Product news Biomaterials 2021

Valid from October 2021 Product news Biomaterials Supplementary to our “Biomaterials Product Catalog”

Biomaterials Product news 2021 | 1 Introduction 2 New products in the portfolio – CeraOss®, SynMax®, Argonaut® and PermaPro™ 2 Safety standards and material properties 3 Bone graft substitutes 4 CeraOss® – a 100 % pure bone mineral of bovine origin 4 SynMax® – a fully synthetic bone substitute material 5 Barriermembranes 6 Argonaut® – a native collagen membrane obtained from porcine pericardium 6 PermaPro™ – a non-resorbable, synthetic and biocompatible PTFE-membrane 7 Product overview 8 Science 10 References 11 Content

2| Biomaterials Product news 2021 New products in the portfolio CeraOss®, SynMax®, Argonaut® and PermaPro™ The right choice of biomaterials is crucial to optimise the clinical outcomes and to achieve favourable functional, structural and esthetic results. This overview is intended to provide a short summary to guide the selection of barrier membranes and bone graft materials in oral rehabilitation. CeraOss® Granules and SynMax® Granules deliver choices to clinicians by providing exceptionally high-quality pure bone mineral of bovine origin and a synthetic alternative to human bone graft materials. These products are indicated for use in bone repair, in procedures such as augmentation or reconstructive treatment of the alveolar ridge and filling of periodontal defects. Additionally, they are suitable for use in conjunction with products intended for Guided Tissue Regeneration and Guided Bone Regeneration and for horizontal and vertical augmentation, ridge preservation, socket preservation, bone defect augmentation, periodontal intrabony defects as well as furcation defects (class I and II). Argonaut® and PermaPro™ membranes are intended for use in oral surgical procedures as e. g. augmentation procedures around implants placed in immediate extraction sockets as well as delayed extraction sockets. Furthermore, they can be used in horizontal/vertical augmentation, fenestration and dehiscence defects, intraosseous defects (1 to 3 walls) as well as furcation defects (class I and II). Clinical proven Partner of success Quality standards Novel solutions

Biomaterials Product news 2021 | 3 Safety standards and material properties Both the product and the production process comply with the required safety standards and requirements of the German and the EU regulations and the as well as the safety regulations required for xenogenic processing if applicable, including EN ISO 22442-1, EN ISO 22442-2 and EN ISO 22442-3. Properties of the bone graft substitutes CeraOss® (bovine) SynMax® (synthetic) Resorption rate Very low due to highly crystalline natural hydroxyapatite (HA) structure Medium due to synthetic HA and β-TCP (β-tricalciumphosphat) structure Volume stability at the grafting site Very high due to only superficial degradation Medium due to bi-phasic resorption rate Regenerative mechanism Osseous cellular integration Controlled cellular resorption Hydrophilicity High level High level Macroscopic structure Human-like bone structure with three-dimensional pore-network Foam-like structure Particle structure and surface Highly porous structure and rough surface Highly porous structure and rough surface Sterilization Sterilized using irradiation Shelf life 3 years 5 years Argonaut® (porcine) PermaPro™ (synthetic) Origin Porcine pericardium, pure collagen matrix 100 % synthetic PTFE barrier membrane Crosslinked – Sterilization Ethylene oxide gas treatment Resorption 12–28 weeks Non-resorbable Thickness ~0.15 mm ~0.08 mm Shelf life 3 years 5 years Properties of the barrier membranes

Bovine bone graft substitute CeraOss® CeraOss® is a 100 % pure bone mineral of bovine origin manufactured by a unique 1200 °C production process. Its three-dimensional porous network enables a fast penetration and adsorption of blood and serum proteins and serves as a depot for proteins and growth factors. The unique processing ensures maximum safety and leads to an exceptionally high purity of CeraOss®, providing ultimate volume stability of the augmentation site [1–3]. Applications include Alveolar ridge augmentation/reconstruction Filling of bone defects (including after root resection, apicoectomy or cystectomy) Filling of extraction alveoli to support alveolar ridge preservation Sinus lift procedure Filling of periodontal bone defects Filling of extraction sockets as part of immediate implantations Filling of peri-implant bone defects Product features 100 % pure natural bone mineral Human-like bone structure Rough, hydrophilic surface Ultimate volume stability Easy handling 4| Biomaterials Product news 2021 SEM picture of CeraOss® at 5000-fold magnification showing microporous structure. Regeneration through osseo- integration – volume stability

