Should Bond Apatite® mix with blood?

After placing the cement in place and pressing above for setting and hardening, there is no need to mix with blood. The graft porosity and its hygroscopic ability allow blood to seep inside immediately.

What is the porosity percentage of Bond Apatite?

The overall structure of Bond Apatite® is composed of microporosity (1-10μm) and macroporosity (50-500μm). The initial surface porosity is about 40 percent; however, since calcium sulfate completely degrades over time, it creates more space for the new bone to be formed.

What are the indications for using Bond Apatite®?

Bond Apatite® can be used in a wide variety of osseous defects, including medium- and large-size defects such as dehiscence, fenestration cases, lateral augmentations (horizontal crest widening), sinus augmentation procedures, periodontal bone defects, filling of bony defects pre-implant placement or simultaneously with implant placement, filling a cavity post-cyst removal, ridge augmentations, bone splits, etc.

Are there are any additives, accelerators, or polymers within the biphasic calcium sulfate matrix of Bond Apatite®?

The cement matrix within Bond Apatite® is made of pure calcium sulfate as a biphasic formulation. No additives, polymers, or other chemicals are added, so the chemical structure of calcium sulfate remains unchanged. The ability of the biphasic formulation to be moldable and to harden instantly in the presence of blood or saliva is due to the fact that the particles within the cement are partially crystallized and still maintain the ability to adhere to set and harden. In this way, the cement is much more stable and has predictable bioactivity.

What is the ratio of biphasic calcium sulfate to HA?

Bond Apatite® is a composite graft made up of 2/3 biphasic calcium sulfate cement matrices and 1/3 hydroxyapatite granules in different sizes and shapes.

What is Bond Apatite®?

Bond Apatite® is a composite graft, made of biphasic calcium sulfate (3D Bond™) matrix mixed  with HA granules in a controlled particle size distribution, intended to fill or augment a vast diversity of osseous defects.

If primary closure in a case of missing buccal plate defect could not be obtained, can collagen membrane be used?

Using a membrane is not recommend. Perform augmentation, close the flap and suture. If the graft is exposed more than 3mm, secure a collagen sponge on top as shown in the protocols.

Are membranes recommended in edentulous ridge augmentation cases?

No membrane is required with Augma bond cement. However, extra caution is needed to minimize removable prosthesis impingment on the grafted area. Contact on to the graft with the removable appliance will significantly reduce bone volume. Consider over building graft, and minimizing flage/prosthesis contact

Can the use of a membrane interfere with the initial neovascularization and neo-osteogenesis during the first post-surgical days?

The use of membranes inhibits soft tissue proliferation above the bone cement. It blocks the periosteum and impairs its osteoprogenerativity. In addition, if membranes are used, traditional bone augmentation rules such as tension-free flaps, and primary closure must be followed.

Can membranes be used with biphasic calcium sulfate?

With Augma bone graft cement, there is no need for membranes. The cement can set and harden in situ. As such, it acts as a graft and a barrier at the same time. The exceptional biocompatibility and bacteriostatic nature of calcium sulfate provide a synergic matrix for soft tissue to proliferate safely and rapidly. Hence, invasive surgery is not needed to gain a tension-free flap, nor for primary closure, which is not mandatory. Placing a membrane above the material delays the healing and forces traditional invasive surgical protocols to be performed, and thus, also exposes the patient to all known traditional complications.

Can Augma bone graft cement be used at sinus floor augmentation when the residual bone is less than 2-4 mm?

Augma Bone Graft Cement can be used for lateral approach sinus lift as described in the protocols.

Continuous sutures often tend to become loose. What alternative can be used?

It is recommended to add additional simple interrupted sutures.

What types of sutures are recommended?

Sutures can be resorbable or nonresorbable. If resorbable sutures are used, avoid fast resorbable sutures that resorb in less than two weeks, such as the Chromic Gut. When using nonresorbable sutures, they should be taken out 10-14 days post-op.

Is the ‘brushing technique’ recommended to release the soft tissue without vertical incisions?

This technique is not recommended.

Can soft tissue grafting be performed before bone grafting if the tissue phenotype is thin?

Soft tissue grafting can be performed in this case.

Should the flap be stretched if the MGJ is closer to the ridge, and reflection is beyond 3 millimeters?

The flap should be stretched in such case.

Can tension-free flap closure be used, or is stretching the flap with tension necessary?

With Augma bone graft cement, no horizontal releasing incision is recommended to gain a tension-free flap. The flap should be under tension during the closure. Therefore, the flap should be minimally reflected according to the protocols, while the flap closure is accomplished by stretching.

If the vertical incision is more than 3mm past the mucogingival line, is it possible to suture without engaging the muscles?

The sutures do not have any influence on muscle engagement. The flap design and the way it is reflected, together with a lack of releasing incisions, are the factors that prevent muscle engagement.

Why should sutures not be engaged with the muscles?

The flap is the part that should not be connected to the muscles; therefore, the flap is minimally reflected, as explained in the protocols. The sutures are not the issue.

Is a full periosteum release recommended to allow tension-free closure, or how much should one release?

Do not perform any periosteum-releasing incisions. The protocols for Augma bone graft cement instruct to maintain tension on the flap during the closure. In this way, the flap is minimally reflected and stretched for closure.

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