*** The terms Ora-Aid, adhesive band, wound dressing and Augma Shield™ all refer to the same product.
What is the Augma Shield™?
The Augma Shield™ is a wound dressing, adhesive band made of polymer, which contains two layers. The outer layer is a protective layer, and the inner layer turns into an adhesive gel when it comes into contact with blood, saliva, or water. As such its adheres to the soft tissue for few hours, however in cases that we want to use the Augma Shield™ as external protector for longer duration, we should secure it in place by sutures. In such cases, the Augma Shield™ completely reabsorbs after about 10-14 days, and as long as it is secured in place it provides external protection to the wound or to the exposed Bond Apatite® graft cement. During that time complete proliferation of the soft tissue takes place and bridges the gap over the exposed Bond Apatite® without provoking any inflammatory reaction. Using the Augma Shield™ as an external physical barrier is very efficient when using Bond Apatite® graft cement. It is especially useful in cases where more than 3 mm of the cement is exposed to the oral cavity, such as in socket preservation procedures, with or without flap reflection, where the Bond Apatite® is left exposed. Securing the Augma Shield™ above the graft will prevent the loss of material during the first stage of healing and until soft tissue proliferation take place. We recommend viewing our Augma Shield™ Webinar for more information on how to use the Augma Shield™.
What product can be used with the Augma bone in USA?
We recommend on using a Collagen plug. You can find on our U.S. website the Matrix Derm Collagen Plug for direct purchase. We welcome you to watch the working protocol in our Socket Grafting webinar.
What is the shelf life of the product?
Shelf life is 2 years for Bond Apatite®, 3 years for Augma Shield™.
Was this procedure only for socket protection, and do we need to use an autograft or allograft with this?
There is no need to mix Bond Apatite® with any other materials such as allograft, xenograft, autograft or others. Unlike allograft or xenograft, which integrate with the bone, Bond Apatite® is a premade composite graft which transforms completely into the patient’s own bone. Bond Apatite® is composed of two thirds Biphasic Calcium Sulfate, and one third Hydroxyapatite (HA). The HA is composed of different sized particles. Histological evaluation reveal that eight months after surgery, 97% of the graft has become the patient’s own bone. When we place Bond Apatite® the Biphasic Calcium Sulfate releases calcium ions that incorporate with the phosphate ions in the area to form the HA, calcium phosphate matrix of the newly formed bone. Therefore, the material is considered a bioactive graft material as it takes an active part in bone formation.
How come you do not follow the principles of GBR? If there is no barrier, and if the buccal plate is missing, how do you avoid epithelial connective tissue invasion?
With bone cements, all the principles are completely opposite to traditional grafting. This is why it is very important to follow the protocols for good predictability.
What is your recommended barrier if the Augma Shield™ is not available?
When the Augma Shield™ is unavailable, the easiest and most recommended barrier is a simple collagen sponge or collagen plug. We offer a webinar on our website about socket grafting with Bond Apatite®, in which we show clearly how to use a collagen plug or sponge as an external barrier above the Augma bone cements.
In this case, with no buccal plate, don’t you need a membrane to prevent soft tissue ingrowth and loss of the cement?
Actually, no. Augma bone cements are completely different than everything we’ve known until now. Since it works differently the performance, the rules and the protocols are completely different. For anyone having their first encounter with bone cements, I highly recommend first taking our online course, where we explain everything step by step. Due to the cohesive matrix that bone cements provide, and the outstanding synergy between Biphasic Calcium Sulfate and soft tissue, the soft tissue is able to proliferate above the graft.
How much material is needed for the average single root socket?
This depends on the tooth. For molars we normally use about 1 cc, and for premolars 0.5 cc will usually be enough. Sometimes we do a few sockets together, and for that we can use the same syringe. In cases of sockets with four boney walls, it is sufficient to place the material on the cervical part of the sockets (no need to push it down to the apex zone ). Then we take a gauze, place above and press strongly with a finger on top of the gauze for 3 seconds. Then we use a periosteal elevator to apply additional compaction for a few seconds on the gauze, instead of with our finger. The material must be well compacted, at least in the cervical zone.
In cases where we do not have a buccal plate, we recommend reflecting a minimal flap according to the protocols, in order to see and clean the site properly. We then place the material on the buccal deficiency, and afterwards on the occlusal part. We then press and compact the material firmly first from the buccal aspect, and then from the occlusal part. After using a finger to compact the material, we do it again with a periosteal elevator in the same manner. When we have four boney walls it’s not important for the material to reach down to the apex of the socket. However, when we have a missing buccal plate, we need to fill the entire socket and compact the entire area in order to get the best results.
Sometimes my patients feel lots of pain about day 3 from a socket graft. I have been using the Matrix Derm collagen plug and silk sutures or PGA sutures. I suture tight. Is it because the collagen plug is too tight on the material?
The reason for 3-day post-operative pains might be in cases when the material is not well compacted at the cervical zone. Therefore, immediately after the application we press it strongly with an unfolded gauze, with the finger for 3 seconds, and then with a periosteal elevator on a gauze, for additional compaction of 3-4 seconds.
In essence, right after injecting the material it should be pressed in the cervical zone. There is no need to push it through the apex if there are 4 bony walls.
Can we use bone cements for the tunneling technique?
The answer is yes, but you must make sure that after injecting the material into the tunnel you place a dry gauze on it, and use an instrument on a gauze for compacting the material within the tunnel. Then add another layer, compact again, and continue until the site is filled. It is important to make sure the material is well compacted inside.
Can the patient wear any temporary removeable prosthesis, or will it crush the graft?
Bone needs two things to grow, space maintaining and graft stability. Therefore, any movement could jeopardize the outcome due to a lack of graft stability. I do not recommend using any kind of removeable prosthesis.
If you feel you need additional augmentation when would you go back in?
I normally go back in after 2.5 or 3 months, after everything has healed. If I need additional augmentation, it’s very simple. I inject another syringe and that’s it.
Would there ever be a need for osseodensification and Versah drills?
As far as we know, there are many dentists who combine the two techniques with a high satisfaction rate. One of them is our Bone Cement Expert – Dr. Michael Katzap.
I have some available cytoplastic membranes from months back. Can I overlay a cytoplastic membrane in much the same way until I can get the oral aid material?
You can use the cytoplastic membrane. However, the collagen sponges are also a viable option and will cost you much less. Either way, make sure to secure it and to place it above the soft tissue and not undermine it. One should use it as a barrier, not a membrane.
Can we use the Augma Shield™ in the case of perforation of the sinus membrane?
No, absolutely not. The Augma Shield™ is not a membrane, it’s just an external protector.
Can PRP be used with Augma?
With traditional grafts, clinicians use PRP and PRF to improve soft and hard tissue healing, however with Biphasic Calcium Sulfate bone cements there is absolutely no need. You can have stunning results without using anything else. If anyone is curious, he can always do a trial by using PRP or PRF in one segment of the mouth and do another segment with only bone cements. You will see that you get fantastic results only using bone cements.
Is Augma looking at a smaller syringe system that could be placed deeper into the sockets and used on smaller tooth applications more easily. Seems like this could allow more consistent adaptation to the cervical region.
There is no major significance if the material reaches all the way to the bottom. However, with this opportunity we are happy to announce we are working on such development. Stay tuned for more updates!