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This depends on the case. In cases of socket grafting, when Augma bone graft cement is used, three months are usually sufficient; in lateral augmentation, 4-5 months is recommended.
Augma Bone Graft Cement is an excellent and effective way to enlarge the bony width around the implants.
The graft volume is optimum at 3-4 months, but the regenerated bone is immature and is still undergoing mineralization. Waiting longer to place an implant will result in regenerated volume reduction.
Cover the socket and the implant and overfill (1-2 mm).
There are no specific torque indications. Use the same torque as with native bone according to the bone type.
Augma Bone cement is a bone regenerative material. Thus, if an implant is placed in an osteotomy, with a bony defect or gap within the bony frame, Bond Apatite bone graft cement can be placed to augment and regenerate the bone around the implant.
It is not easy to convince the patient to go for three months without teeth, but this is the best option to achieve bone growth. In some cases, if 2-3 temporary narrow implants can be placed in the anterior part and loaded immediately, this can provide the patient with a fixed temporary partial bridge in the anterior zone. Patients accept this more readily than no teeth at all. If this option is not feasible; however, the patient should be supported in managing the entire healing period without teeth, as any removable denture risks the outcome. In general, noncontact and lack of movement on or of the grafted site is of paramount importance no matter what graft material is used. It is up to the clinician to have a conversation with their patient and guide them during the healing process and oral maintenance following a GBR procedure. Some options to consider are tooth, or provisional implants supported fixed partial (or complete) dentures ( without soft tissue contact and support). For optimum success, NO PROSTHESIS is the recommended approach.
The key to any successful graft procedure ( irrespective of material or method used) is stability during the healing period. Using removable prosthetic appliances, and especially appliances with direct contact of the tissue overlaying the graft site, will cause disruption of proper osteogenesis. In the case of Bond Apatite, any movement and pressure of the appliance on the graft site will disturb the compacted cement matrix and will result in diminished graft volume.
Yes, make sure to respect osseodensification protocols and bone cement protocols. Osseodensification best used on available medullary bone. Particulate graft does not predictably covert to the medullary bone in 3-6 months period. Thus osseodensification of a grafted site (especially xenografts) could be counterproductive. Augma bone cement completely disappears after 3-6 months and is replaced with the patient’s own bone, thus permitting osseodensification.
The key to working with Augma bone cement is the attainment of a compact cohesive cement matrix prior to suturing. Thus, if the cement breaks when compacting, simply place a dry sterile gauze above, press firmly for one second, and continue.
There is no need for PRF. Soft tissue healing is optimal due to the characteristics of the material and its high ability to promote angiogenesis. Use of PRF as a membrane over exposed augma bone graft cement may not provide an adequate barrier to prevent material wash out. Using PRF to mix in with Augma bone graft cement interferes with proper bone graft cement matrix formation and detracts from bone regeneration results.
There is no need, as Augma bone graft cement is a bioactive material that dissolves and facilitates the formation of a new bone. In case a clinician insists on creating a composite graft with autogenous particles, it can be done only with 3D Bone (according to the specific protocol).
It is not recommended to mix autogenous particulate with Bone Apatite, which is already a pre-made composite graft. Please note that the key to success with Augma Bond Apatite bone graft cement is the cohesive biphasic calcium sulfate matrix that is formed when the cement is activated placed and pressed in to place. The continuity of the matrix is of paramount importance. The introduction of other and unrelated particulate matter interfere with matrix formation and the bone regeneration potential of Augma bone graft cement.
There is no need to mix Bond Apatite® with other grafts since it is a pre-made composite graft. If one chooses to make their own made cocktail, 1cc 3D Bond can be mixed with any particles of other grafts according to the mixing protocol.
The key to success with Augma Bond Apatite bone graft is the cohesive biphasic calcium sulfate matrix that is formed when the cement is activated placed and pressed in to place. The continuity of the matrix is of paramount importance. Introduction of other and unrelated particulate matter interfere with matrix formation and the bone regeneration potential of Augma bone graft cement.
No direct socket drilling is recommended. Augma Bone Graft Cement is bioactive and pulls in resources from the surrounding circulation, which usually exists in the socket walls.
Decortication prior to placing Augma Bone Graft Cement is recommended in cases where there is a thick cortical plate. The decortication osteotomies should penetrate the entire cortex to reach the medullary bone.