Is this an effective way to treat peri-implantitis?

Hi Dr.T Would your allograft be cortical or cancellous or both? Do you use anything else beside BMP and what is your ratio of BMP/allograft? How successful have you been with this mixture for GBR? VD

Hi Montana Unfortunately no radiographic hx. Implant was placed 5 years ago. Currently there is suppuration and bleeding on probing. VD

Hi CRS Didn't see or feel any cement when probing and scaling. Implant placed 5 yrs ago. VD

Hi Peter So would you or would you not attempt to do GBR in this case? Does it help to mix antibiotics with the graft? I'm considering metronidazole and tetracycline but not sure which one is better. VD

Dr. Peter Fairbairn, what do you mean by "change the patient"? I have a great respect for your opinions and I'd appreciate if you could elaborate a little more on this subject. Thank you!

Hi Peter My understanding is that in the past you did use allografts mixed it with CaSO4 for GBR procedures and did NOT use any membrane, and had great results. Is this correct? Also i'm very interested in Ethoss, but it's not yet available in Canada. Is the BetaTCP in Ethoss any different from other pure phase BetaTCP, for example Bioresorp (a BetaTCP from ImplantDirect) which is available in Canada? Thank you, Andrew

Thank you very much!

Thank you very much Peter. I just found out that Bioresorp is available in US, but not in Canada. The only synthetic product available to me, which has BTcP in its composition, is BoneCeramic (from Straumann). It is 60% HA and 40% BTcP. Do you think this is a better material (compared to an allograft) to use in combination with CS? Regards, Andrew

If you are looking for a good synthetic composite, you should look into Bond Apatite. It is available in the US, here. It combines biphasic calcium sulfate with a formula of hydroxyapatite granules in a pre-filled syringe. You can check out the videos at the links above. If you are interested in understanding why Augma chose HA over bTCP for the composite graft with CS, you can see this response to that question on another thread on OsseoNews.

Thanks very much Sam for the links. Augma stated that HA was chosen to "act as an innocuous space maintainer and it has no influence on the bone growth". BTcP on the other hand, I think, has positive influence on the bone formation process... (Peter can confirm and explain further on this). So it seems for smaller bony defects where space maintenance is less critical, BTcP mixed with CS might be a better choice than Bond Apatite? Regards, Andrew

Hi Andrew, Thanks for the interesting discussion. My long-winded layman response, after reading alot of research on these materials: Not sure what you mean to say with "positive influence on bone formation." With the exception of autogenous bone, I think it is proven that all graft materials, even bTCP, are only osteoconductive. So none of the materials actually positively influence bone formation, if by that you mean osteoinduction. The question here is really about resorption rate. I do no think one mixture is proven to be better than other, as far as bone formation, and I'm not aware of any studies that compare the two composites (i.e. bTCP + CS vs HA+CS) on that factor. It's just that HA+CS has a certain resorption profile, which Augma wanted so the material could be used in a large diversity of bone defects. In smaller defects site, I guess a faster resorption profile is not an issue??? Anyway, the main difference between bTCP and HA is the resorption profile. bTCP seems to resorb alot more quickly than HA. CS absorbs even more quickly, which is why it needs to be used in a composite and not alone. So a composite of HA+CS, should in theory, resorb more slowly, than bTCP+CS. This is also why BoneCeramic with Straumann mixes bTCP and HA. It's simply done to create a certain kind of resorption profile because bTCP resorbs quickly relative to HA. So the extent that HA resorbs more slowly, I would think that it should provide higher osteoconductivity. However, the truth is that I do not think there is any clear research or conclusions on the relationship between resorption rate and bone formation, even intuitively it makes sense to think there should be some sort of relationship. A good article about bTCP vs HA is available here (it's about spinal fusion, but still relevant as a general discussion of bTCP and HA): http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2762171/ "Commercially available hydroxyapatite is resorbed very slowly, under normal physiological conditions, whereas beta-tricalcium phosphate is generally resorbed within 6 weeks after implantation" This is another good article on bTCP vs HA: http://www.joionline.org/doi/pdf/10.1563/AAID-JOI-D-11-00061

Thank you Peter for the info. I'm very interested in reading the paper by Habovic that shows "HA is least osteoinductive, then BCP and BTcP is the most osteoinductive". Could you please tell me where I can look it up? Is it true that CS (hemihydrate or dihydrate) is also osteoinductive to some extent? Any published paper on this?

Hi Andrew on the Beach at moment , Pubmed will show there are many papers on this with her name on ..... "Osteoinductive Biomaterials : current knowledge ......" Barradas A , Habobviv P et al European Cells and materials Vol 21 2011 ( pgs 407-429 ) is a start

New Paper out that really sums up all the years of her work in this area in Trends in Biotechnology ( Impact factor 12.025 ) Review CaP and angiogenesis ; Implications and advances in Bone Regeneration by Anghrad Molhatra and Pamela Habibovic just published ... and really good read if interested in this area . Regards Peter