Recommended Protocols / Tips for working with Augma Biomaterial’s biphasic calcium sulfate cement (3D Bond™ and Bone Apatite®)• Socket grafting with 4 bony walls (Can be two ways) Option 1: without flap reflection

1.No need to raise a flap

2.Extract the toothandpreparethesocketforgrafting.

3.Eject the cementintothesocket.

4.Press firmly overthecementfor3secondsusingdrysterilegauzeandfingerpressure. Do not use an instrument topushandcompactthecementintothebottomofthesocket. (Iftheinterdentalspaceistoonarrowtoaccommodatedirectfingerpressureonthesterile

gauze,thenamirrorhandleorsimilarinstrumentcanbeappliedontopofthegauze).

5.Protect the cementbycoveringitwithacollagen spongeandsecure thespongeinplace tothesurroundingsofttissuebyaninitialsuturethereafterwithacrossstitchabove.During the initial stage of healing, the cement should not be left exposed.

Option 2 - with flap reflection Usethesameprotocolassuggestedbelowforsocketswithmissingbuccalplate.

• Socket grafting (single or multiple extractions) when the buccal plate is missing and the bony walls frame exists 1. BeforeFlapreflectionperformshortmesialobliqueverticalincision(upto2mmintothe mobilemucosa).

2.Raise full thickness flap, minimally as needed to expose the entire defect – (Donot preformanymanipulationtogettensionfreeflap.Nohorizontaldissectionreleasecuts,andno brushing.theflapshouldbewithtensionduringclosureandnottensionfree).

3.Extract the tooth and prepare the site for grafting

4.Cement application • ejectthecementintothesite

• placedrysterilegauzeandpressfirmlyfor3secondsonthebuccalandocclusalaspects.

5.Reposition the flap for maximal closurebystretchingitdirectlyabovethecement (exposureof2-3mmisfine,butnomorethanthat).

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Recommended Protocols /Tips by the expert:

Dr. Amos Yahav, DMD

• Sinus lift Protocol Sinus Lift - Lateral window approach protocol 1. Activatethesyringeandwait1minutebeforeapplication.

2. Ejectthecementintothesinuscavitythroughthesinus lateralwindowuntil2/3ofthesinusisfilled(Duringcement dispersioninthesinuscavity,ifneededtapgentlyabove thematerialwithasteriledrygauzetoabsorbexcessof fluidandblood).

3. Forfillingthelast1/3andclosingthesinuswindow. Afteractivationofthecement(Donotwait1minute,eject itimmediatelyintothesite,placesteriledrygauze,press firmlyfor3seconds,andclosetheflap.

Sinus Lift - Intra crestal approach protocol 1. Activatethesyringe. 2. Afteractivation,ejectthematerialintoadishandletitset for3minutes. 3. Usethesyringeasacarrier(Anyotherbonecarrierscan beusedaswell).

Biphasic CS bone cement radiographic appearance **Duetothereplacementofthecementintothepatients ownbone,theRadiographicappearancewillvaryduring thehealingperiod. • Duringgraftplacement-Radiopaque • 2-3weekspostop-Radiolucent • 12weekspostop-Radiopaque

• Defects with no bony wall frame (Lateral augmentation, ridge widening)

1.Raise a flap • Theflapshouldbeminimallyreflectedinordertoexpose theentiregraftedsite.(Theverticalcutsshouldbe 2-3mmintothemobilemucosa)Donotperformany horizontalperiostealdissectionforrelease.

2.Prepare the site for grafting

3.Cement application • Applythecementandpressfirmlyfor3secondsto adapttothedefectusingsteriledrygauze. • Ifneeded,applyadditionallayertoobtaindesired volume(slightlyoverfill). • Pressfirmlywiththedrysterilegauzefor3seconds aftereachlayer.

4.Flap Closure • Repositiontheflapbystretchingitdirectlyabovethe cementformaximalclosure(upto2-3mmofgraft exposureisfinebutnotmorethanthat).

Biphasic CS technology the foundation for complete bone regeneration

Table 1: Appropriate indications for 3D Bond™ and Bond Apatite® * Only recommended in relatively small sockets such as incisives and premolars.

3D Bond™ Bond Apatite®

Socket preservation *Simultaneous augmentation of bone defects around ImplantsBone augmentation in periodontal defectsLateral augmentation, ridge expansion, and ridge preservationSinus Lift- Lateral window approachSinus Lift Intra crestal approach Dehisence, fenestrations around teeth and/or Implants

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