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Regeneration \ Repair
Core of BCS Bondbone® Core of unresorbable granules augmentation material
BB as a composite
Regeneration /Repair
Core of BCS Bondbone® Core of unresorbable granules
augmentation material
BB as a composite
necessity Desire and
determination realization
Calcium Sulfate (CS) Alderman, 1969;
Bahn, 1966;
Bell, 1964;
Coetzee, 1980;
Edberg, 1930;
Gitelis et al., 2001;
Kelly et al., 2001;
Peltier and co-worker, 1957;
Peltier and Lillo, 1957;
Peltier and Orn, 1958;
Peltier and Speer, 1981;
Peltier et al., 1957;
Peltier, 1959;
Peltier, 1961;
Robinson et al., 1999;
Silveira et al., 2008;
Tay et al., 1999;
First used in 1892 by Dreesmann
Self reinforced
Biocompatible
Cementable material
Biodegradable (totally replaced by bone)
Promotes bone formation
Compatible with other augmentation materials, medicaments, Growth factors, antibiotics, etc
Haemostatic
Bacteriostatic
Complete wound closure during surgery is not required (epithelial can grow over it)
Abundant and not expensive material
Throughout the years it has been found to be non-toxic, non-irritating, highly biocompatible and osteoconductive, inexpensive, available and easy to use (Coetzee, 1980; Gitelis et al., 2001; Kelly et al., 2001).
Lack of significant host response post implantation is an important characteristic of calcium sulfate (Alderman, 1969; Bahn, 1966; Bell, 1964; Peltier, 1959; Peltier, 1961; Peltier and Orn, 1958)
Histologic studies of the use of calcium sulfate in animals, mainly in dogs and in rabbits, have shown that the trabecular bone, filling surgically created bone defects, was qualitatively similar to that seen with autogenous bone graft.
The resorption profile of calcium sulfate matches the rate at which the host environment can lay down bone around the implant (Bahn, 1966; Tay et al., 1999). (Silveira et al., 2008)
In humans, calcium sulfate has been shown to be a completely resorbable promoting osteogenic activity, and stimulating bone growth in contact with bone or periosteum (Coetzee (1980), (case report with SurgiPlaster, Scarano et al., 2007), Slater et al (2008))
Ricci and co-authors (2000) reported formation of a mineralized, HA - like latticework as the calcium sulfate dissolved.
Sulfate particles bind firmly to adjacent bone, and guide new bone formation as the material resorbs (Coetzee, 1980). For every molecule of calcium sulfate resorbed, a molecule of hydroxyapatite may be deposited in its place.
Calcium sulfate is radiopaque, thus allowing for the monitoring of their resorption following implantation by X-ray technique in the clinical setting.
One of the major concerns regarding calcium sulfate is
related to its fast resorption.
Ricci (2001) assumed that it is very likely that improper use
of calcium sulfate or of inconsistent material have
resulted in failed attempts to use this material as bone filler
Calcium sulfate hemihydrate is not suitable for the
treatment of large cavities due to several reasons:
Its expansion properties during
setting, which may cause pain to the
patients
Its low mechanical
integrity, and setting under
blood and saliva.
its high dissolution rate and fast
resorption by the human bone
Calcium sulfate dihydrate has acceptable expansion
properties. However, its use in repairing bone defects is
limited since it has no cementitious properties.
Bond BoneTM is a novel self reinforced bone augmentation material , made from highly pure biphasic medical grade calcium sulfate .
Advantages:
• Extremely biocompatible
Cementable self reinforced &Moldable
Compatible with other augmentation material s ,grows factor ,
medicaments .
