Dentogen Calcium Sulfate: Do I mix this with other grafts?

dentogen_3dDentogen, from Orthogen Corp., is a medical-grade calcium sulfate hemihydrate. Calcium sulfate is a material that has been used successfully as a bone-filling material for more than one-hundred years 1. The literature has described several mechanisms of action for calcium sulfate when it degrades in a bone defect 2.

Although DentoGen, can be used as a bone graft by itself in smaller defects, many clinicians have found that, due to the unique properties of calcium sulfate, DentoGen works very well in combination with other bone grafts, such as allograft.

In terms of the types of mixtures, there are various clinical studies demonstrating different combinations. In one such study 3, DFDBA (demineralized freeze-dried bone allograft) was mixed with medical grade calcium sulfate at a ratio of 75:25. In another case 4, calcium sulfate was used in combination with synthetic betatricalcium phosphate (ß-TCP). In a third case, an extraction site was filled with DentoGen calcium sulfate and a cortical/cancellous bone allograft. 5

In conclusion, the decision of how best to use Dentogen is up to each clinician and very much depends on the specific clinical situation. However, the literature supports the addition of Dentogen to other graft materials, to enhance the activity of these grafts. As stated in one report: “Because Calcium sulftate has significant bone regeneration properties of its own as a bone graft, it not only acts as a binder that prevents DFDBA from migrating out of the deep bone defect but also further aids in bone growth by depositing a calcium phosphate trellis, preventing ingrowth of soft tissues, stimulating blood vessel formation, and affecting the release of growth factors.”3

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Notes
1. Peltier LF. The use of plaster of Paris to fill defects in bone. Clin Orthop. 1961;21:1–31.
2. Resources: Ricci J, Alexander H, Nadkarni P, et al. Biological Mechanisms of Calcium Sulfate Replacement by Bone. Toronto, Canada: em squared Inc; 2000. Walsh WR, Morberg P, Yu Y, et al. Response of a calcium sulfate bone graft substitute in a confined cancellous defect. Clin Orthop Relat Res. 2003;228–236.
3. Bone repair in periodontal defect using a composite of allograft and calcium sulfate (DentoGen) and a calcium sulfate barrier. J Oral Implantol. 2011 Apr;37(2):287-92. Mazor Z1, Mamidwar S, Ricci JL, Tovar NM.
4. Enhancing extraction socket therapy with a biphasic calcium sulfate. Compend Contin Educ Dent. 2012 Jun;33(6):420-6, 428. Horowitz RA1, Rohrer MD, Prasad HS, Tovar N, Mazor Z.
5. Socket preservation and implant insertion in a smoker with a 10-year history of bisphosphonate use: a case report. J Long Term Eff Med Implants. 2010;20(4):327-34.
Sunkara S1, Beneduce C, Andreana S.

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