Vallianou NG, Gounari P, Skourtis A, Panagos J, Kazazis C (2014) Honey and its anti-inflammatory, anti- bacterial and anti-oxidant properties. [12] A synthetic resorbable membrane (eg: Powerbone Barrier Membrane) is an ideal alternative to the resorbable collagen material. A membrane is a thin collagen sponge that is used to cover the graft initially. Conservation of the bone height and width, and ultimately, restoration of masticatory function can be accomplished through use of GBR. (1997) Phenotype expression of gingival fibroblasts cultured on membranes used in guided tissue regeneration. Initial steps in the treatment process of a patient with severe periodontitis begins with the diagnosing of all hopeless teeth in need of extraction. HHS Vulnerability Disclosure, Help Xue and colleagues performed a study that analyzed an MNA loaded PCL/Gelatin electrospun membrane for local MNA delivery for GTR [59]. Depends on graft: Membranes are made of different materials and may be resorbable or non-resorbable. Because cells that originate in the periodontal ligament are important for deposition and resorption of alveolar bone, it is important to consider the healing and regeneration of the alveolar bone and periodontal tissue in conjunction. Use of GTR procedures and results were reported in the early 1980s with the placement of an occlusive membrane between the gingival connective tissue and the alveolar bone to prevent epithelial cell migration into the defect [11]. Non-resorbable membranes have th e disadvantage of requiring The variation in membrane composition and treatment leads to a wide range of tensile strengths from 40-140 MPa for PLA and PGA scaffolds [37]. The resorption time is around 4-6 months and have shown to have a greater host-tissue response, impaired vascularization and tissue dehiscence. address a host of clinical indications and surgical procedures. The osteogenic layer of periosteum consists of production of cells capable of differentiation into osteoblasts and is balanced by the timely loss of osteocytes [19]. The membranes did not exhibit any cytotoxic effects [59]. Nagarajan S, Reddy B (2009) Bio-absorbable polymers in implantationAn overview. Other materials available xenografts (tissue donor from another species[13]) and autogenous bone. Resorbable Collagen Dental Membranes are advanced resorbable membranes for bone defects, localized ridge augmentations, and guided bone regeneration in dehiscence defects. This helps stabilize the graft. Dental Economics 102(7). used ePTFE membrane, a. Clipboard, Search History, and several other advanced features are temporarily unavailable. (2009) The effects of recombinant human growth/differentiation factor-5 (rhGDF-5) on bone regeneration around titanium dental implants in barrier membrane-protected defects: a pilot study in the mandible of beagle dogs. The Role Of Collagen Membranes In Dental Bone Preservation One of St. Lawrence Dentistry's key focus areas is jaw bone preservation and its rebuilding. In patients with systemic problems interdisciplinary collaboration is indicated to adjust therapy background so that it does not adversely affect implanto-prosthetic treatment. The use of e-PTFE helps promote tissue growth of the socket flap compared to the use of less porous PTFE membranes. Collaborations, Submit scholarly communications through the effective use of editorial and Do I Need One For My Implant Bone Graft? A common and underlying limitation to rapidly degrading polymeric membranes is the formation of immature tissue as a result of the disappearance of the membrane before true tissue development and/or remodeling [53,54]. Advanced knowledge sharing through global These membranes can be obtained from bovine or porcine or dermis. It retards the migration of fibroblasts into the bone, allowing for osteoblasts to regenerate underlying bone. Vital bone formation showed significant increase with the placement of a membrane and graft, thus decreasing the risk of bone resorption and increasing positive healing outcomes. Aside from risks associated with additional surgeries, there exists a lack of consensus or standardization on the appropriate time to remove membranes post-implantation. Based on Melchers theory, physical barriers could be placed to retard the migration of unwanted cells, such as the epithelial cells, to allow the healing cells to assist in the regeneration. In addition to its wear and contouring characteristics, the macroporosity of titanium meshes is advantageous for the maintenance of the blood supply as well as enhancing wound stability and tissue integration [18]. Additionally, titanium-based meshes can cause continual soft tissue irritation due to perforation of the gingival tissue upon accidental exposure of the sharp edges of the membrane, and although they can enhance tissue integration, the removal of such meshes can be detrimental to soft tissue growth [18]. GBR can be used for bone regeneration on exposed implant coils . Using resorbable synthetic membranes additionally decreases the need for surgical intervention from inflammation of membranes as well [34]. [2] The theoretical principles basic to guided tissue regeneration were developed by Melcher in 1976, who outlined the necessity of excluding unwanted cell lines from healing sites to allow growth of desired tissues. 