:17: so I think that it is very interesting... I normally use only these types of membranes

00:40:25: technique.

00:40:26: And the degradation time of Jason three to six months helps you in the sausage decay?

00:40:30: A lot because we know very well nowadays that more biomaterial remains stable, more we have a new regeneration of bone and more bone we have in the bone regenerated.

00:40:45: it's really important to maintain a stable biomaterial during the healing surgery but not only at beginning.

00:40:55: This now, it's an evidence.

00:40:58: So we need something that maintains the material not for first week but at minimum two months because We have to think how the blood vessels go inside and in beginning are very thin.

00:41:15: if you move them You may have a lot of problems.

00:41:19: But I want tell this in particular for the young clinician, we have to back to the past a little because all this data regarding their regenerative technique are very well documented.

00:41:38: And so the past may be very useful also from the future.

00:41:42: Nice!

00:41:43: So two conclude the podcast.

00:41:45: let's do these rapid fire questions... This is just an experiment.

00:41:50: Let see... In GBR Membrane, yes.

00:41:55: No why?

00:41:57: Yes Why we need to have a stability of the graph.

00:42:05: Inter or Milan.

00:42:07: You were

00:42:08: you very good Sausage technique.

00:42:13: Yes no Y

00:42:15: sausage technique Very good option for horizontal defect.

00:42:20: I Suggest four three-dimensional defector for more huge.

00:42:27: In fact, we use other techniques in order to have something that maintains the volume in a more stable way.

00:42:35: But I think it is very good option when you increase the horizontal profile of your crest and then we have to recreate the bone volume.

00:42:45: One bone one membrane or white portfolio where can choose?

00:42:52: We need sure about the membrane membrane, we need metrics and this is really very important.

00:43:05: Not only a membrane it's sufficient.

00:43:08: about the bone I think that It's more challenging because i think on one side to have A bone alone with collagen Is a good option in some situations.

00:43:24: In other situation may be useful for having bones with collagen.

00:43:28: In other situations, bone we are only acid.

00:43:31: but nowadays it's difficult to be very precise in which field is better to use one or in which is better the other?

00:43:41: We need do some studies.

00:43:42: Yes.

00:43:44: You have to work a lot.

00:43:45: Yes, apro or campare

00:43:46: spritz Both

00:43:49: Very good

00:43:50: Depend from time.

00:43:53: Thank you

00:43:54: very much.

00:43:55: Really, thank you very.