Fast and efficient setting under blood and saliva (2-5
min)
Bioactive, Haemostatic, Bacteriostatic
High crystalline percentage
Biodegradable (Resorbtion rate equivalent to bone growth 4-10
weeks)
Average reaction temperature 30°C
pH neutral
Abundant and not expensive
Biphasic calcium sulfate
By itself - Graft material Graft binder / extender –
Composite graft Barrier in guided tissue
regeneration - Membrane Delivery vehicle for growth
factors and drugs
Seed
Particle
Bi- phasic calcium sulfate
10
46%
porosity
Micro Pores
1-50 μm
Macro pores
300 - 800 μm
Bi- phasic C.S post setting
Bioactivity and biocompatibility of calcium sulfate
SEM of a human primary osteoblastic cell over calcium sulfate after a 30-min incubation. The presence of a contractile ring and the process of cytokinesis are signs of a cell in a late stage of mitosis x4000 [3]
It is not just a filler
Orsini, G., et al., Bone-defect healing with calcium-sulfate particles and cement: an
experimental study in rabbit. J Biomed Mater Res B Appl Biomater, 2004. 68(2): p.
199-208
100% Regeneration
Socket preservation
3 month post op
Using BB as excellent haemostatic
Bleeding is stopped instantly after BB application
After 3 months
Reenter after 3 months
• In the periodontal literature there are case reports of intra bony defects treated with calcium sulfate or composite grafts.
• Paolantonio et al. (2008) reported that there were no significant differences between collagen membrane and calcium sulfate treatments.
• Both treatments had significantly greater PD reduction and CAL(clinical attachment level ) and DBL(defect bone level ) gain compared to the OFD
Paolantonio M, Perinetti G, Dolci M, Perfetti G, Tetè S, Sammartino G, Femminella B, Graziani F. Surgical treatment of periodontal intrabony defects with calcium sulfate implant and barrier versus collagen barrier or open flap debridement alone: a 12-month randomized controlled clinical trial. J Periodontol. 2008 ; 79(10):1886-93.
Endo-perio lesion
1y post-op
A case from periodontal department Hadassah Jerusalem.
Dr. Moshik Tandelich, Dr. Keren Anavi
Histology by prof. Lior shapira & prof. Piattelli.
Histology Dr. Martin Nemec D.M.D (Germany)
Composite Graft : magnification 40
Composite Graft : magnification
100 400
Bio-oss®
Bondbone®
Bondbone®
Bio-oss®
Composite Graft : magnification 2000 and 4000
Clinical cases
Bone cyst augmentation using Bondbone®+bio-oss®
After surgery
Surgery preformed by Dr. Martin Nemec D.M.D (Germany)
Core harvesting for histology evaluation and implant placement
Surgery preformed by Dr. Martin Nemec D.M.D (Germany )
Histology of composite graft using Bondbone®+Bio-oss® one year post
operation
Histology Dr. Martin Nemec D.M.D (Germany)
Extraction and augmentation procedure
Epithelial healing and wound closure
AFTER ONE WEEK
AFTER 3 WEEKS
AFTER 3 MONTHs
Before & after
Using Bond Bone™ as a composite graft
7 days post op 12 weeks post op
Suture removal one week p.o
12 weeks p.o
Using BB as excellent haemostatic and augmentation material
After 3 months
Using BB in a sandwich technique
• Scarano et al. (2007) evaluated the tissues in a peri-implant site regenerated with calcium sulfate.
• In light microscopy histology , trabecular bone was present with no remnants of calcium sulfate.
• Transmission electron microscopy showed, in the areas of the interface with the implant surface, mature bone with many osteocytes.
• On the metal surface an amorphous layer of osteoid was found.
Scarano A, Orsini G, Pecora G, Iezzi G, Perrotti V, Piattelli A. Peri-implant bone regeneration with calcium sulfate: a light and transmission electron microscopy case report. Implant Dent. 2007 J;16(2):195-203.
3 month post op
After 3 months
Dr.Guido Esquivel Panama
1week post op 12 weeks post op
At the surgery day
One day post op 16 days post op
12 weeks post op
BB composite graft application
Perio patch application
6 days post op Sutures removal ,(despite very poor oral hygiene , favorable healing can be seen )
8 weeks post op 8 weeks post op
Bone reconstruction post peri implantitis
60 days post op ptp removal 30 days post ptp removal
At day 1 3 months post op
Day 1 60 days post op