Bond Apatite Clinical Case

Clinical Case

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Bond Apatite® - Clinical Case - 1 RIDGE RECONSTRUCTION WITH BOND APATITE® CEMENT

Deformed crest with large bone deficiency can be seen after multiple extractions

Implant in place within the reconstructed ridge

Graft stability was achieved instantly during the placement of Bond Apatite® cement

The graft was covered directly and thoroughly by the soft tissue, using conventional primary soft tissue closure techniques

4.5 months post-op during reentry, the entire ridge reconstruction can be seen

Bond Apatite® - Clinical Case - 2 Augmentation of large bone defect using Bond Apatite® In this case the two inferiors hopeless molars 37 38 was removed .the socket and the ridge was preserve by augmenting the area with Bond apatite bone graft cement. After teeth removal and complete debridement of the site the application of the cement was according to the protocol in 3 consecutive steps ,place ,press ,close . the cement was ejected directly into the grafted site from its ”all in one ”syringe and then press firmly with a dry gauze for 3 second ,followed by primary soft tissue closure directly above the cement .no membrane was needed .

12 weeks post op at reentry the new patient own bone was formed and the 3D ridge volume was preserved . At this stage implant placement took place

Bond ApatiteÂŽ - Clinical Case - 3 Bone reconstruction in the aesthetic zone In the following case, a 30 years old female came to the clinic describing discomfort feeling and tooth mobility of the left upper lateral incisive. during clinical evaluation a fistula was detached buccally near the apex zone of the tooth .preapical radiographic evaluation reveals a large radiolucency in connection with the tooth apex.

The treatment plan was to extract the tooth and to remove the lesion .to augment and to place an implant at the second stage.

After the extraction and the site preparation for augmentation Bone Apatite cement was used as a graft material .the soft tissue was primarily closed directly above the graft without using any membrane.

3 months post op one piece implant was placed and load with a provisional acrylic crown.

Fistula can be seen during Clinical examination

Periapical and CBCT scan slice radiographic appearance reveal Large bone deficiency at the apical Portion of the upper lateral incisive that was treated Unsuccessfully By apicoectomy 4 years earlier

Bond ApatiteÂŽ - Clinical Case - 3 Bone reconstruction in the aesthetic zone

The defected tooth was carefully extracted and the granulation soft tissue was removed completely.

Leaving behind a large bone defect with buccal plate deficiency.

Bond apatite was placed in the Augmented site

3 months post op At the second stage Implant was placed with provisional acrylic Crown

Radiographic appearance with implant in place

Bond Apatite® - Clinical Case - 4 Crest Preservation with Immediate Implant Placement

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After clinical and radiographic evaluation due to the poor prognosis of the existing dentition. The treatment plan was to extract all the existing lower teeth and in addition to removing the 2 failed implants 45,46 (29,30) while keeping implant 33 (22) in place.

Thereafter, to perform immediate implant placement of 3 implants and simultaneously augment and preserve the crest. The final prosthetic plan was to provide the patient removable overdentures on those implants.

After extraction and complete debridement, implants were placed with good primary stability and the crest was augmented by using Augma’s Bond Apatite bone graft cement.

Pre op radiography

Pre op clinical appearance

Bond Apatite® - Clinical Case - 4

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Crest Preservation with Immediate Implant Placement Implant placement and Augmentation Procedure

The flap was raised and minimally dissected for release, the release should be as minimal as required in order to have moderate tension during the closure, not tension free. Hard tissue was prepared and the implant (DMI Technologies Ltd.) was placed submerged by one millimeter below the crest with good primary stability, it’s important that the implant is anchored to the bone in order to regain their primary stability.

Thereafter, Augma’s Bond Apatite Cement was used to augment the crest.

After activation of the cement within its syringe, it was ejected directly above the implants and above the crest and slightly overfilled.

Thereafter pressed for 3 seconds using a dry gauze pad above. ( An instrument should not be used to push the cement between the implant and the socket walls .)

Following the placement of the cement, soft tissue closure occurred. The cement was covered directly by the flap and no membrane was used. The flap was sutured in place with moderate tension. ( it’s important that the soft tissue closure shouldn’t be tension free as within the conventional augmentation techniques ).

The Soft tissue should be maximally closed, do not leave the cement exposed more than 1-3 mm.

