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F.A.Q. 3D Bond™

F.A.Q. for 3D Bond™

What is 3D Bond™ and why should I work with it?

3D Bond™ is a cementable, osteoconductive bone substitute, made of pure Biphasic Calcium Sulfate; the only one of its kind that can set in the presence of blood and saliva. The material is completely resorbed within 4-10 weeks, coinciding with the time period it takes for bone to form. The outcome is a complete replacement of the graft with the patient’s own bone.

The medical use of Calcium Sulfate has the longest history in the augmentation field, with over 120 years of use in the areas of Orthopedics, Plastics, Oncology and Maxillofacial medicine. This material has been studied and documented most extensively and is the only one that is associated with thousands of articles in various areas of medical literature.
Throughout the years there has been a constant insistence on working with Calcium Sulfate due to its extraordinary features that distinguish it from currently existing augmentation materials. Notwithstanding, the material in its basic form has two prominent drawbacks; namely, its inability to harden as cement in the presence of blood and saliva existing in the oral environment, and the materials fast resorption rate.

The development of 3D Bond™ originated from a clear clinical need to simplify the complexity of today’s augmentation procedures, shorten the working time as well as the recovery time. The development of this material was a process of over 15 years of intensive research, focusing on the use of the pure raw material without any additives or accelerators. The outcome is a superior bone graft material that has the ability to set instantly in the presence of blood and saliva.

What is biphasic calcium sulfate and why is it different from the old known calcium sulfate?

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 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 contact with blood or saliva; therefore, it could not be easily used as a suitable cement in the maxillofacial field.

What are the indications for using 3D Bond™?

The 3D Bond™ can be used in three ways:

  1. On its own for filling osseous lesions.
  2. As a binder mixed with other granular augmentation materials, enhancing graft stability
  3. 3. As a membrane over other augmentation materials.

Notwithstanding, it is important to remember that 3D Bond™ is a short range space maintainer, so use on its own is restricted to relatively smalls lesions surrounded by at least 3 bony walls of support, such as socket preservation from first-central up to second premolar, or a molar with septum present. For larger defects, 3D Bond™ can be mixed with longer range space maintaining granules, creating a cementable composite graft suitable for a wide range of defects.

Is it possible to combine the 3D Bond™ with other bone substitutes?

Certainly. Combining 3D Bond™ with various granular bone substitutes enhances the overall quality of the graft and creates a composite cementable mixture. The granule type can be selected according to the clinician’s preference.

Nonetheless, for larger lesions that require the use of a long lasting space maintainer, it is recommended that the additional bone substitute chosen can address this requirement.

How long does it take for the material to harden?

The initial setting time is approximately 3-5 minutes.

It is possible to extend the setting time by using a previously cooled saline liquid, although in our experience this is unnecessary.

Is it possible to use 3D Bond™ as a membrane?

Most certainly.

What am I supposed to see in an x-ray while working with 3D Bond™?

When 3D Bond™ is used on its own, the material is completely resorbed and replaced by the patient’s own bone, which is apparent while viewing an x-ray.

Approximately a week post-operation, a radiolucent shading in the circumference can be noticed in an x-ray. This shading will expand up to the forth week when the entire area will be completely radiolucent. It seems as though the material has completely disappeared, but this is not the case. This is the un-calcified osteoid. Gradually, calcification of the area will take place, so that up to three months after implantation, the entire area will be radiopaque in the x-ray, with an identical appearance to the adjacent native trabecular bone.

What are the risks of using the material?

Calcium sulfate is the most documented material for bone grafting in history, with over 120 years of literature behind it, and its safety has been proven beyond any doubt. Nevertheless, the clinician should review the User Manual in order to have the best performance.

Is there a learning curve for the use of 3D Bond™, and what should I be meticulous about?

Certainly, there is a learning curve, but it is a short one. One should be meticulous about reading the User Manual or demanding training. The material is cement, which is a different concept than working with conventional granules, and we must take a different approach when working with it. We must respect the working time, setting time, and the viscosity of the cement.

