Biphasic Calcium Sulfate as an Alternative Grafting Material in Various Dental Applications
Various grafting materials have been used in oral and periodontal surgeries to augment and rebuild bone intraorally. Calcium sulfate, a synthetic material, also known as an alloplast, has been used for decades in orthopedics, plastic surgery, and oncologic and maxillofacial surgeries for the treatment of osseous deficiencies caused by trauma or inflammation. Biphasic calcium sulfate provides benefits as a short-term space maintainer. Use of biphasic calcium sulfate as the sole material are limited to relatively small osseous defects surrounded by at least 3 bony walls (eg, extraction sockets). Thus, for augmenting large and more complex bone deficiencies Bond Apatite, a composite graft formulation, is indicated. This work will review the various clinical applications of Bond Apatite as an alternative to other graft materials.
Figure 1. Following extraction, an oblique vertical releasing incision is made at the mesial aspect and a full thickness flap elevated. Figure 2. The papilla is sutured in a tension manner by stretching the flap to place for closure. Figure 3. The crestal aspect of the flap is closed with maximum closure in a tension manner. Figure 4. The socket is filled with Bond Apatite following extraction of the tooth. Figure 5 A suture is placed through the collagen sponge prior to placement intraorally in order to secure the sponge in place. Figure 6. Sutures are placed within and over the collagen sponge covering the large area of exposed Bond Apatite.
Figure 7 . Following a full thickness flap, elevation bleeding points are created in the buccal lateral aspect of the ridge. Figure 8. Bond Apatite is placed over the area to be grafted to widen the ridge. Figure 9. The flap is stretched for closure and secured with sutures in a tension manner to gain maximal closure (3 mm graft exposure is acceptable). Figure 10. After being reloaded into the syringe, Bond Apatite is introduced via the syringe into the site receiving the crestal sinus elevation. Figure 11. An osteotome is utilized to place the Bond Apatite superiorly into the elevated sinus area. Figure 12. Conventional window created for lateral sinus elevation.
Figure 13. Following mixing of the Bond Apatite it is allowed to sit in the syringe for 1 minute before applying into the sinus. Figure 14. The Bond Apatite is applied into the sinus via the syringe. Figure 15. The sinus is filled with Bone Apatite to be level with the exterior lateral osseous surface.
Figure 16. Large defect with missing buccal wall following extraction of the tooth 30 (a) and socket filled with Bond Apatite prior to flap closure (b). Figure 17. Following 3 months of healing a cone beam computerized tomography was taken to verify osseous fill of the socket (a), the site was flapped and bone was noted filling the grafted socket (b), and a trephine core sample of healed bone was taken for histological analysis (c). Figure 18. Histology of the core sample taken at the 3 months healed site demonstrating new bone (NB), residual scaffold (RS) particles of Bond Apatite, and connective tissue surrounding the graft particles (CT) at ×4 (a), ×10 (b), and ×20 (c) magnification.
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