Recommended Protocols Per Procedure

Socket Grafting With Four Bony Walls

Without flap reflection

Socket Preservation Protocol Without Lifting a Flap

  1.  No need to raise a flap.
  2.  Extract the tooth and prepare the socket for grafting.
  3.  Eject the cement into the socket.
  4.  Press firmly over the cement for 3 seconds using dry sterile unfolded gauze and finger pressure followed by another 3 second press with a peritoneal elevator. Do not use an instrument to push the cement into the apex. 
  5. 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.
Socket Grafting With Flap Reflection (Buccal Plate Missing)

Augmentation Protocol When Buccal Wall is Missing

  1. Before Flap reflection perform mesial oblique vertical incision (up to 2 mm into the mobile mucosa).
  2.  Raise full thickness flap, minimally as needed to expose the entire defect (Do not perform any manipulation to get tension free flap. No horizontal dissection release cuts, and no brushing. the flap should be with tension during closure and not tension free).
  3. Extract the tooth and prepare the site for grafting.
  4. Cement application
    • Eject the cement into the site.
    • Place dry sterile gauze and press firmly for 3 seconds on the buccal and occlusal aspects.
    • Press again on top of the gauze using a periosteal elevator in order to compact and compress the cement well.
  5. Reposition the flap for maximal closure by stretching it directly above the cement (exposure of 2-3 mm is fine, but not more than that).
Lateral Augmentation/Crest & Ridge Widening

Lateral Augmentation/Crest & Ridge Widening

  1. Raise a flap
    • The flap should be minimally reflected in order to expose the entire grafted site (Only one vertical cut should be performed no more than 2-3 mm into the mobile mucosa). Do not perform any horizontal periosteal dissection for release.
  2.  Prepare the site for grafting
  3.  Cement application
    • Apply the cement and press firmly for 3 seconds to adapt to the defect using sterile dry gauze.
    • If needed, apply an additional layer to obtain the desired volume (slightly overfill).
    • Press firmly with the dry sterile gauze for 3 seconds after each layer.
    • Press again with a periosteal elevator in order to compact and compress the cement well.
  4. Flap Closure
    • Reposition the flap by stretching it directly above the cement for maximal closure (up to 2-3 mm of graft exposure is fine but not more than that).
    • Suture first the mesial corner, then distal, in between, and lastly the vertical aspect. 
Sinus Lift - Lateral Window Approach

Sinus Lift – Lateral Window Approach

  1. Activate the syringe and wait 1 minute before application.
  2. Eject the cement into the sinus cavity through the sinus lateral window until 2/3 of the sinus is filled (During cement dispersion in the sinus cavity, if needed tap gently above the material with a sterile dry gauze to absorb the excess of fluid and blood).
  3.  For filling the last 1/3 and closing the sinus window. After activation of the cement (Do not wait 1 minute, eject it immediately into the site, place sterile dry gauze, press firmly for 3 seconds, and close the flap.
Sinus Lift - Intra Crestal Approach

Sinus Lift – Intra Crestal Approach

  1. Activate the syringe.
  2. After activation, eject the material into a dish and let it set for 3 minutes.
  3. Use the syringe as a carrier (Any other bone carriers can be used as well).
Radiographic Appearance

Biphasic Calcium Sulfate Radiographic Appearance

Due to the replacement of the cement into the patients own bone, the Radiographic appearance will vary during the healing period.

Biphasic Calcium Sulfate Radiographic Appearance
Biphasic Calcium Sulfate Radiographic Appearance
  • During graft placement – Radiopaque
  • 2-3 weeks post op – Radiolucent
  • 12 weeks post op – Radiopaque

Day one before graft placement

3 months post op

7 months post op