After extraction with implants in place

Bond apatite cement in place

Soft tissue closure

Bond Apatite® - Clinical Case - 4

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Crest Preservation with Immediate Implant Placement 3 Months Post Op

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Healing went uneventfully and re-entry took place after 12 weeks.

During re-entry a diamond bur was used to remove access bone grown above the cover screws, integration of the implants was achieved and ball attachments were connected to the implants

Soft tissue appearance 12 weeks post op

Soft tissue closure

Radiographic appearance 12 weeks Post op

Clinical appearance during reentry 12 week Post op

Ball attachments in place

Before

After

Bond ApatiteÂŽ - Clinical Case - 5 Socket preservation using Bond ApatiteÂŽ

Histology analysis of the harvested core reveal complete regeneration by new bone formation:

3 months post-op implant was placed :

Bond Apatite® - Clinical Case - 6 Extensive Ridge Deficiency Reconstructing by Bond Apatite®

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The case describes a rehabilitation process of the upper jaw. As a result of advanced periodontal disease the severe bone destruction is evident. It was thus necessary to laterally augment the narrow ridge in the area of the incisors with regeneration of the alveolar crest and bone restoration in the area of the molars following their removal.

Following the extractions a composite cement graft material was used which contains biphasic calcium sulfate and HA ( Bond Apatite – Augma Biomaterials LTD).

The surgical procedure of graft placement, using the bone graft cement, is easy and user friendly to the surgeon and minimally invasive for the patient. This is due to the fact that the full thickness mucoperiosteal flap is minimal, without the need of flap releasing dissection or periosteal incisions in order to achieve a tension free flap as is mandated with other bone substitutes and grafting techniques.

Anterio segment sagittal view preaugmentation Pre-surgical clinical and radiographic view Radiographic view anterior segment Three months post augmentation Note that this is newly formed bone, Thus the area is not as radiopaque as a graft performed with a non resorbable graft

Bond Apatite® - Clinical Case - 6 Extensive Ridge Deficiency Reconstructing by Bond Apatite®

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The grafting technique is easy, fast and simple while adherence to the simple protocol of PPC..Place, Press and Close. Closure of the flap is done under tension and permits up to 3mm exposure of cement during wound suturing.

Placement of the cement in to the graft site is done by injection, followed by pressure on the cement and its adaptation in to place using sterile gauze and finger pressure on the gauze pad for 3 seconds. Immediately after pressure application and cement adaptation closure should begin by stretching and placing the flap directly over the cement without the use of any membranes or PRF. The closure is maximal and not necessarily water tight. A gap, up to 3mm, is permitted due to the unique cement features to allow healing by secondary intention and rapid soft tissue proliferation across the cement surface. This is a major difference from other bone substitutes or membrane, where if the flap is not tension free and closure is not primary significant complications of the graft and soft tissue will occur which will compromise the success of the treatment.

Naturally, whenever it is possible to adapt the gingival flap with tension and without primary closure, the surgery is easier for the clinician and the treatment sequence has reduced morbidity for the patient; since the procedure for the doctor is simple and fast, due to the fact that all he/she has to do it expose the graft site, place the material, press it and as soon as it is adapted and gets hard, allows immediate closure of the flap, over it , with tension.

Pre-surgical view

Immediate post extraction note the narrow residual ridge in the incisors, canine and first molar areas

Deployment of Bond Apatite® in to the host site

Bond ApatiteÂŽ - Clinical Case - 6 Extensive Ridge Deficiency Reconstructing by Bond ApatiteÂŽ

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For the patient the procedure is minimally invasive since no addition vertical releasing incisions are performed. This prevents unnecessary trauma, which significantly reduces post operative pain, swelling, and other accompanying sequela that are typical in cases where the treatment is done with tension free flap. In addition, a gingival flap where releasing incisions were not done and is in tension over the graft material, is a more stable flap. The flap is not connected the the movable musculature in the area, which causes the reduction of complication from suture line openings. Another benefit of flap closure with tension is the stability of the graft material during the healing period; it is critical to the bone regeneration process.

Immediate closure over the graft

Alveolar view full thickness flap elevation during implants placement

Soft tissue view three months post augmentation

Addition of Bond Apatite to enhance ridge thickness