Should 3D Bond™ be mixed with blood?

No, 3D Bond™ should not be mixed with blood. The material is extremely hydrophilic, and when it sets, blood immediately begins penetrating its unique pore structure.

Should the lesion’s area be dried before placing the 3D Bond™?

Absolutely not. The 3D Bond™ is able to properly harden in this environment, as long as one works according to the rules specified in the User Manual.

Is it possible to place 3D Bond™ layers one upon the other for larger lesions?

Definitely, yes. You would place one layer, press above with dry gauze, and place the second layer, and third accordingly in the same manner.

Is it necessary to use a membrane?

In small to medium size defects, there is no need to use a membrane, as long as good primary closure and a good suturing technique are used. However, in your first few cases using the material, we do recommend that you use a membrane until you are used to the behavior of the material.

What is the working time with the material? What is the setting time? What will happen if I pass the working/setting time, can I still use the material?

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 activating the material.

As soon as the material is placed in the defect, it should be compressed with a dry gauze pad for 2-5 seconds, and the material will harden in-situ immediately. At this point, a wet gauze pad is placed above the graft passively, with no pressure. (The patient can just close his mouth above the gauze for 2 minutes.) (Setting time)

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

How should I use the material in a socket preservation?

3D Bond™ is indicated to be used by itself for socket grafting from the first-central until second-premolar, or a molar with an existing septum. After placing the material and pressing above with dry gauze, the clinician SHOULD NOT use a tool to push the material into the apex region as is customary with granules. Condensing the cement into the apex region with a tool can lead to pain for the patient. The blood clot that develops in the apex region is optimal.

How long should I wait before implantation or loading?

Working with 3D Bond™ by itself within its range of indications, 3 months is a sufficient period of time. Working with 3D Bond™ as a composite graft mixed with granular augmentation materials, the time frame varies between 3-5 months, depending on the defect size and morphology.

Can 3D Bond™ be used on its own for sinus lift?

It is not recommended to use 3D Bond™ on its own in a sinus lift, because it is a short range space maintainer. However, it can be used to close the sinus window after filling the sinus with granules.

Is the material suitable for periodontal lesions?

Definitely, yes, however, it should not be used by itself. It should be used as a composite graft so that it will have a longer space maintaining ability.

Can we use 3D Bond™ in lateral and vertical augmentations?

In such cases, 3D Bond™ cannot be used by itself. It should be used as a composite graft with longer range space maintaining granules. However, in vertical augmentations, placement of the material is not sufficient; specific stabilization techniques and tools should be used.

When is it recommended to use 3D Bond™ on its own, and when as a composite graft?

3D Bond™, used by itself, is a short term space maintainer, which has a resorption pattern which corresponds to the bone formation rate. Hence, it can be used by itself in defects less than 10mm in width, with at least 3 bony walls of support, such as sockets from the first-central to second-premolar, and molars with a septum present.

3D Bond™ as a composite graft, mixed with granular long term space maintaining graft materials, can be used for a larger diversity of augmentation procedures.

What bone substitute is most recommended for use with 3D Bond™ for forming a composite graft?

The selection of the desired of the augmentation material is according to the clinician’s preference. However, the basic rule should be remembered that when there is a larger lesion without osseous support walls, it is better to combine 3D Bond™ with a bone substitute that has a long range resorption pattern. Use of materials with fast resoprtion will result in loss of volume during the healing process.

If I use bone substitutes in putty form, can I mix it with 3D Bond™?

Bone grafts in putty form should not be mixed with 3D Bond™, however, 3D Bond™ can be used in this case as a rigid barrier above the putty.

Does 3D Bond™ consist of additional material that causes it to harden in the presence of blood and saliva?

No, 3D Bond™ is a pure Biphasic Calcium Sulfate without any additional material added.