Ghanaati-Education

"Oral Health Influences Systemic Health" 

By Prof. Dr. Dr. Dr. Shahram Ghanaati
MD, DDS, PhD

What is Ghanaati-Education?

Introduction

Covered Socket Residuum (CSR) - A Newly Discovered Mechanism of Bone Healing

For decades, alveolar bone healing after tooth extraction was believed to be a fully regenerative process. But recent research from Professor Shahram Ghanaati has revealed a previously unknown biological mechanism guiding this process:

In his radiological studies, he visualized three-dimensional cone-beam computed tomography (CBCT) data sets to observe the socket healing after tooth extraction.

Within six months, significant structural changes were detected: the buccal and lingual bone plates collapsed by up to 55% horizontally and 34% vertically.

This collapse represents a natural mechanism through which the body transforms a large “critical size defect” into a smaller, non-critical defect, which can contribute to a spontaneous bone regeneration within the crestal part of the socket.

In the meantime, bone formation occurs predominantly along the peripheral socket walls, while the central region of the socket often remains unmineralized.

As a result, a structure develops that is sealed by a mineralized crestal plate, but whose interior remains incompletely ossified — the Covered Socket Residuum (CSR). Histological analysis reveals an incomplete mineralization. CSR therefore represents a biologically regulated socket closing process that provides structural stability without achieving full bone regeneration.

Differentiation from So-Called Cavitations

In the past, similar radiological findings were frequently interpreted as “jaw cavitations” or bone defects associated with chronic inflammation.

Current evidence clearly differentiates CSR from these concepts:

CSR is not a pathological cavity, but rather a physiological and regulated socket closing mechanism.
While cavitations might be of destructive, inflammatory, or degenerative in nature, CSR represents a programmed biological adaptation — a controlled transformation from a post-extraction defect into a stable, partially crestally mineralized structure.
This distinction establishes, for the first time, a scientific separation between disease-related bone alterations and a natural, adaptive healing response within the jawbone.

Health Implications of Non-Mineralized Areas

Non-mineralized zones within CSR are now a major focus of Professor Ghanaati´s ongoing research, as they might represent metabolically and immunologically active regions.

If such areas persist, they may impair local microcirculation and cellular signaling, potentially sustaining low-grade inflammatory processes, which could harm the success of dental implantology.
Additionally, these chronic micro-inflammatory signals could influence patient’s systemic immune balance, metabolic regulation, or chronic disease patterns.
Professor Ghanaati´s current studies therefore aim to determine under which biological and clinical conditions CSR regions fully mineralize or persist. Furthermore, his developed surgical concept Guided Open Wound Healing (GOWH) -based regenerative protocols does prevent CSR and contribute to a complete guided socket healing.

The long-term objective is to understand CSR as a controllable biological mechanism and to develop targeted regenerative strategies ensuring stable, inflammation-free bone formation.


Evidence
  • Radiological Evidence: 3D imaging shows bone collapse of up to 55% within six months after extraction, with unhealed spaces in the center of the socket (Ghanaati et al., 2025; Bioengineering1, Ghanaati et al., 2025; Bioengineering2)

  • Molecular Evidence: Cavitations are "biologically" active, producing inflammatory messengers like RANTES/CCL5, which disturb both local healing and the immune system (Lechner 2013; Ghanaati et al., 2025; Biomedicines)

  • Microbiological Evidence: Harmful bacteria (including the "red complex" pathogens linked to gum disease) hide deep in the jawbone and can only be removed by specific surgical techniques like decortication
    (Ongoing clinical studies)

  • Histological  Evidence:  Microscopic analysis jawbone samples from patients with chronic facial pain revealed areas of ischemic osteonecrosis — dead or poorly perfused bone tissue — often accompanied by chronic inflammation.  These findings confirm that hidden, low-grade jawbone infections can exist even when X-rays appear normal, contributing to persistent neuralgic pain.  (Bouquot et al., 1992; Oral Surgery)                        


Based on these insights Ghanaati-Education has a clear order in its Vision Statement:

Integrating the Oral–Systemic-Link in medical and dental education for ensuring the highest standard of practice and patient care!

Our Mission

From Research to Clinical Application –

Guided Open Wound Healing (GOWH)

At Ghanaati Education, our mission is founded on the Guided Open Wound Healing (GOWH) method - a surgical technique developed by our founder, Prof. Dr. Dr. Dr. Shahram Ghanaati. The clinical concept of GOWH emerged as a practical application of the CSR mechanism. It aims to guide biological healing rather than simply closing wounds. 

Through targeted decortication, the application of bone substitute materials, and the use of autologous blood concentrates (PRF), this approach maintains vascularization, prevents bone wall collapse, and supports complete, biologically guided regeneration.
By integrating CSR biology into clinical decision-making, GOWH enables practitioners to actively direct the healing process and promote long-term bone stability.

Clinical Implementation – Translating the CSR Mechanism into Practice

The discovery of the CSR mechanism has also defined a set of clinical parameters that embody the translational philosophy of Professor Ghanaati and his educational approach.

These central parameters form the foundation of biologically guided treatment:

1. Radiological Detection – 3D visualization and assessment of affected areas within the jaw to identify non-mineralized or metabolically active regions.

2. Nutritional and Vitamin Balance – Optimization of nutrient and vitamin intake pre- and postoperatively to ensure biological readiness for healing.

3. Hydration – Maintaining sufficient patient hydration before and after treatment to support microcirculation and cell metabolism.
 
4. Decortication – Comprehensive cleaning and biological activation of the extraction socket to remove the infected tooth associated infected/necrotic socket bone, in order to enhance vascular and osteogenic responses. 

