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The decision to load implants is case dependent. One of many factors is the amount of presurgical available bone. In general, Bond Apatite bone graft cement on average regenerates bone in lateral sinus lifts in 5 months. Ascertaining appropriate implant stability to accept prosthetic loading in a clinical decision that has to undertaken by the clinician and their particular patient.
There is no limitation. One can add as many syringes as needed one after the other. The second consecutive layer always bonds to the first one, even when the cement has already hardened.
In a crestal approach, after the cement is activated, it is ejected into a sterile dish and left to set for 3 minutes, then crushed into small fragments. During this stage, the particles become sticky. The reason to use this approach is that it is easier to push sticky particles into the osteotomy and to lift the sinus membrane simultaneously.
Yes, Augma bone cement can be used together with osseodensification techniques. The cement can be applied according to the procedure for a crestal approach sinus lift.
If there is a perforation of the sinus membrane during the preparation for a crestal sinus lift, it is recommended to stop the procedure, close the flap, wait a few months, and then try to perform the procedure again.
The initial stability for any implant is due to placement in the residual bone. The purpose of bone graft cement is to regenerate bone around the implant. It has no continuous cementing properties. Bond Apatite has bioactive properties to regenerate bone.
When 3D Bond™ is used on its own, the material is completely resorbed and replaced by the patient’s own bone, which is apparent while viewing an x-ray.
Approximately a week post-operation, a radiolucent shading in the circumference can be noticed in an x-ray. This shading will expand up to the fourth week when the entire area will be completely radiolucent. It seems as though the material has completely disappeared, but this is not the case. This is the un-calcified osteoid. Gradually, calcification of the area will take place, so that up to three months after implantation, the entire area will be radiopaque in the x-ray, with an identical appearance to the adjacent native trabecular bone.
Biphasic calcium sulfate is a patented formulation of calcium sulfate. This is the only formulation of calcium sulfate that has the ability to behave as a cement in the oral cavity. Additionally, the BCS is moldable and can set and harden instantly in the presence of blood and saliva. The old calcium sulfate could not set and harden when it got it to contact with blood or saliva; therefore, it could not be easily used as a suitable cement in the maxillofacial field.
3D Bond™ is a cementable, osteoconductive bone substitute, made of pure Biphasic Calcium Sulfate; the only one of its kind that can set in the presence of blood and saliva. The material is completely resorbed within 4-10 weeks, coinciding with the time period it takes for the bone to form. The outcome is a complete replacement of the graft with the patient’s own bone.
The medical use of Calcium Sulfate has the longest history in the augmentation field, with over 120 years of use in the areas of Orthopedics, Plastics, Oncology, and Maxillofacial medicine. This material has been studied and documented most extensively and is the only one that is associated with thousands of articles in various areas of medical literature.
Throughout the years there has been a constant insistence on working with Calcium Sulfate due to the extraordinary features that distinguish it from currently existing augmentation materials. Notwithstanding, the material in its basic form has two prominent drawbacks; namely, its inability to harden as a cement in the presence of blood and saliva existing in the oral environment and the materials fast resorption rate.
The development of 3D Bond™ originated from a clear clinical need to simplify the complexity of today’s augmentation procedures, shorten the working time as well as the recovery time. The development of this material was a process of over 15 years of intensive research, focusing on the use of pure raw material without any additives or accelerators. The outcome is a superior bone graft material that has the ability to set instantly in the presence of blood and saliva.
The working time with Bond Apatite® starts when the powder is mixed with saline by advancing the plunger in the smart syringe and introducing the saline in to the premeasured BCS/HA powder chamber. At this time, the material is moldable and pliable. The best pliability is seen immediately after cement activation. Thus, it is vital to have the host site completely prepared before the activation of Bond Apatite®. After the site has been prepared, activate the cement within its smart syringe and eject it into the site. As soon as Bond Apatite® is placed in the site, it should be compressed with a dry sterile gauze pad for 3 seconds, and then the material hardens in situ immediately. The compression should be done by applying finger pressure on the gauze for 3 seconds, followed by an additional few seconds' compactions with a periosteal elevator on the gauze. Once completed, remove the gauze and continue with soft tissue closure according to the protocols.
In the oral cavity, pressing with gauze for 3 seconds generates an instant primary setting. In vitro hardening takes approximately 3-5 minutes.
As can be seen in the protocols, it is recommended to activate the cement within its smart syringe after complete site preparation, injec the cement directly into the site, and immediately place a dry sterile gauze pad above and press with a finger on top for 3 seconds. This should be followed by an additional few seconds' pressure on the gauze with a periosteal elevator.
The material does not remain hard. The resorbtion process begins immediately after placement, while new bone formation simultaneously takes place.
Due to the nature of the graft, the biphasic calcium sulfate matrix within the graft is simultaneously replaced by the patient’s bone; therefore, the radiographic appearance is completely different compared to other grafts, which always appear radiopaque due to their constant presence in the grafted site.
In contrast, the radiographic appearance with Bond Apatite® is as follows:
During day one after graft placement, it appears radiopaque.
Gradually, a radiolucent appearance takes its place (reflecting the graft's transformation into the newly-formed osteoid before its calcification).
Two to four weeks after graft placement, the majority of the grafted site appears radiolucent while few radiopaque spots remain, reflecting the presence of the HA particles. Within 12 weeks, radiopacity takes place with the appearance of the native trabecular form. This is the time when the new osteoid has already calcified.
There is no recommended specific protocol at this point for vertical augmentation.
Please see the protocols.
Please see the protocols.
Sinus Lift – Lateral Window Approach
Please see the protocols.
Socket Grafting With Flap Reflection
3 mm of incision line opening is acceptable. However, in socket grafting procedures or in case of a site that contains bony walls to protect the graft, more than 3 mm of incision line opening should be protected by a collagen sponge secured above as showed in the protocols.
Due to the cement's properties, using a membrane, between the flap and the cement, is not needed. Tissue closure is accomplished by stretching the flap on top of the cement. Please see the protocols.
2 thoughts on “FAQ”
I used bond apatite today for the first time and it didn’t harden at all at the surgical site, and kept almost flowable about 20 minutes.
How could that be?
In order for the material to harden properly it should be used as follows:
During activation the shaft of the syringe should be advanced until the first piston reaches the blue line. Then the cap is removed, and the material should be injected into the site. Immediately place on it a dry gauze, not too folded, simply in two layers. Then press strongly with a finger on top of the gauze for 3 seconds, and again with a periosteal elevator for an additional 3 seconds. That’s all you need to do and the material will set instantly. It will never be hard like a stone, but it is definitely stable. During suturing, if the material breaks, place a dry gauze on it and press for one second before continuing to suture.
If the material didn’t harden, it’s probably because the pressure with the gauze was not done immediately. As such, the crystals are soaked with blood and it will not set properly, and will be flowable.
Please see our online course for more instructions on proper use.