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Bond Apatite is a new grafting product that combines biphasic calcium sulfate with a formula of hydroxyapatite granules in a pre-filled syringe to create a self-setting cement for bone graft procedures.
Bond Apatite Key Benefits
Bond Apatite® is a combination of biphasic calcium sulfate with a formula of hydroxyapatite granules. This is a cement-based osteoconductive composite, synthetic bone substitute that is used for bone reconstruction in a range of dental applications and is intended for filling, augmenting and reconstructing the wide diversity of defects in the maxillofacial bones.
Bond Apatite® is FDA cleared and CE approved. Bond Apatite® is delivered in a dual-chamber, prefilled syringe, containing the granulated powder and physiological saline. Mixing the powder component with the liquid in the driver results in a viscous composite that is suitable for injection into the graft site.
Compared to prior versions of the driver, in which additional accessories had to be used to inject the saline into the driver’s head, this new development of the Bond Apatite® driver ensures easy and more convenient handling by the clinician.
Bond Apatite Clinical Applications
Bond Apatite Protocols and Tips
Bond Apatite: Additional Tips
In cases of four bony walls socket grafting, eject the material into the socket, and press frmly with dry guaze above the material; however, do not use any tool to push the material toward the apex as you are used to when working with granules (doing so will exert pain to the patient).
In case of socket grafting, if you choose not to refect the flap, do not leave the material exposed to the oral cavity. The material should be protected with a collagen sponge or a membrane which must be stitched together with the surrounding tissue (lack of physical graft protection will cause material and volume loss).
In cases of periodontal defects, prior to graft placement, thorough debridement by scaling and root planning should be done. In cases of tooth mobility, the teeth must also be stabilized before graft placement.
Dehiscence and Fenestrations
The cement should be placed above the bone and the exposed threads of the new placed implant or above the exposed root after scaling and root planning. Remember to slightly overfill in order to compensate for graft shrinkage during the healing process. The cement is not indicated in cases when there are implant threads exposure of a previously (old) placed implant. In such cases, the outcome might be compromised as with any other grafts.
Lateral Augmentations & Crest Widening
Hard tissue preparation and soft tissue release should be done before activation of the cement (Decortication is optional). Place the cement into the augmented area and slightly overfll. Then press above firmly with dry gauze for 3 seconds to stabilize the material. You might shape, if required, and press again for 3 seconds. At this point, close the fap. (In large lateral augmentation cases we recommend to use additional horizontal mattress sutures for better soft tissue stabilization above the graft). Membrane coverage is not essential as long as your soft tissue is well stabilized, completely closed, and well sutured.
In your first few cases, we defnitely do not recommend to use the material for vertical augmentations. After gaining experience with the cement, vertical augmentation can be done only if you are familiar with vertical augmentation techniques. As well, you must remember it is obligatory to use a rigid graft stabilization techniques (such as rigid bariers) to protect the cement from lateral movments during the healing phase. If you place the graft without rigid stabilization, your outcome will be completely compromised.
Open sinus lift
In a small to medium sized sinus cavity, you can use Bond Apatite® for fillng the sinus cavity and window closure as well (no need for membrane). In larger sinus cavities, it is less comfortable since you will need to place the material by incremental steps. In such cases, we recommend you to use your prefereable granules to fill 2/3 of the sinus, and the last 1/3 fll with Bond Apatite® cement as a graft enhancer and for window closure. This will save you time, save membrane cost and will enrich the sinus with ions of calcium.
Close sinus lift
Due to the large size of the syringe opening, it is not recommended to eject directly the material from the syringe into the drilled cavity. The graft can be ejected into a dish and should be left for 3 minuets to set, and then can be crushed into small fragments that will be used in such case.
1. 4Matrix is a registered trademark of MIS Implants.
|Questions and Answers|
Due to the cement properties of Bond Apatite, using a membrane is not needed in most of the clinical cases as long as primary soft tissue closure is achieved. Using a membrane might be recommended in large size defects in which soft tissue stabilization cannot be ensured or in socket preservation procedure when a flap was not reflected and the material is completely exposed to the oral environment. In such cases, a protection barrier is required above the graft to prevent volume loss. For a barrier you can use a collagen sponge or a membrane that can be left exposed above the graft. In terms of exposure, NO – It is not recommended to leave Bond apatite exposed. Leaving the material exposed without a protection of a physical barrier can lead to material volume loss. Nevertheless, leaving the material exposed with a gap of 1-3 mm is not an issue as soft tissue will migrate rapidly over it and will close the gap in a few days. Finally, it is worth nothing that Bond Apatite is primarily calcium sulfate, which is in and of itself is a material that can be used as a barrier membrane, per the restrictions above. In fact, it is common to layer calcium sulfate over other graft materials instead of having to fit a membrane fragment.
