F.A.Q Bond Apatite®

F.A.Q for Bond Apatite®

What is Bond Apatite®?

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

What is the ratio between the biphasic calcium sulfate and the HA?

Bond Apatite is a composite graft composed of 2/3 biphasic calcium sulfate cement matrix’s and 1/3 hydroxyapatite granules in different sizes and shapes.

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

No, the cement matrix within Bond Apatite ® is made of a pure calcium sulfate as a biphasic formulation. We did not add any additives, polymers or other chemicals, so the chemical structure of calcium sulfate was not changed at all. Its ability to be moldable and to harden instantly in the presence of blood or saliva of the biphasic formulation is due to the fact that the particles within the cement are partially crystalized and still maintain the ability to adhere and to set and harden. In that way, the cement is much more stable and has a predictable resorption behavior.

What are the indications for using Bond Apatite®?

Bond Apatite® can be used in a wide diversity of osseous defects, including medium and large size defects such as dehiscence, fenestration cases, lateral augmentations (horizontal crest widening), small or medium sizes of sinus cavities, or as lateral bone window closure in some very large sinus cavities, 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.

What is the resorption time of Bond Apatite®?

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 a short-range space maintainer scaffold. It completely degrades in strict relation to the bone formation rate (4-10 weeks), while the HA acts as a long term space maintainer. The amount of HA within the graft is a relatively small proportion (33%), and is intended only to slow down the overall resorption of the graft. The bioactivity and the graft transformation into vital bone are due to the biphasic calcium sulfate, which is 66.6% of the graft.

What is the porosity percentage of Bond Apatite?

The overall structure of Bond Apatite® has micro porous (1-10μm) and macro porous (50-500μm). The initial surface porosity percentage is about 40 percent; however, since Calcium Sulfate completely degrades over time, it creates more space for the new bone to be formed.

Should I mix the Bond Apatite with blood?

No. After placing the cement in place and pressing above for setting and hardening, you should not. The graft porosity and its hygroscopic ability will seep inside of the blood immediately

How long does it take for the Bond Apatite to harden?

The setting time is approximately 3-5 minutes.

Is it necessary to use a membrane?

Due to the cement properties, using a membrane is not needed in most of the clinical cases as long as primary soft tissue closure is achieved.

Using a membrane might be recommended in large size defects in which soft tissue stabilization cannot be ensured or in socket preservation procedure when a flap was not reflected and the material is completely exposed to the oral environment. In such cases, a protection barrier is required above the graft to prevent volume loss. (It can be a collagen sponge or a membrane that can be left exposed above the graft.)

Can I leave the Bond Apatite exposed to the oral cavity?

NO – It is not recommended to leave the material exposed. Leaving the material exposed without a protection of a physical barrier can lead to material volume loss.

Nevertheless, leaving the material exposed with a gap of 1-3 mm is not an issue as soft tissue will migrate rapidly over it and will close the gap in a few days.

What is the recommended protocol for using Bond Apatite® in socket preservation procedures?

In socket grafting procedure, eject the material from its syringe into the socket, place a dry gauze above the material, and with your finger (or a spatula if there is not enough space for your finger), press firmly for 3 seconds then remove the gauze and close the flap in cases when you did not reflect a flap. In order to prevent volume loss, you must protect the exposed graft by physical barrier such as with an inexpensive collagen sponge or a membrane. Those can be left exposed, however; any such physical barrier must be well stabilized and sutured to the proximity soft tissue until the proliferation of the soft tissue above the graft will take place.

*When 4 bony walls exist, do not use any tool to push the cement into the bottom of the socket as you are used to with granules.  Doing so might cause pain to the patient due to the cement expansion.

How Can Bond Apatite® be used for a sinus lift?

In small to medium size sinus cavities, Bond Apatite® can be used by itself. Small or medium sized sinus cavities are cases when one or two syringes of Bond Apatite® can be sufficient for the entire procedure. In such cases, eject the material from its syringe through the crest direction into the sinus cavity and then   place dry gauze above the material, place your finger above the gauze and press for 3 seconds, and then remove the gauze and close the flap. There is no need for membrane coverage. Additionally, in large sinus cavities when more than 2 cc (2 syringes) are required, it is less comfortable to work just with Bond Apatite® because you will need to work by increment; therefore, we recommend you to fill 2/3 of the sinus cavity with your preferable granular augmentation material and the final 1/3 with Bond Apatite®. It will enrich the grafted site with calcium ions and will also close the sinus window. No additional need for membrane is required.

How should I use the Bond Apatite® in lateral augmentation?

It is very simple. Reflect the flap and prepare the site, with decortication or without, prepare and release the soft tissue for final coverage. Then, after graft activation, eject it into the augmented site, place a dry gauze pad above and press for 3 seconds and close the flap. There is no need for membrane as long as your soft tissue is primary closed and well sutured.

Can Bond Apatite® be used for vertical augmentation?

Bond Apatite® can be used for vertical augmentation only if you are already familiar with the material and experienced with vertical augmentation techniques. In such cases, a well-stabilized rigid protection barrier is always required.

Should I expect a different radiographic appearance than I am used to?

Due to the graft nature, the biphasic calcium sulfate matrix within the graft is simultaneously replaced by the patient’s own bone; therefore, the radiographic appearance is completely different compared to other grafts which always appears radiopaque due to their constant presence in the grafted site.

In contrary, the radiographic appearance with Bond Apatite® is as follows:

During day one after graft placement –it appears radiopaque.

Gradually, radiolucency appearance takes place (reflecting the graft transformation into the new formed osteoid before its calcification).

2-4 weeks after graft placement, the majority of the grafted site will appear 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. That is the time when the new osteoid has already calcified.

Does the Bond Apatite remain hard during the healing period as a block?

No, the material does not remain hard. The degradation process starts immediately after its placement while new bone formation simultaneously takes place.

What is the working time with the Bond Apatite?

The working time with the material starts when the powder is mixed with saline. At this time, the material is moldable and pliable for about 3 minutes (Working time). Thus, it is important to have the lesion fully prepared prior to the activation of the material. As soon as the material is placed in the defect, it should be compressed with a dry gauze pad for 3-5 seconds and then the material will harden in-situ immediately. At this point, you should proceed with primary soft tissue closure.

Keep in mind – your augmentation procedure should be done by 3 consecutive simple steps – place –press –close

And you should keep it simple as it sounds. In less than a minute, your graft placement and stabilization can also be done in the most challenging cases.

Place the material into the grafted site, press above it with dry gauze for 3 seconds and close the flap.

(No need for membrane, as long as your soft tissue is well sutured and primary closed)

* Passing the working time will influence the pliability and moldability of the material. The material can still be used, however, not with its cementing properties.