5. Use of Bone Substitute Materials and Blood Concentrates – Careful selection of biomaterials combined with autologous blood concentrates (PRF) to stimulate angiogenesis, osteogenesis, and tissue regeneration.

6. Systemic Condition of the Patient – Detailed evaluation of overall health, including pre-existing diseases and metabolic or inflammatory conditions, followed by individualized treatment adaptation.

Together, these parameters translate biological insight into evidence-based regenerative strategies that respect both, local bone biology and systemic health.

Ghanaati-Education –
Bridging Research, Practice, and Teaching

Ghanaati Education translates these biological and clinical insights into structured learning and training modules.

Through an innovative 3D visualization approach based on radiological diagnostics (CBCT and CT), CSR can be detected at an early stage. The application of GOWH as an innovative regenerative and reconstructive surgical concept enables jawbone areas to be revitalized.
To generate robust scientific data, each patient’s medical condition is carefully evaluated using a comprehensive medical questionnaire developed by Professor Ghanaati. This assessment begins prior to surgery and continues for up to one year post-surgery. The resulting data provides valuable insights into the systemic medical impact of CSR surgeries, allowing us to continually refine our methods and improve patient outcomes.

Dentists and surgeons gain a deep understanding of CSR and GOWH – from identifying biological healing patterns to implementing them clinically.
This integrative approach unites scientific evidence, surgical precision, and systemic health awareness, forming the foundation of modern biologically guided regenerative dentistry and surgery.

Currently, over 100 dental specialists worldwide have been trained by Professor Ghanaati in the method of GOWH through his Maxi Residency Program at Tufts Dental University, in collaboration with the Academy of Medical and Oral Regeneration. Furthermore, there is the possibility for dental centers to become certified GOWH Centers, once they have successfully fulfilled specific criteria, ensuring the highest standard of practice and patient care

Find out more about our Educational Concept...

A New Era of Health Focused Guided Healing 

Together, CSR and GOWH represent a paradigm shift in how bone healing inside tooth socket is understood, taught, and practiced.
They redefine the post-extraction process not as a binary state of “healed or unhealed,” but as a dynamic, biologically variable adaptation.

By linking research, clinical application, and education, this concept fosters a future in which bone healing is not only observed but consciously guided — for predictable regeneration, sustainable health, and a biologically intelligent approach to oral surgery.

The Founder

Professor Shahram Ghanaati
MD, DDS, PhD

Professor Shahram Ghanaati is a board-certified oral and maxillofacial surgeon with additional specialization in plastic surgery. He serves as Deputy Director and Senior Chief Consultant of the Department of Oral, Cranio-Maxillofacial and Plastic Facial Surgery at Frankfurt University Medical Center, where he also directs the Head and Neck Cancer Center and the Wound Center. He is internationally recognized for his pioneering research in biomaterials, tissue engineering, and biologics, and for translating these innovations into clinical practice worldwide.

From the beginning of his career, Professor Ghanaati has combined excellence in clinical practice, research, and teaching. Since joining Goethe University Frankfurt in 2007, he has founded the FORM-Lab for biomaterial research and tissue engineering, mentored countless researchers, and established a study unit dedicated to clinical trials in regenerative therapies. Through this work, he has built one of the world’s foremost centers for clinically oriented biomaterial research, translating basic science into everyday clinical practice.

In both his clinical practice and research, Professor Ghanaati focuses on two key areas: reconstruction with biomaterials and regeneration using blood concentrates for tissue repair throughout the body. As a leading oncological and reconstructive surgeon, he develops innovative approaches for treating large bone and soft tissue defects following cancer surgery. His work has introduced novel surgical methods, including the Guided Open Wound Healing Concept (GOWH) for biomaterial-based tissue augmentation. Since 2010, in collaboration with Dr. Joseph Choukroun, he has advanced the field of autologous blood concentrates, co-developing the Low-Speed Centrifugation Concept (LSCC), which laid the foundation for the AWMF S3-guideline on the clinical use of platelet-rich fibrin in dentistry.

In 2020, Professor Ghanaati founded the Academy for Medical and Oral Regeneration (AMOR), an international platform dedicated to advancing biologics and biomaterials in medicine. AMOR supports basic and clinical research, conducts clinical studies to explore the link between oral health and systemic health, and provides national and international training in GOWH. Building on his extensive experience, he has also pioneered new educational formats for physicians and dentists, integrating cutting-edge science with practical training. To enhance knowledge transfer, he introduced 3D visualization into surgical education and, in 2024, founded Visiogenics and its online platform, ghanaati-education.com, to expand global access to biologic surgical education.

Professor Ghanaati is a highly sought-after speaker, having delivered more than 180 lectures at international congresses and over 250 hands-on courses and workshops worldwide. He has published more than 200 peer-reviewed papers, with an H-Index of 41 and a cumulative impact factor exceeding 640. In addition to serving as a reviewer for numerous journals in regenerative medicine, oral and maxillofacial surgery, and head and neck oncology, he is Senior Associate Editor of the Journal of Oral Implantology (JOI).

He has received numerous national and international awards for his clinical and scientific contributions and has served as a guest lecturer and adjunct faculty at universities worldwide. Since 2024, he has been Adjunct Instructor at Brooks Rehabilitation College of Healthcare Sciences, Jacksonville University, where he teaches biologic concepts for facial treatment and aesthetics. At Tufts University School of Dental Medicine in Boston, he created the innovative Maxi Residency in Biological Dentistry, Biological Surgery and Implantology based on Guided Open Wound Healing, which combines theory, hands-on training, case presentations, and online modules. The program culminates in Frankfurt, Germany, where participants observe live surgery.