Working with Bond Apatite is beneficial in many ways, including increased comfort and handling, improved results and cost savings. It is important to know: The transition to working with cement requires a completely different approach than those we are used to working with when using granules or putty. In order to achieve the optimal result: 1\. \*Unlike granules, cement has a defined working time and a defined hardening time, therefore it is important to prepare the lesion in its entirety before carrying out the augmentation (both in terms of hard and soft tissue preparation). 2\. \*The flow of work should be continuous and not exceed the working time. 3\. \*The material is activated by pushing the syringe’s shaft down towards the marked line. It is important to push until you feel maximum resistance (This will activate the cement by wetting it and expelling the excess liquid). 4\. \*The material should be ejected from the syringe immediately after its activation and in a continuous action. 5\. \*After placing the material on the graft site, compress it firmly with a dry gauze pad above it. Do not try to disperse the material or shape it before the first compression (If you would like to shape the material, you can do it after this step using the tool of your choice, and re-compress it again with dry gauze). 6\. \*The material should be compressed for no more than 3-5 seconds. (Over-compressing will break the cement and prevent it from hardening). Remember: Compressing the material is necessary because it improves the quality of the cement and does not prevent the penetration of blood and cells into the graft. 7\. \*Due to the fact that the matrix resorbs and is replaced by the patient’s own bone within 3 months, in order to maintain the final desired volume, it is important to overfill the graft site with 2-5mm (corresponding to the lesion size). 8\. \*X-Ray Evaluation: A radiolucent appearance during the first 3 months is normal, due to the replacement of the matrix with the patient’s own bone. General surgical principles, such as proper site preparation, primary closure, and adequate suturing should be respected. This document is designed as a guideline and is not designed to substitute or replace the user manual supplied in the product’s package.
Yes, certainly, Bond Apatite® can be used in sinus lifts, however, it would need to be placed in increments which make the technique not comfortable to work with. Hence, our recommendation is to fill 2/3 of the sinus cavity with your preferred granular augmentation material, and the final 1/3 with Bond Apatite®. It will enrich the graft with calcium ions, and will also close the sinus window with no need for additional membrane placement.
Bond Apatite® is a composite graft made of Biphasic Calcium Sulfate and HA in a specific particle size distribution, in a ratio of 2:1. This combination takes advantage of each part of its components. 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 (33%), and is intended only to slow down the overall resorption of the graft. The bioactivity and the graft transformation into vital bone are due to the biphasic calcium sulfate, which is 66.6% of the graft.
Bond Apatite® can be used in a wide diversity of osseous defects, including medium and large size defects such as dehiscence, fenestration cases, lateral augmentations (horizontal crest widening), sinus lifts, periodontal bone defects, filling of bony defects pre-implant placement, filling a cavity post cyst removal, ridge augmentations, etc.
Bond Apatite® is a composite graft, made of 3D Bond™ matrix mixed with HA granules in a controlled particle size distribution, intended to fill or augment a large diversity of osseous defects.
