ADVANCED BONE GRAFT SYSTEM OVERVIEW

ADVANCED BONE GRAFT SYSTEM OVERVIEW

NANOSS BIOACTIVE ADVANCED BONE GRAFT Table Of Contents INTRODUCTION System Overview... 1 NANOSS BIOACTIVE COMPONENTS Comparison of nanoss Bioactive and Human Bone... 1 CLINICAL Clinical Application... nanoss Bioactive Spinal Fusion Study... 2 2 ORDERING INFORMATION nanoss Bioactive... 3 nanoss Bioactive Loaded... 3 INDICATIONS & WARNINGS nanoss Bioactive Indications, Contraindications, Warnings, Precautions... nanoss Bioactive Loaded Indications, Contraindications, Warnings, Precautions... 4 4 NANOSS BIOACTIVE

SYSTEM OVERVIEW NANOSS BIOACTIVE SYSTEM OVERVIEW nanoss Bioactive advanced bone graft combines a collagen-based biopolymer and nanocrystalline hydroxyapatite that mimic the structure of bone to give a natural bone growth solution. The bioscaffold carrier provides an ideal cellular environment for bone repair. The advanced carrier in nanoss Bioactive utilizes a patented process to open collagen s triple helical structure to form an open bioscaffold for tissue infiltration. Host cells interact with the open bioscaffold carrier that provides an ideal environment for bone formation. INTRODUCTION Traditional closed collagen carrier nanoss Bioactive open structure COMPARISON OF NANOSS BIOACTIVE AND HUMAN BONE: NANOSS BIOACTIVE IS SYNTHETIC BONE Human Bone nanoss Bioactive Contains Hydroxyapatite and Collagen Bone Composition: 60% hydroxyapatite 32% collagen 8% water 8% 32% 60% COMPONENTS Contains interconnected porosity nanoss Bioactive s osteoconductive scaffold is composed of nano-sized hydroxyapatite crystals that are the same size, composition and shape as human bone. These similarities allow the body to recognize nanoss Bioactive as bone and effectively remodel this graft into new bone. Equivalent crystal size and structure 25-500 nm 15-100 nm Optimal size for tissue interaction High surface area 100 m 2 /g 70 m 2 /g High surface area increases attachment and replication of bone forming cells and improves mineralization, leading to remodeling of nanoss Bioactive into the patient s own bone. ADVANCED BONE GRAFT 1

NANOSS BIOACTIVE ADVANCED BONE GRAFT CLINICAL CLINICAL APPLICATION 11 weeks post surgery x-ray of tibial plateau fracture repaired with nanoss Bioactive. 1-year CT image of patient treated with nanoss Bioactive combined with bone marrow aspirate and local bone graft across the transverse process. NANOSS BIOACTIVE SPINAL FUSION STUDY L5-L6 Posterolateral Fusion in rabbit 12 Week Duration 3 Treatment Groups nanoss Bioactive Granule nanoss Bioactive + Bone Marrow Aspirate + Autograft New Bone Competitive Product + Bone Marrow Aspirate + Autograft Bone Marrow Aspirate + Autograft Bone Marrow RESULTS - nanoss Bioactive mixed with bone marrow aspirate and Autograft had: Excellent handling properties Autograft Bone Statistically stronger fusions (peak load and stiffness) than the Competitive Product Excellent histology results PEAK LOAD (N) 2.5 times more new bone formation than Competitive Product nanoss Bioactive Competitve Silicate Product Autograft *nanoss Bioactive resulted in a significantly higher peak load compared to the Competitive Product, (p<0.05), but was not different than Autograft. There was no significant difference between the Competitive Product and Autograft. 2 NANOSS BIOACTIVE

SYSTEM OVERVIEW nanoss Bioactive ORDERING INFORMATION Unit Size Product Catalog # Storage 1cc nanoss Bioactive 90-100-01 Room Temperature 2cc nanoss Bioactive 90-100-02 Room Temperature 5cc nanoss Bioactive 90-100-05 Room Temperature 10cc nanoss Bioactive 90-100-10 Room Temperature 20cc nanoss Bioactive 90-100-20 Room Temperature nanoss Bioactive Loaded nanoss Bioactive Loaded Adapter Bone graft delivery syringe nanoss Bioactive Loaded + adapter + bone graft delivery syringe Unit Size Product Catalog # Storage 10cc nanoss Bioactive Loaded 90-200-10 Room Temperature 10cc Each nanoss Bioactive Loaded Kit (10cc unit, bone graft delivery syringe & adapter) nanoss Bioactive Loaded Accessory Kit (bone graft delivery syringe & adapter) 90-200-1002 Room Temperature 90-900-02 Room Temperature Each Bone graft delivery syringe 53-syringe-1 Room Temperature 10 pack Bone graft delivery syringe 53-syringe Room Temperature ADVANCED BONE GRAFT 3

