Bondbone Synthetic Bone Graft: thoughts on quick resorption?

Yes, you are 100% correct. Calcium sulfate resorbs very quickly, usually in 4 to 6 weeks. For this reason, it is recommended, to mix calcium sulfate with other bone substitutes with longer resorption profiles to create a composite-type graft. This is especially the case when there is a larger lesion. The granule type that is mixed with calcium sulfate can be selected according to the clinician’s preference. Many clinicians mix calcium sulfate with allograft, and others use other synthetics like b-TCP or hydroxyapatite. With regards to b-TCP, you may want to check out the article: "Enhancing extraction socket therapy with a biphasic calcium sulfate. Horowitz RA1, Rohrer MD, Prasad HS, Tovar N, Mazor Z.Compend Contin Educ Dent. 2012 Jun;33(6):420-6, 428. Also, there is a new bone graft cement from the same company that created BondBone(or 3D Bond, the generic name). This new product is called Bond Apatite, which addresses the issues you raised with using calcium sulfate alone. Bond Apatite is a combination of biphasic calcium sulfate with a formula of hydroxyapatite (HA) granules. Calcium sulfate acts a short-range space maintainer scaffold. It completely degrades in strict relation to the bone formation rate (4-10 weeks), while the HA acts as a long term space maintainer. The amount of HA within the graft is a relatively small proportion, and is intended only to slow down the overall resorption of the graft.

Hi Phil, thanks for the info. What I find interesting is Fortoss Vital does the same thing, but with bTCP, whereas Bond Apatite uses HA. I would think using bTCP makes more sense as it resorbs and is replaced by bone faster than HA, so bTCP would be a better choice to combine with biphasic calcium sulphate?

Hi Phil and Andrew , yes what Phil has said is correct but it is not a black and white as that in reality as the basic materials can be varied a large amount in manufacture and thus HA can be made to not resorb at all or even be relatively highly resorpable ( Nano or highly porous HA ) . Likewise the nature of BTcP can be varied a lot as well and after many years we are getting to understand more about them ( can Pubmed one of my animal studies , have another two awaiting publication and just started a fourth ) . So many of the older BTcP products were like earlier cars performance wise and the time of resorption is the key to success as it must be in time with the formation of the new host bone . The product mentioned are great and developed essentially by CS manufacturers which is great but I feel that the material it is mixed with plays a greater role hence have spent more development time in this area. After 13 years only using these materials in 3,500 grafts ( Pubmed protocol ) without ever using a membrane I feel they will be the future especially in tunnel grafting techniques . Minimally invasive surgical protocols are the way forward and these materials work very well in this aspect . In the US , yes Allografts are very popular and this is what most mix CS with and have great results again following a set protocol always helps . I feel that BTcp is the ideal mix after trying many over the years due to its Osteo-inductive properties ( See many research papers in Orthopedics and Bone journals , as well as work of Pamela Habovic ) and these new biphasic ( CS and BTcP ) materials appear to be even more osteo-inductive than the BtCp and HA materials used in past research. We have just started another study to hopefully show this as we are seeing it clinically where we see 50% new host bone at as little as 8 weeks in core samples . Recently we have developed a material EthOss which appears to be a nice step in the right direction with improved handling and consistent results which was launched in October in Europe . Sadly Australia is a smaller market and possibly not on the companies priority list so mixing is the best solution at the moment but as I said early on the BTcp you mix with is a very important aspect for the end result . Not sure what you have in Australia to use , if you can give me some products available I can look into it .. Will be speaking on it in Baden Baden on Saturday , in London next Thursday ( Tesla ) and Porto next Friday . But generally early days , CS has a big future Regards Peter

Peter, How about a combination of BondBone, irradiated cancellous and L-PRP? how would you mix and apply this? Dr. John McCullough

Peter, I'm thinking specificily of an upper central where potentially you have a fenestration, desiring a screw retained prosthesis.

