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