What am I supposed to see in an x-ray while working with 3D Bond™?

When 3D Bond™ is used on its own, the material is completely resorbed and replaced by the patient’s own bone, which is apparent while viewing an x-ray.

Approximately a week post-operation, a radiolucent shading in the circumference can be noticed in an x-ray. This shading will expand up to the fourth week when the entire area will be completely radiolucent. It seems as though the material has completely disappeared, but this is not the case. This is the un-calcified osteoid. Gradually, calcification of the area will take place, so that up to three months after implantation, the entire area will be radiopaque in the x-ray, with an identical appearance to the adjacent native trabecular bone.

Does Bond Apatite® remain hard during the healing period?

The material does not remain hard. The resorbtion process begins immediately after placement, while new bone formation simultaneously takes place.

Should one expect a different radiographic appearance with Bond Apatite®?

Due to the nature of the graft, the biphasic calcium sulfate matrix within the graft is simultaneously replaced by the patient’s bone; therefore, the radiographic appearance is completely different compared to other grafts, which always appear radiopaque due to their constant presence in the grafted site.

In contrast, the radiographic appearance with Bond Apatite® is as follows:

During day one after graft placement, it appears radiopaque.

Gradually, a radiolucent appearance takes its place (reflecting the graft's transformation into the newly-formed osteoid before its calcification).

Two to four weeks after graft placement, the majority of the grafted site appears radiolucent while few radiopaque spots remain, reflecting the presence of the HA particles. Within 12 weeks, radiopacity takes place with the appearance of the native trabecular form. This is the time when the new osteoid has already calcified.

There are ‘white’ particles three months post-op; are these HA (hydroxyapatite)?

The particles are the large HA particles that comprise the remaining 10% of the composition of the Bond Apatite® composite graft cement. At this stage, they are in the process of resorption.

Is there a risk of development of granulation tissue after using Augma bone graft cement?

Augma Bone graft cement is inorganic matter, and thus cannot form fibrous tissue. The cement dissolves completely. If at placement Augma Bone Graft Cement is not properly activated, placed and pressed into place and into a properly prepared host site, and if there is a removable prosthesis, or a movable flap or anything else that might interfere with graft stability, then the cement matrix might not hold the space and heal by scar tissue.

What is the histological difference between Augma bone formation and classic allograft formation?

The histology slides of Augma bone graft cement present new bone with osteocytes within the bone. This fact reflects that the new bone is vital. With allografts, there is an integration of the allograft particles with the surrounding bone. However, there are no osteocytes within the integrated allograft particles, which is a confirmation that those particles are sterile sequestrum and not vital bone.

What are some common reasons for finding less than optimum results?

Please keep in mind that Augma’s bone graft cement performs as well as under performs in different ways then traditional graft materials

  • There is no conversion to scar tissue- the biphasic calcium sulfate is not biologic and cannot covert to fibrous connective tissue like allograft/autograft/Xenograft.
  • There is no infection as a result of the material - the material is inorganic and thus will not be prone to the bacterial assault like allograft/autograft particles do. In addition, it is NOT particulate like other Xenograft/Alloplasts and thus will not harbor bacteria in its porous structure to infect the site of future implants. The biphasic calcium sulfate will, however, yield less then optimum results if surgical placement protocols are not followed.
  • Removable appliances are pressing and moving over the grafted site will cause graft volume reduction or elimination.
  • The patient does not follow postoperative instructions; will cause graft volume reduction or elimination.
How long does it take Augma bone graft cement to resorb completely?

Augma Bone Graft Cement - 3D Bond™, composed of pure biphasic calcium sulfate completely resorbs in 4-10 weeks.

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 as a short-range space maintainer scaffold; it completely degrades in strict relation to bone formation rate (4-10 weeks), while the HA acts as a long term space maintainer. The amount of HA within the graft is in a relatively small proportion in a controlled particle size distribution and is intended only to slow down the overall resorption of the graft. The small and medium size of the HA particles resorbs as well in 4-6 months, while the large particles, which consist of about 10%, remain in the grafted site for a longer period. The bioactivity and the rapid graft transformation into vital bone are due to the biphasic calcium sulfate that occupied most of the grafted site. The calcium sulfate encourages angiogenesis, osteoblastic activity, enhanced calcification and is completely degraded and replaced with the patient’s own bone

Is Augma-grafted bone more vulnerable to developing peri-implantitis?

Augma Bone Graft Cement completely transforms into the patient’s bone. Therefore, it behaves like any vital natural bone and carries no increased risk of peri-implantitis.

What is the quality of the bone after five years or more?

Augma bone graft cement does not integrate with the bone. Instead, it resorbs and transforms completely and regenerates the patient’s own bone. After the bone formation, the natural biological bone remodeling process takes place continuously, while the bone continues to calcify and mature throughout the years like any living bone.

What type of bone density should one expect to see after four months?

In most cases with Augma bone graft cement, one can expect to see type 2-3 bone after four months.

What is the recommended time to wait before reentry?

This depends on the case. In cases of socket grafting, when Augma bone graft cement is used, three months are usually sufficient; in lateral augmentation, 4-5 months is recommended.

Can there be an issue if waiting for more than 4-5 months between augmentation and implant placement? (For example, one year)

The graft volume is optimum at 3-4 months, but the regenerated bone is immature and is still undergoing mineralization. Waiting longer to place an implant will result in regenerated volume reduction.

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