1997 Nov-Dec;12(6):844-52. Since the late 1990s, the effectiveness of collagen (resorbable) and e-PTFE (non- resorbable) membranes has been studied and the membranes compared extensively. A similar trend was seen for the placement of implants, with general dentists performing nearly 1/3 of all implant placements in 2006. 2009). Honey also generates hydrogen peroxide (H2O2) as glucose is broken down, which is primarily responsible for its natural antimicrobial effects [62]. Periodontitis is extremely common with nearly half of adults over the age of 30 having some form of the disease with an even higher percentage of 70% for adults over the age of 65. researchers, each embracing the concept that basic knowledge can foster Strategic Goals and Following a treatment plan for extraction, where subsequent ridge preservation is required, the defect site is debrided, and the bone is perforated by the surgeon to create bleeding points prior to implantation of the bone graft and membrane, as shown in Figure 1(A) [13]. We offer collagen, which is available in lyophilized and film as well as tissue made from both bovine and porcine-sourced pericardium and peritoneum. Resorbable membranes are available as natural and synthetic. The removal requires an additional surgery, with the use of anesthesia, making the procedure not ideal. Copyright 2019 Elsevier Inc. All rights reserved. (2012) The impact of thickness of resorbable membrane of human origin on the ossification of bone defects: a pathohistologic study. Loos BG, Craandijk J, Hoek FJ, Dillen PMW-v, Velden UVD (2000) Elevation of systemic markers related to cardiovascular diseases in the peripheral blood of periodontitis patients. Results: Studies show that alveolar ridge/socket preservation following tooth loss/extraction significantly reduces the need for further augmentation at the time of implant placement when compared to unassisted socket healing procedures. GBR membranes can be divided into two types resorbable and non-resorbable depending on their degradation cha racteristics [ 10 ]. to worldwide, enabling them to utilize available resources effectively. Although PTFE and titanium are non-resorbable and require a second surgery, surgeons continue their use due to their surgical handling properties, malleability, structural rigidity in preventing collapse, and space maintenance for large ridge defects [18]. New techniques were developed which utilized a combination of non-resorbable barrier membranes and bone grafts [23-26]. (2015) Comparative evaluation of honey, chlorhexidine gluconate (0.2%) and combination of xylitol and chlorhexidine mouthwash (0.2%) on the clinical level of dental plaque: A 30 days randomized control trial. Collagen tape: a thin collagen tape that is used for hemostasis and smaller graft sites. To prevent the related complications associated with hopeless teeth affected by periodontitis, it may be necessary to undergo oral surgery to have these teeth removed. The https:// ensures that you are connecting to the Membranes have optimized. Weng D, Poehling S, Pippig S, Bell M, Richter EJ, et al. The collagen induces the aggregation of platelets, thus resulting in the degranulation and the release of bone-growth factors. Various fabrication methods are used to create dense or porous variations of these materials. Resorbable membranes dissolve in the body over time. Clinical trials, a systematic review and meta-analysis have shown no statistically significant difference in most clinical indications between both types of membrane. Dive into the research topics of 'Guided Tissue Regeneration with a Resorbable Barrier Membrane (Vicryl) for the Management of Buccal . Locci P1, Calvitti M, Belcastro S, Pugliese M, Guerra M, et al. Christensen GJ (2012) Is socket grafting standard of care? Drugs used in barrier membranes, such as Metronidazole (MNA) and N-methylpyrrolidone (NMP) have selective activity against bacteria and have been used to treat bacterial infections for nearly fifty years [55,59]. Tal H, Kozlovsky A, Nemcovsky C, Moses O (2012) Bioresorbable collagen membranes for guided bone regeneration. While collagen membranes do not provide sufficient mechanical protection of the covered bone defect, titanium reinforced membranes and non-resorbable . Most resorbable membranes are made of collagen products and are xenoplastic (from animals). In an effort to overcome the need for a second operation for membrane removal, barrier membranes are also constructed from biodegradable materials. Jung G-U, Pang