What type of flap is needed, partial- or full-thickness?

A full-thickness flap is necessary.

Can the ‘tunnel technique’ work with Augma bone graft cement?

Aumga can be used with the ‘tunnel technique.’ However, make sure to compact the cement properly in place.

How long has the material has been on the market?

Calcium sulfate has been in use in medical surgery for more than 120 years—the patented biphasic calcium sulfate, since 2010. The reason Calcium Sulfate has not been used widely in dentistry is due to its inability to set in the presence of blood and saliva. Dr. Yahav has developed the formulation that allowed the material to be used intraorally.

Can Augma bone graft cement can be used for grafting of periodontal defects around teeth?

Augma Bone Graft Cement can be used in the treatment of periodontal defects. The flap reflection, graft placement, and soft tissue closure are the same as the protocols for socket grafting with flap reflection.

Can Augma be used for peri-implantitis treatment?

There is no predictable recommended protocol at the moment for peri-implantitis treatment using Augma. This includes cases with less severe mobility.

Is there a time frame in which Augma graft cement can be used in acute infection?

No augmentation should be performed until all signs, and acute symptoms have disappeared. This may take about 2-3 weeks, and sometimes even longer, after antibiotic administration and elimination of the cause. Therefore, there is no definite, exact time frame. The decision should be made at least two weeks after the recession of the acute symptoms.

Can Augma be used immediately after extractions when a patient has periapical infections?

In cases of acute infection, no augmentation should be performed until all symptoms regress. In symptomless chronic situations, augmentation can be performed after proper debridement.

Can Augma bone graft cement be placed over the top of perforation, or does the perforation need to be closed first?

When performing socket preservation, after the extraction and preparation for a future implant, a small perforation may be visible on the buccal or the base of the socket. Augma can be placed over the perforation simultaneously with the closing of the perforation.

Are tenting screws for graft stabilization recommended if the defect is large?

Augma Bone Graft Cement is self-stabilizing. No tenting screws are needed

For how long is a soft diet recommended?

A soft diet is recommended for the first 2-3 weeks post-op.

What is recommended in an upper molar extraction site without primary closure?

This type of site must be protected with a secured collagen sponge/plug or a wound dressing according to the protocols.

There are ‘white’ particles three months post-op; are these HA (hydroxyapatite)?

The particles are the large HA particles that comprise the remaining 10% of the composition of the Bond Apatite® composite graft cement. At this stage, they are in the process of resorption.

What is the reason for the discrepancy between the CBCT appearance and bone density during reentry?

A CBCT image with traditional bone grafting appears radiopaque at all times from day of placement along the course of healing, as well as during reentry, due to the fact that the graft integrates with the bone and is not replaced by it. Therefore, the radiopacity seen in CBCT reflects more the presence of the graft in the site and less the newly-formed bone in between the graft particles. In contrast, when biphasic calcium sulfate bone cement is used, complete resorption of the graft takes place, and the augmented site transforms into a new vital bone. Therefore, in 3-4 months, it is a young bone that might look less radiopaque than the surrounding native bone.

Is there a risk of development of granulation tissue after using Augma bone graft cement?

Augma Bone graft cement is inorganic matter, and thus cannot form fibrous tissue. The cement dissolves completely. If at placement Augma Bone Graft Cement is not properly activated, placed and pressed into place and into a properly prepared host site, and if there is a removable prosthesis, or a movable flap or anything else that might interfere with graft stability, then the cement matrix might not hold the space and heal by scar tissue.

What is the histological difference between Augma bone formation and classic allograft formation?

The histology slides of Augma bone graft cement present new bone with osteocytes within the bone. This fact reflects that the new bone is vital. With allografts, there is an integration of the allograft particles with the surrounding bone. However, there are no osteocytes within the integrated allograft particles, which is a confirmation that those particles are sterile sequestrum and not vital bone.

What are some common reasons for finding less than optimum results?

Please keep in mind that Augma’s bone graft cement performs as well as under performs in different ways then traditional graft materials

  • There is no conversion to scar tissue- the biphasic calcium sulfate is not biologic and cannot covert to fibrous connective tissue like allograft/autograft/Xenograft.
  • There is no infection as a result of the material - the material is inorganic and thus will not be prone to the bacterial assault like allograft/autograft particles do. In addition, it is NOT particulate like other Xenograft/Alloplasts and thus will not harbor bacteria in its porous structure to infect the site of future implants. The biphasic calcium sulfate will, however, yield less then optimum results if surgical placement protocols are not followed.
  • Removable appliances are pressing and moving over the grafted site will cause graft volume reduction or elimination.
  • The patient does not follow postoperative instructions; will cause graft volume reduction or elimination.
How long does it take Augma bone graft cement to resorb completely?

Augma Bone Graft Cement - 3D Bond™, composed of pure biphasic calcium sulfate completely resorbs in 4-10 weeks.

Bond Apatite® is a  composite graft made of biphasic calcium sulfate and HA in a specific particle size distribution, in a ratio of 2:1. This combination takes advantage of each part of its components. Calcium sulfate acts as a short-range space maintainer scaffold; it completely degrades in strict relation to bone formation rate (4-10 weeks), while the HA acts as a long term space maintainer. The amount of HA within the graft is in a relatively small proportion in a controlled particle size distribution and is intended only to slow down the overall resorption of the graft. The small and medium size of the HA particles resorbs as well in 4-6 months, while the large particles, which consist of about 10%, remain in the grafted site for a longer period. The bioactivity and the rapid graft transformation into vital bone are due to the biphasic calcium sulfate that occupied most of the grafted site. The calcium sulfate encourages angiogenesis, osteoblastic activity, enhanced calcification and is completely degraded and replaced with the patient’s own bone

Is Augma-grafted bone more vulnerable to developing peri-implantitis?

Augma Bone Graft Cement completely transforms into the patient’s bone. Therefore, it behaves like any vital natural bone and carries no increased risk of peri-implantitis.

What is the quality of the bone after five years or more?

Augma bone graft cement does not integrate with the bone. Instead, it resorbs and transforms completely and regenerates the patient’s own bone. After the bone formation, the natural biological bone remodeling process takes place continuously, while the bone continues to calcify and mature throughout the years like any living bone.

What type of bone density should one expect to see after four months?

In most cases with Augma bone graft cement, one can expect to see type 2-3 bone after four months.

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