Peter I am using Easy graft, does this need a membrane? Also can this be left exposed? Sorry to go slightly off topic

Leal , contact CPM Pharma ( Carlos Ribiero ) in Porto . John , Hi you mean L-PRF , best not to mix with the Bond Bone , just mix the bond bone with the Allograft and then you can place the L-PRF over it if you wish to improve the soft tissue healing.. Bond Apatite from Augma is another nice product well packaged but personally I prefer BTcP as I said and allograft which I used to mix about ten years ago .. Peter

Quick editorial update: We spoke to the people at Augma and below is their response for the reason they chose to use HA in their new CS composite graft, Bond Apatite. Regarding long term space maintainers: Actually b-TCP could have been used, however we instead chose to use HA in a controlled particle size distribution with our Biphasic Calcium Sulfate matrix in Bond Apatite®. The HA was chosen because it enables the use of the graft in a large diversity of bone defects without any concerns about whether it will give sufficient space maintenance for wide defects with less bony wall support. If the clinician did not make the right evaluation about what should be the best space maintainer for a specific case, the material will compensate for this and give good three dimensional stabilization due to the HA. The HA was used as an innocuous space maintainer; it has no influence on the bone growth, it just provides space maintenance for the Biphasic Calcium Sulfate, which is more than 60% of the graft, and which resorbs into the patient’s own bone in a large defect. In addition, it is important to note that the Calcium Sulfate itself is different than any other CS used in grafting products. The CS used in the European composite graft you referred to that is mixed with b-TCP, is a CS Hemihydrate, commonly used in dental grafting over the years. However, Bond Apatite’s CS is Biphasic Calcium Sulfate. Biphasic Calcium Sulfate is a patent of Augma Biomaterials and provides improved handling and results over other forms of CS, both in terms of handling and results. On the handling side, CS Hemihydrate does not know how to set and harden in blood and saliva in an amount of time conducive to a surgical procedure. Biphasic Calcium Sulfate, on the other hand, sets and hardens in situ in 3 minutes, providing improved handling and a more comfortable work flow. On the results end, Biphasic Calcium Sulfate’s resorption profile matches the bone growth profile, while CS Hemihydrate’s does not. This means the Biphasic Calcium Sulfate in Bond Apatite® is simultaneously replaced by the patient’s own bone as it resorbs, providing a better quality and quantity of bone in a predictable amount of time.

Question is human allograft not available in Europe? That changes the discussion due to availability. In fracture healing bone takes about 6-8 weeks for primary callus then the bone remodels and matures over approximately 4 months. Good calcification shows up on X-ray about four months. The HA which I used thirty years ago is permanent and gets incorporated into bone. Bio OSS stays around forever. In selected cases I have started using easy graft and done a few tunnels. So I am definitely not opposed to synthetics and have not used a pure autograft in years. I think it is very important to try new materials and see how they work in various clinical situations. However bone physiology is the one parameter which is difficult to change. I Ike it when there is actual bone, nascent or regenerated to support the implant. Great discussion.

Yes CRS agree ........ more residual material less host bone ......... simple .......habits are hard to change for Dentists. The Systemic review of Hl Chan ,,, and Wang in Jomi suggested that Xenograft had 23 % less host bone and Synthetic had 22 % more .......we are not dealing with a hard substance ( like Wood ) but a living one ... Most research is obsessed with solely quantity of material and Quality is ignored sadly ... Yes Synthetic materials like CS and CaP s have been used in this field for over 100 years ..... there is nothing new , mixing Di and Hemihydrates with CS again was done decades ago .... But the synthetics are much better now and Augma is a great company helping as others are in exploring them..

Peter Fairbain how does the cs/btcp materials eg. ethoss/vital fortoss compare with Novabone. Does Novabone work just as well as it is also synthetic?

Hi CRS , yes they are in some countries and some not strangely (France not , Swtizerland ye etc ) . BUt these new Cap and Cs products seen to be a very exciting area as the bone growth is very impressive although surgical skill is needed and following the protocol is advised , as with everything. Hi Andrew , I have never used Novabone so cannot really comment , I lectured with George Kotsakis of Washington State Uni in Madrid at the end of last year and he showed some interesting cases . It is a Ha Silicate material which has always been interesting but again is said to be fully bio-absorped so great idea .. Regards Peter

Hi if anybody knows about novabone putty or novabone morsels as i have mixed results with morsels and little better results with putty

Hi Andrew , yes you can do it both ways and I show cases in my talks , BUT best to keep it simple and use in easy case that are shown . You can buy the new club that Speith uses ........ but it takes time to get the drive he has consistently. The real future is Tunnel grafting where we are getting amazing results ...in fact can use BTcP Cad/ CAM blocks where you place through a tunnel incision as well if you like blocks . Saw a great talk by Thomas on Saturday on tunnel block approach ... Regards Peter

Have anybody used Calcium Hydroxide ( not calcium sulfate) mixed with bone graft for socket preservation. Someone told me that and I want to see if anyone use that technique. Thank you