E-K, Park C-J (2014) Anterior maxillary defect reconstruction with a staged bilateral rotated palatal graft. Wang HL, Boyapati L (2006) "PASS" principles for predictable bone regeneration. A barrier membrane is utilized in the GBR technique to cover the bone defect and create a secluded space, which prevents the connective tissue from growing into the space and facilitates the growth priority of bone tissue. Variable results have been reported when combining nonresorbable membranes with different types of bone substitutes. By incorporating bioactive molecules or anti-infective agents in barrier membranes, the infection can be avoidable or treatable via the membrane. Careers. Ren Y, Fan L, Alkildani S, Liu L, Emmert S, Najman S, Rimashevskiy D, Schnettler R, Jung O, Xiong X, Barbeck M. Int J Mol Sci. They are the first company to explore this natural ingredient in the field of dental surgery. Xue J, He M, Niu Y, Liu H, Crawford A, et al. SweetBio, Inc.s first product is a resorbable collagen-derived, Manuka honey-incorporated barrier membrane for GTR procedures. Periodontitis is a gum infection that damages the tissue near the tooth and can destroy the bone if not properly treated, leading to potential tooth loss. [4] Recent studies have shown greater attachment gain for guided tissue regeneration (GTR) over open flap debridement. Rakhmatia YD, Ayukawa Y, Furuhashi A, Koyano K (2013) Current barrier membranes: titanium mesh and other membranes for guided bone regeneration in dental applications. Barrier membrane; Guided bone regeneration; Guided tissue regeneration; Nonresorbable membrane; Resorbable membrane. A membrane is a thin collagen sponge that is used to cover the graft initially. eCollection 2022. Guided tissue regeneration around dental implants in immediate extraction sockets: comparison of resorbable and nonresorbable membranes. Bacteria present in the oral cavity and usually the root cause of infections from a GTR procedure include Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Streptacoccus mutans [60]. A separate in vitro study performed by Kasaj et al. Barrier Membranes for Guided Bone Regeneration (GBR): A Focus on Recent Advances in Collagen Membranes. Forty one percent of adults in the U.S. alone have at least one site in need of treatment, and at least 23% of adults over 65 years of age are edentulous (lacking teeth) [1,6,7]. As such an issue is likely to occur, and is often unavoidable, hybrid membranes and drug-coated anti-infective biomaterials have been examined for barrier applications. During ridge augmentations, a surgeon may use a titanium mesh or a titanium-reinforced membrane since there are no resorbable membranes that can compare in rigidity and stability. Canullo L, Malagnino VA (2008) Vertical ridge augmentation around implants by e-PTFE titanium- reinforced membrane and bovine bone matrix: a 24- to 54-month study of 10 consecutive cases. Intact tissue providing increased mechanical strength that resists being pulled out during suture removal . Handling characteristics: conformability vs. stiffness. PMC Additionally, the low pH of Manuka honey contributes to the process of angiogenesis, which is essential for tissue regeneration and integration [65,66]. (2014) Honeya potential agent against Porphyromonas gingivalis: an in vitro study. An implant appointment will be scheduled once your graft has matured. PRF can be used as a resorbable membrane as it tends to last 7-14 days. Absorbable membranes can be naturally derived materials like cross-linked collagen or synthetic polymers like poly-D,L-lactideco-glycolide. As pericardium must be able to withstand the opening and closing of the heart, it is a tougher, denser and more tear-resistant membrane, allowing for an extended time as a barrier. Membranes (Basel). As a means of incorporating an anti-infective drug into the membranes and monitor the drugs release, MNA was combined with slowly degrading PCL and gelatin (to mediate the degradation rate) then electrospun. Your OMS may discuss the use of membranes to help guide and promote healing. (Polyglycolic Acid Trimethylene Carbonate), (Poly-LD-Lactic-Glycolic Acid Trimethylene Carbonate). Manuka honey has been used for a variety of other applications such as treatment for ulcerative colitis, oral rinses for plaque reduction, open dermal wounds, burn wounds, and even as an anti-proliferative agent against cancer cells [61,67-69]. Clinical trials, a systematic review and meta-analysis have shown no statistically significant difference in most clinical indications between both types of membrane. sterilization prior to implantation) and is corrosion resistant when easily passivated. Such membranes types allow for the combination of multiple polymers which in turn allows more tailored degradation timelines. Accepted date: January 02, 2018 A collagen membrane works by covering the bone defect and provides a barrier between gingival