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