Synthetic bone graft substitute SynMax® SynMax® is a fully synthetic, safe and biocompatible material that, whenbrough intoanosseous environment, serves as anosteoconductive scaffold to support the ingrowth and fusion of adjacent, vital bone. It‘s composed of 60 % hydroxyapatite and 40 % beta-tricalcium phosphate. After implantation, the material undergoes a natural remodeling and is gradually resorbed and replaced by new bone. SynMax® is a bone graft material that provides clinicians and their patients with an ideal alternative to human allograft and animal origin bone graft material [4–6]. Applications include Sinus lift Ridge augmentation Intraosseous defects Extraction sockets Osseous defects Furcation defects Product features 100 % synthetic, no risk of disease transmission, high safety Controlled resorption due to biphasic composition Very rough surface and high porosity supports integration and bone formation Biomaterials Product news 2021 | 5 Controlled celluar resorption SEM picture of SynMax® at 1000-fold magnification showing microporous structure.

Porcine collagen membrane Argonaut® Naturally long barrier function, slow degradation Argonaut® is a long lasting, conformable barrier membrane that drapes easily for graft site contours. It has excellent strength and stability for optimal graft site protection. Argonaut® membrane is a completely resorbable collagen membrane produced from porcine pericardium in a standardized, controlled purification process and used to support guided tissue and bone regeneration, for covering implants, and for periodontal tissue regeneration. Because of the special structure and strong fiber-linking of the pericardium, Argonaut® membrane offers a naturally long barrier function without chemical cross-linking, allowing for predictable regeneration, particularly of large defects [7–9]. Applications include Extraction sockets Periodontal defects Block graft coverage Ridge reconstruction Product features Naturally long barrier function Low thickness Excellent tear resistance Very good surface adaption Not sticky after rehydration Can be pinned or sutured 3-year shelf life Can be stored at room temperature SEM picture of Argonaut® at 1000-fold magnification. Manufacturing process of Argonaut® – a native pericardiummembrane Multi-stage cleaning process Pericardium of German pigs* Lyophilization (Freezedrying) Packaging / Ethylene oxide sterilization Sterile product (3 years) *animals destined for the food industry and certified according to international standards. 6| Biomaterials Product news 2021

Synthetic PTFE membrane PermaPro™ Open healing possible [10, 11] PermaPro™ is an exceptionally thin, non-resorbable and biocompatible membrane. It is composed of biologically inert, high-density polytetrafluoroethylene (PTFE), which acts as an efficient barrier against bacterial and cellular penetration, and can therefore be used for open healing in certain indications. Applications include Socket and ridge preservation (open healing) Horizontal/vertical ridge augmentation Fenestration and dehiscence defects Intraosseous defects (1 to 3 walls) Preference for PermaPro™ over a collagen membrane Higher form stability Augmentation outside the ridge contour Synthetic nature – no religious or dietary conflicts Exposure – situations where primary wound closure is not desired (indication dependent) Product features 100 % synthetic PTFE barrier membrane Ultra-thin (~0.08 mm) Impervious to bacteria due to dense structure Easily removable due to minimal tissue ingrowth into the surface structure No need for primary soft tissue closure (indication-dependent) [10, 11] Easy recovery thanks to blue color Rounded edges for minimal tissue trauma Easy fixation with sutures or pins SEM picture of PermaPro™ at 30-fold magnification Biomaterials Product news 2021 | 7

8| Biomaterials Product news 2021 Product overview Bone graft substitutes CeraOss® (bovine bone graft substitute) Art. No. Volume Particle size BM1011.1005 0.5 cm3 500–1000 µm BM1011.1010 1.0 cm3 500–1000 µm BM1011.1020 2.0 cm3 500–1000 µm BM1011.1050 5.0 cm3 500–1000 µm BM1012.1005 0.5 cm3 1000–2000 µm BM1012.1010 1.0 cm3 1000–2000 µm BM1012.1020 2.0 cm3 1000–2000 µm BM1012.1050 5.0 cm3 1000–2000 µm SynMax® (synthetic bone graft substitute) Art. No. Volume Particle size BM1013.1005 0.5 cm3 500–1000 µm BM1013.1010 1.0 cm3 500–1000 µm BM1014.1005 0.5 cm3 800–1500 µm BM1014.1020 2.0 cm3 800–1500 µm

Biomaterials Product news 2021 | 9 Barrier membranes Argonaut® (porcine collagen membrane) PermaPro™ (synthetic PTFE membrane) Art. No. Product size BM2004.1520 15 x 20 mm BM2004.2030 20 x 30 mm BM2004.3040 30 x 40 mm Art. No. Product size BM2005.1520 15 x 20 mm BM2005.2030 20 x 30 mm BM2005.3040 30 x 40 mm 15 x 20 mm 30 x 40 mm 20 x 30 mm 15 x 20 mm 20 x 30 mm 30 x 40 mm