tissue and bone. Typically, GTR membranes remain in the wound site between 4-6 weeks while GBR membranes should remain longer to support bone growth over several months with the final implantation time being dependent on the surgeons discretion. Kasaj A, Reichert C, Gtz H, Rhrig B, Smeets R, et al. [7] For higher predictability, nonresorbable titanium-reinforced d-polytetrafluoroethylene (d-PTFE) membranesas a barrier against the migration of epithelial cells within the grafted siteare recommended. Do this 4-5 times per day for 7 days. Sell SA, McClure MJ, Garg K, Wolfe PS, Bowlin GL (2009) Electrospinning of collagen/biopolymers for regenerative medicine and cardiovascular tissue engineering. Depending on the extent of the bone graft needed, they can dissolve in a couple months, or until the doctor removes it after the bone graft has healed. Dr. Rodriguez is an employee of SweetBio, Inc. Selders, Fetz, Gehrmann, Dr. Stein, Dr. Evensky, and Dr. Green have no conflicts of interest or financial ties to disclose. Ivanovski S, Vaquette C, Gronthos S, Hutmacher DW, Bartold PM (2014) Multiphasic scaffolds for periodontal tissue engineering. Collagens are the most common type used. Their absorption rage is typically 3-4 months. Nonresorbable membranes . Guided tissue regeneration surgery can be applied here, aiming to regenerate the periodontal tissues. Useful during oral or periodontal surgery, resorbable membranes are placed in the surgical site to prevent epithelium from growing into the healing site before bone and other desired tissues can form. and transmitted securely. Also known as resorbable barrier membranes, they are made from either collagen or synthetic materials. Since collagen is more biocompatible and does not require a secondary surgery, it can be used as a valid alternative to non-resorbable e-PTFE membranes [44,45]. Ohnishi H, Fujii N, Futami T, Taguchi N, Kusakari H, et al. Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJ, et al. As it stands with products clinically available today, the ideal membrane characteristics depend on the procedure. The choice of membrane varies according to the choice of grafting materials and nature of defect. It is stretched out and made thin so that it can be sutured. The impact of membrane perforation and L-PRF for vertical ridge augmentation with a xenogeneic block graft: an experimental study in a canine model. In addition to the advantages of its composition, the effectiveness of collagen membranes can be enhanced when used in combination with a bone graft. This sweet ingredient has been incorporated into clinically available products, such as Derma Sciences Inc. MediHoney which is often used for burns, ulcers, and wound dressings, and has been known to fight infections, including MRSA and Pseudomonas aeruginosa [61,67,68]. Hold this in the mouth for 30 seconds and spit out. Schneider D, Weber FE, Grunder U, Andreoni C, Burkhardt R, et al. We aim to bring about a change in modern Diao J-M, Pang X, Qiu Y, Miao Y, Yu M-M, et al. The .gov means its official. Compared to canines treated only with flap positioning, results showed that bone regeneration was dependent on provisional space, yet exclusion of gingival connective tissue from a defect site did not solely prevent root resorption [22]. 2022 May 16;9:904307. doi: 10.3389/fsurg.2022.904307. According to the literature, when applying non-resorbable membranes in combination with AP + BDX for vertical GBR, approximately 9 months of healing is needed for proper graft maturation and tissue integration, allowing for implant placement and long-term crestal bone maintenance. Considering the numerous advantageous properties of Manuka honey, the use of this material as an ingredient in the development of dental barrier membranes should not be ignored. Eick S, Schfer G, Kwiecinski J, Atrott J, Henle T, et al. [15] The e-PTFE membrane is sintered with pores of 5 - 20m within the framework of the material. The consequence of losing a tooth takes many forms; it affects the patient functionally, physiologically, esthetically, psychologically and anatomically via loss of jaw bone through resorption. BioXclude, a thin membrane derived from human placenta, has recently been adopted and is commercially available. Kim D, Kang T, Gober D, Orlich C (2011) A liquid membrane as a barrier membrane for guided bone regeneration. It becomes a durable, kind of slimy consistency which can protect a bone graft. Often, membranes serve a role in protecting grafts by preventing unwanted tissues from growing into the area of bone healing. Biomaterials for Periodontal Regeneration. E.g. [7], The destructive gum condition, chronic periodontitis, in the susceptible individual results in the breakdown of both the connective tissues which attach the tooth, and the bone supporting the root. in 1988 on rats. Alvarez-Suarez JM, Gasparrini M, Forbes-Hernndez TY, Mazzoni L, Giampieri F (2014) The composition