In the following case, the implant has failed and there is no option but to remove it. On an ailing implant, once the implant is detoxified and the defect is grafted Bond Apatite can be used as a final graft layer/membrane. This will allow a more conservative flap reflection, and a quicker conclusion to the procedure. The bond apatite should not be used as the sole graft material against detoxified implant threads, since complete implant sterility cannot be guaranteed and thus results will be unpredictable.
When working with Augmabio bone cements the Key factor is keeping the workflow as simple as we recommend.
Socket Preservation Tip
There are two options when performing socket preservation :
1- Without reflecting a flap when there are four bony walls – the clinician can use a collagen sponge to protect the graft.
2- With a flap reflection when there are four bony walls or less
(this can also be implemented when the buccal plate is missing) –
a. Extract the tooth and remove all granulomatous tissue.
b. Create a short mesial vertical incision 1 mm into the non-keratinized (mobile) mucosa (Take notice of vital anatomical structures), and reflect the flap partially until the defect is exposed.
c. Apply the cement into the socket from its syringe, place a dry STERILE gauze and press above, thereafter press firmly for 3 seconds.
d. Hold the flap, with tissue forceps, in its mesial crestal (Superior) corner and stretch/mobilize the flap to close the crestal gap by placing your first suture into the lingual aspect of the socket. Make a distal suture trying to approximate the buccal flap into the lingual aspect.
Thereafter, in the middle between the mesial and the distal suture to close the border of the flap. The middle suture, however, should be loose.
Please remember that crestal primary closure is not mandatory at the crest. 1-2mm opening is ok. However, the flap has to be properly secured on its mesial and distal aspects.
Working with Augma Biomaterial’s biphasic calcium sulfate cement
(3D Bond and Bone Apatite):
Socket grafting with 4 bony walls
• No need to raise a flap
• Eject the cement into the socket.
• Press firmly over the cement for 3 seconds using dry sterile gauze
and finger pressure. Do not use an instrument to push and
compact the cement into the bottom of the socket.
• If the interdental space is too narrow to accommodate direct finger
pressure on the sterile gauze, then a mirror handle or similar
instrument can be applied to the top of the gauze.
• Protect the cement by covering it with a collagen sponge and
secure the sponge in place to the surrounding soft tissue by an
initial suture thereafter with a cross stitch above – During the
initial stage of healing the cement should not be left exposed.
During immediate implant placement when 4 bony walls socket exists do not use an instrument to push down the cement between the socket walls and the implant
Eject the cement above –press firmly with dry gauze pad above for 3 seconds and close the flap with a moderate tension
In cases after flap reflection, it should be slightly and minimally released.
The release cut should be at the base of the flap and minimal as possible, so during the closure itself, the flap should be placed directly above the graft without using any membrane while there should be maximal closure with moderate tension. (shouldn’t be tension free as we are used to with granules and membranes).
It will provide less pain to the patient, less swallowing, stability to the graft during healing and higher predictability.
Exposure of maximum 1-3mm is not an issue. The soft tissue will proliferate rapidly above the cement and bridge the gap. Do not leave it exposed more than this as you may lose volume.