There are several potential situations that you may face when grafting with Bond Apatite for socket preservation, below is a review of the main protocols. At the bottom of this reply you will also find videos showing the various protocols. ## Socket grafting with 4 bony walls ### Socket Preservation Protocol without lifting a flap - No need to raise a flap. - Extract the tooth and prepare the socket for grafting. - Eject the cement into the socket. - Press firmly over the cement for 3 seconds using dry sterile gauze and finger pressure. Do not use an instrument to push and compact the cement into the bottom of the socket. (If the interdental space is too narrow to accommodate direct finger pressure on the sterile gauze, then a mirror handle or similar instrument can be applied on top of the gauze). - Protect the cement by covering it with a collagen sponge and secure the sponge in place to the surrounding soft tissue by an initial suture thereafter with a cross stitch above. During the initial stage of healing, the cement should not be left exposed . ## Socket Preservation Protocol with lifting a flap - Before Flap reflection perform short mesial oblique vertical incision (up to 2 mm into the mobile mucosa). - Raise full thickness flap, minimally as needed to expose the entire defect – (Do not perform any manipulation to get tension free flap. No horizontal dissection release cuts, and no brushing. the flap should be with tension during closure and not tension free). - Extract the tooth and prepare the site for grafting. - Cement application - Eject the cement into the site. - Place dry sterile gauze and press firmly for 3 seconds on the buccal and occlusal aspects. - Reposition the flap for maximal closure by stretching it directly above the cement (exposure of 2-3 mm is fine, but no more than that). ## Augmentation Protocol When Buccal Wall is Missing - Before Flap reflection perform short mesial oblique vertical incision (up to 2 mm into the mobile mucosa). - Raise full thickness flap, minimally as needed to expose the entire defect – (Do not perform any manipulation to get tension free flap. No horizontal dissection release cuts, and no brushing. the flap should be with tension during closure and not tension free). - Extract the tooth and prepare the site for grafting. - Cement application o Eject the cement into the site. o Place dry sterile gauze and press firmly for 3 seconds on the buccal and occlusal aspects. - Reposition the flap for maximal closureby stretching it directly above the cement (exposure of 2-3 mm is fine, but no more than that). -
Yes. Bond Apatite is basically calcium sulfate mixed with some HA. Both of these synthetic materials are routinely used in combination with allografts and you can find such instances in the clinical literature. Since calcium sulfate is approved as a barrier membrane, you can graft with any material of choice and then layer calcium sulfate on top of it. If you are planning on using calcium sulfate on top of a graft, you may want to consider Dentogen, as the calcium sulfate product to use, as it maybe easier to work with the granules as opposed to a syringe, when layering on top of a graft.
Bond Apatite Socket Grafting with Flap
Socket preservation protocol with lifting a flap
Bond Apatite Flapless Socket Preservation
Socket preservation with Bond Apatite protocol without lifting a flap
Augmentation Protocol When the Buccal Wall is Missing using Bond Apatite
Video shows the Bond Apatite protocol was implemented in a case of a deficient buccal plate
I would like to share with you my experience with new bone graft cement called Bond Apatite. I started using this product six months ago and now I am getting my first results. As with any new material, I used Bond Apatite in the beginning with small number of cases: four cases of lateral augmentations in different levels. In all of them I had great success, clinically and radiographically. However, one of the cases even surprised me. The case involved placed implant in the inferior molar area 36 with large deficiency of the buccal plate, which required bone grafting and augmentation procedure. After placing the implant and decortication of the bone I augmented with Bond Apatite .Since this case involved just a single implant and the quantity of the material’s syringe is 1 cc (there is still no smaller packaging), excess material was left in place. I removed some excess and with the rest I covered the ridge and the head of the implant. In this particular case I didn’t use a membrane, however I closed passively and hermetically the soft tissue. Reentry and implant exposure was preformed after 4 months. In the radiography, before the exposure, I distinguished a radiopacity layer above the implant head. As well, while elevating the flap there was a respectable amount (1-2 mm height) of hard vital bone, that required certain effort from me in order to discover the head of the implant. In fact, I also got a vertical height of vital bone with good mechanical properties. I will be glade to share with you additional interesting and surprising cases in the future.
Dr. Mark Shultsman
I have been using augma Bond Apatite bone cement for over two years. The main reason I decided to use augma was the fact that I have an osteoconductive material that I can safely and predictably bring to the surgical site and could expect bone. The delivery system and ease of use are an excellent benefit. Grafting large posterior sockets is done easily and FAST. I even uses the cement as a membrane over a sinus window, or other large defects that needed support. In many applications no tacks or screws required. I highly recommend adding augma bond apatite bone cement to one's clinical grafting armamentarium.
MICHAEL KATZAP DDS
When I began using Bond Apatite, I was impressed, as it exceeded my expectations. Not only was it user-friendly and highly conducive to use in a clinical environment, it provided predictable and top-notch results.
Dr. Isaac Goldschmidt
DDSGadget Guide for:
Bond Apatite: Bone Graft Cement