and biological activity of honey: A focus on Manuka honey. Speer SL, Schreyack GE, Bowlin GL (2015) Manuka Honey: A Tissue Engineering Essential Ingredient. When bone loss occurs below the sinus cavity, the cavity tends to drop as a result. However, fulfilling the needs of surgeons, subsequent key requirements for an ideal barrier membrane include the following capabilities: 1) be cell occlusive; 2) be resorbable while functioning as a barrier; 3) provide sufficient strength to be sutured or tacked, if needed; 4) remain functional if exposed, particularly in cases where primary closure cannot be achieved; 5) allow for conformability to the wound site; 6) compression resistant preventing underlying graft from collapsing (Shu-Tung Li: Collagen Matrix, Inc.). The choice of membrane varies according to the choice of grafting materials and nature of defect. Original language: English: Pages (from-to) 435-441: Number of pages . OA Texts journals are led by prominent Mardas N, Trullenque-Eriksson A, MacBeth N, Petrie A, Donos N (2015) Does ridge preservation following tooth extraction improve implant treatment outcomes: a systematic review. Gottlow J, Nyman S, Lindhe J, Karring T, Wennstrm J (1986) New attachment formation in the human periodontium by guided tissue regeneration. Recently, the development of antibiotic resistant strains of bacteria has become a threatening reality of clinical procedures, especially related to barrier membranes. Jardini MA, De Marco AC, Lima LA (2005) Early healing pattern of autogenous bone grafts with and without e-PTFE membranes: a histomorphometric study in rats. If this is an intentional citation to a retracted paper, please replace, "Mechanisms of guided bone regeneration: a review", "Bone Grafts For Implant Dentistry: The Basics", "Guided Bone Regeneration in severely resorbed maxilla", "Mechanisms of Guided Bone Regeneration: A Review", "Enamel matrix derivative (Emdogain(R)) for periodontal tissue regeneration in intrabony defects", Periodontitis as a manifestation of systemic disease, https://en.wikipedia.org/w/index.php?title=Guided_bone_and_tissue_regeneration&oldid=1138774850, Wikipedia articles needing page number citations from September 2010, Articles unintentionally citing retracted publications, Creative Commons Attribution-ShareAlike License 3.0, Primary closure of the wound to promote undisturbed and uninterrupted healing, Space creation and maintenance to facilitate space for bone in-growth, Stability of the wound to induce blood clot formation and allow uneventful healing, Building up bone around implants placed in, Sinus Lift Elevation prior to implant placement, Filling of bone after removing the root of a, Repairing bone defects surrounding a dental implant caused by peri-implantitis, Vertical and horizontal augmentation of the upper and lower jaws, Unable to achieve wound closure after surgery due to insufficient soft tissues, Severe furcation involvement, i.e. Is my bone graft healing properly? 1976: The concept behind guided tissue regeneration was first written about by Melcher in which he described the exclusion of unwanted cells from penetrating the healing sites. [1]. Kasaj A, Reichert C, Gtz H, Rhrig B, Smeets R, Willershausen B. (2005) A three-layered nano- carbonated hydroxyapatite/collagen/PLGA composite membrane for guided tissue regeneration. In the past, general dentists usually only performed preventive care and referred patients needing periodontal treatment to periodontists. Periodontitis compromises the dentition to an irreversible point, which can necessitate non-surgical therapy, surgical therapy, or even tooth extraction. In clinical trials comparing use of Atrisorb membranes with various debridement methods, the Atrisorb trials showed increases in clinical attachment level of gingival tissues (3.61 mm vs. 1.64 mm) and also in growth of alveolar bone (2.76 mm vs. 1.42 mm) over the span of a year [36]. FOIA Although there is a broad spectrum of commercially available membranes to meet a variety of surgeons needs, the expansion into conformable Manuka honey incorporated membranes and those containing pro- healing and antiinflammatory substances could have additional benefits including moisture retention, wound healing and infection prevention. The typical resorption time is 10-14 days. We will formulate a product specifically for your application. Using resorbable synthetic membranes additionally decreases the need for surgical intervention from inflammation of membranes as well [34]. KLEINTIERPRAXIS 58:617-+. When a bone graft is needed in the rear of the mouth and in the upper jaw, the procedure is more complicated because the sinus cavity is often involved. With a broad spectrum of barrier membranes clinically available, it is essential to review the advantages and disadvantages of current designs, and those developing within the field. Rodriguez and Bowlin have an equity interest in