10| Biomaterials Product news 2021 Science It's the cells that make the decision Functionality of biomaterials results from their optimal biological interactions with tissue cells. Bone is a structure difficult to duplicate. Research in tissue engineering, especially in nano topography, can lead to improved biomaterials. There are numerous biomaterials available, some of natural origin, others of synthetic origin. When choosing a biomaterial, many factors come into play next to functionality. From a biological point of view, the ideal biomaterial should promote formation of a stable blood coagulum. It should be functional, biocompatible, and it should favor healing processes. Autogenous bone is still the gold standard in grafting. However, it is linked to higher costs, longer treatment times and it requires an additional surgical procedure, possibly leading to increased donor site morbidity. This needs to be considered when carrying out augmentation procedures. Therefore, the possibilty of reducing potential complications is an important factor. Easy handling of the materials is of advantage for the clinician. Aside from these decisive factors, it must not be forgotten that bone augmentation surgery is often performed as a part of dental implant surgery. Therefore, different biological aspects should be considered when choosing biomaterials. Comparative studies have shown that different biomaterials can be safely used [12]. The needs and preferences of the treating clinician play as important a role as the indication, the requirements of the patient, as well as time and costs. In the end, selection of the appropriate biomaterial must be made with the knowledge of its properties and its clinical outcome. The goals are always predictable results and clinical success. Conclusion: Prior to using a biomaterial, it is recommended to balance and consider the biological interaction between the biomaterial and the endogenous cells [13] – it’s the cells that make the decision.

Biomaterials Product news 2021 | 11 References [1] Riachi et al. International journal of dentistry, Vol. 2012, p. 737262. [2] Lorean et al. Int J Oral Maxillofac Implants 29 (3), 705-708. May-Jun 2014. [3] Tawil et al. Int J Oral Maxillofac Implants. 2016 Jul-Aug;31(4):827-34. [4] Binderman et al. Haim Tal, IntechOpen. April 4th 2012. [5] Jelusic et al. Clin Oral Implants Res. 2017 Oct;28(10):e175-e183. [6] Lorenz et al. Int J Implant Dent. 2017 Sep 5;3(1):41. [7] Rothamel et al. 2012. Int J Oral Maxillofac Implants 27(1):146-54. [8] Barbeck et al. 2015. J Oral Implantol. 41(6):e267-81. [9] Kloss et al. 2018. Clin Oral Impl Res. 29:1163–1175. [10] Zafiropoulos et al. Medicina (Kaunas). 2020 Apr 28;56(5):216. [11] Papi et al. Antibiotics (Basel). 2020 Mar 3;9(3):110. [12] Data on file, Debbie Yuen et al.: Prediction of in vivo stability of a resorbable, reconstituted type I collagen membrane by in vitro methods. World Biomaterials Congress Transactions, Sixth World Biomaterials Congress Transactions. Collagen Matrix Inc., Franklin Lakes, NJ 07417 USA. [13] Scott J. Roberts et al.: The combined bone forming capacity of human periosteal derived cells and calcium phosphates. Biomaterials 32, 2011; 4393–4405.

Validity: Upon its release, this literature supersedes all previously published versions. Availability: BioHorizons continually strives to improve its products and therefore reserves the right to improve, modify, change specifications or discontinue products at any time. 12| Biomaterials Product news 2021

Rights to change reserved · M-0473-CAT-EN-INT-BHCL-00-102021 Headquarters CAMLOG Biotechnologies GmbH | Margarethenstr. 38 | 4053 Basel | Switzerland Phone +41 61 565 41 00 | Fax +41 61 565 41 01 | | CeraOss®, SynMax®, Argonaut® and PermaPro™ are manufactured by botiss biomaterials GmbH. CeraOss®, SynMax® and Argonaut® are registered trademarks of CAMLOG Biotechnologies GmbH. PermaPro™ is a trademark of CAMLOG Biotechnologies GmbH. BioHorizons® is a registered trademark of BioHorizons. They may, however, not be registered in all markets. As applicable, BioHorizons products are cleared for sale in the European Union under the EU Medical Device Directive 93/42/EEC and the human tissues and cells Directive 2007/47/EC. We are registered to ISO 13485:2016, the international quality management system standard for medical devices, which supports and maintains our product licenses with Health Canada and in other markets around the globe. Original language is English. ©BioHorizons. All rights reserved. Not all products shown or described in this literature are available in all countries. Customer number: Distributors For further information about the distributors in 90 countries, please visit