NANOSS BIOACTIVE ADVANCED BONE GRAFT NANOSS BIOACTIVE - INDICATIONS & WARNINGS INDICATIONS nanoss Bioactive and nanoss Bioactive Loaded are both indicated for bony voids or gaps that are not intrinsic to the stability of bony structure. These defects may be surgically created osseous defects or defects created from traumatic injury to the bone. These products are indicated to be used in the posterolateral spine in conjunction with bone marrow aspirate and autograft bone. nanoss Bioactive and nanoss Bioactive Loaded are also indicated to be gently packed into the bony voids or gaps in the skeletal system (extremities, pelvis) in conjunction with autogenous blood and sterile saline. These products provide a bone void filler that resorbs and is replaced with bone during the healing process. CONTRAINDICATIONS Use of nanoss Bioactive or nanoss Bioactive Loaded is contraindicated in the presence of one or more of the following clinical situations: fractures of the epiphyseal plate. metabolic or systemic bone disorders that affect bone or wound healing. fractures for which stabilization of the fracture is not possible. significant vascular impairment proximal to the graft site. infected or contaminated wounds, or fractures for which intraoperative soft tissue coverage is not planned or possible. acute and chronic infections in the surgical area (soft tissue infections; inflammatory, bacterial bone disorders, osteomyelitis). impaired calcium metabolism. treatment with steroids and other drugs affecting calcium metabolism. immunosuppressant therapy. use in the area of the open epiphyseal growth plate. patients allergic to porcine collagen products. WARNINGS nanoss Bioactive and nanoss Bioactive Loaded do not possess sufficient mechanical strength to support the reduction of a fracture site prior to soft and hard tissue in-growth or to support a load. Standard internal fixation techniques such as the use of plates and/or screws must be followed to obtain rigid stabilization. External stabilization alone is not sufficient to achieve the rigidity necessary for bony in-growth of nanoss Bioactive. nanoss Bioactive and nanoss Bioactive Loaded material must not be used to gain screw purchase or to stabilize screw placement. All screws used in conjunction with this product and fixation devices must attain rigid fixation into the host bone. nanoss Bioactive must not be used to repair metaphyseal defects. Complete postoperative wound closure is essential. nanoss Bioactive Loaded must not be used to repair metaphyseal defects where complete soft tissue coverage cannot be achieved. nanoss Bioactive Loaded must not be used to gain screw purchase or to stabilize screw placement. All screws used in conjunction with this product and fixation devices must attain rigid fixation into the host bone. never introduce nanoss Bioactive Loaded into closed cavities under pressure, as this may lead to fat embolization or embolization of device into blood stream; and avoid application of nanoss Bioactive Loaded beyond intended treatment site, as this may damage surrounding tissues. Avoid application of nanoss Bioactive Loaded beyond intended treatment site as this may damage surrounding tissue. Clinical human data using nanoss Bioactive is limited. 4 NANOSS BIOACTIVE

SYSTEM OVERVIEW PRECAUTIONS nanoss Bioactive and nanoss Bioactive Loaded are intended for use only by surgeons familiar with bone grafting and rigid fixation techniques. nanoss Bioactive and nanoss Bioactive Loaded granules are radiopaque and the radiopacity may mask underlying pathological conditions. nanoss Bioactive and nanoss Bioactive Loaded are intended for single use only. do not apply nanoss Bioactive or nanoss Bioactive Loaded dry to the defect. do not resterilize nanoss Bioactive or nanoss Bioactive Loaded. discard any un-used nanoss Bioactive or nanoss Bioactive Loaded. nanoss Bioactive and nanoss Bioactive Loaded have no weight bearing function. Postoperative patient management should follow the same regimen as similar cases utilizing autogenous bone grafting. Standard postoperative practices should be followed, particularly as applicable to defect repairs involving the use of fixation devices. always follow recommended mixing instructions when rehydrating nanoss Bioactive. postoperative patient management should follow the same regimen as similar cases utilizing autogenous bone grafting. Standard postoperative practices should be followed, particularly as applicable to defect repairs involving the use of fixation devices. NANOSS BIOACTIVE - INDICATIONS & WARNINGS REFERENCES: Walsh, W, Hill, R.S., Lloyd, W., Bertollo, N., Shinoda, T., Merger, A., Oliver, R., and Yu, Y. In vivo Response to Synthetic Bone Graft Substitutes in a Preclinical Posterolateral Fusion Model. Accepted for Presentation at the 2009 North American Spine Society Meeting, San Francisco, CA, Nov 2009. *See product insert for complete labeling limitations related to this device. nanoss Bioactive is synthetic bone ADVANCED BONE GRAFT 5

NANOSS BIOACTIVE ADVANCED BONE GRAFT 2011 Pioneer Surgical Technology. All rights reserved. The trade name Pioneer Surgical as used herein and elsewhere refers to the legal entity Pioneer Surgical Technology, Inc. Pioneer Surgical owns the following trademarks: Pioneer, Moving Forward Together and nanoss. The following trademarks are registered in the U.S.: Pioneer. All other trademarks are property of their respective owners and holders. Pioneer Surgical Technology 375 River Park Circle Marquette, MI 49855 800-557-9909 www.pioneersurgical.com MKT-167-D/113506 4/2011