SweetBio, Inc. and are co-inventors of the patent-pending technology. It is, therefore, essential, to review and evaluate current clinically available barrier membranes, the advantages and disadvantages of current designs, and those new and developing within the field. sharing sensitive information, make sure youre on a federal Not only has the number of scaling and root planing procedures tripled in the last 20 years, but the proportion of those procedures being performed by general dentists has increased from 25% to nearly 90% [17]. This could be 6 months or more. 31, 32 Lekovic et al. [14] Current treatments for destructive periodontal disease are not able to restore damaged bone and connective tissue support for teeth (infra-bony defects). Collagen membranes started to become popular within the dentistry industry as they are very biocompatible and have higher capabilities of promoting the healing of wounds through blood clots. Immunological Response to Nonresorbable Barrier Membranes Used for Guided Bone Regeneration and Formation of Pseudo Periosteum: a Narrative Review. Increased porosity of e-PTFE membranes causes an increase in bacteria migration and tissue ingrowth within the porous membrane. Honey, as a substance, is viscous, osmotic, and hygroscopic in nature which are crucial properties for maintenance of moisture at the wound site, wound fluid exudation, and providing a physical protective barrier over the wound, all of which are associated with wound healing [61,62]. examined three commercially available collagen membranes and three non-resorbable PTFE membranes concluding that resorbable membranes are more suitable to stimulate cellular proliferation when compared to non-resorbable membranes [46]. Limitations and options using resorbable versus nonresorbable membranes for successful guided bone regeneration. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. [5], Four stages are used to successfully regenerate bone and other tissues, abbreviated with the acronym PASS:[6], After tooth removal, it takes 40 days for the normal healing process to take place (clot formation to socket filled with bone, connective tissue and epithelium). Titanium meshes offer substantial increased surgical malleability, improved space management, and prevention of collapse (leading to sufficient bone growth), and high strength while being lightweight. [3] Based on positive clinical results of regeneration in periodontology research in the 1980s, research began to focus on the potential for re-building alveolar bone defects using guided bone regeneration. With the demonstrated clinical benefit and clinician outlook, it is likely that the field is moving towards implementing ridge/socket preservation as a routine procedure following tooth extraction when restorative considerations are in the treatment plan. 1988:The concept of space making was created in which the central portion of the membrane is stiffened, creating support and resisting the collapsing of the tissue. Resorbable membranes are available as natural and synthetic. This site needs JavaScript to work properly. Strenuous physical . Cytoplast Titanium-Reinforced Non-Resorbable High-Density PTFE Membranes - 2 Pack $215.00. Drs. Disclaimer. In general, you can expect to feel more normal after a few weeks. Emami E, de Souza RF, Kabawat M, Feine JS (2013) The impact of edentulism on oral and general health. [6][11] The selective ingrowth of bone-forming cells into a bone defect region could be improved if the adjacent tissue is kept away with a membrane; this was confirmed in a study by Kostopoulos and Karring in 1994. This collagen membrane delivers predictable bone graft in dental surgery procedures, filling bony defects, ridge construction, and dental implant placement. A material choice which minimizes this inflammatory response involves the use of decellularized bovine bone as a guiding membrane. Both GTR and GBR treatment efforts serve to achieve stability of the blood clot, wound site healing, isolation of the bone- healing site from soft connective tissues, and provide adequate space for bone/ridge healing [11]. Ramsey A (2014) What Is A Membrane? (2014) High-density polytetrafluoroethylene membranes in guided bone and tissue regeneration procedures: a literature review. Synthetic polymers are such that it is a polylactic acid bilayer, or the collagen-derived membranes. Engebretson SP, Lalla E, Lamster IB (1999) Periodontitis and systemic disease. Additionally, particularly unique to Manuka honey, is the presence of high amounts of methylglyoxal (MGO) which produce a non-peroxide antibacterial effect, ultimately preventing adjacent tissue damage and promoting tissue regeneration [60,61,64].This MGO content is described as the Unique Manuka Factor (UMF) and has become a standard measurement (rating scale) of the non-peroxide antibiotic activity of the honey, increasing with increased antibiotic activity [60,61].