Historically, orthopaedic surgeons have used a variety of bone graft substitutes in treating complex segmental bone defects. However, only autograft has proven to have superior clinical outcomes in terms of modified overall success.
Autologous bone grafting is considered the gold standard because of its osteoconductive, osteoinductive and osteogenic healing properties. However, it has several drawbacks including donor site complication and pain, increased blood loss and limited supply of the graft material.
Specialty Powders
Our specialty powders are used for bone augmentation and can be combined with other types of products to form composite grafts. They are formulated to provide the ideal surface for bone formation and promote revascularization. They also support the growth of bone-forming cells and stimulate osteogenesis and resorption. These materials are available in a putty or granule form and can be mixed with demineralized bone matrix (DBM), hydroxyapatite, or bone morphogenetic protein to create a graft that is tailored for the specific clinical application.
Our bone graft substitutes are processed in a clean room environment by experienced technicians, and undergo serological testing to eliminate the risk of communicable diseases. They are then packaged and exposed to low-dose gamma irradiation to sterilize them. This ensures clinicians can confidently use these materials in surgical applications without worrying about contamination or infection.
This allows surgeons to use a more natural method of bone grafting and reduce the complications associated with harvesting autogenous cortical bone from the donor site. For example, using bone powder treatments to treat thin sinus bones in the upper jaw can allow for successful placement of dental implants later on without having to return to the patient for another surgery. This is especially important for patients with aging or other health issues that may prevent the ability to get additional surgical procedures done in the future.
Granules
Our granules are a nonstructural allogenic bone substitute made of silicate-substituted beta-tricalcium phosphate (b-TCP) and hydroxyapatite (HAp). The HAp component is derived from Australia bovine bone (BSE free) and is chemically and structurally similar to mineralized human bone. These granules are used for augmentation of bone defects. They are available in a syringe-like applicator that can be easily wetted with blood or PRF for use in the surgical site.
Bone healing is a multilateral process requiring mechanical stability, revascularization, and osteogenesis [8]. Osteogenesis is the maturation of undifferentiated stem cells to create new bone tissue either by laying down osteoid or through the enchondral calcification of cartilage to form new bone tissue. During this process, the graft substitute material must provide the scaffold for osteoconductivity and promote osteoinduction to stimulate primitive bone-forming cells to develop into the bone-forming lineage.
The granules are chemically treated to achieve a partial demineralization, which exposes the collagen fibers and facilitates the release of growth factors. Micro-scale pores in the granules increase their wettability and provide an optimal environment for bone cell adhesion, proliferation, and differentiation. The syringe-like applicator allows for the precise placement of the granules in the surgical site. Moreover, the granule size can be adjusted according to the clinical requirements of guided bone regeneration procedures. This enables the surgeon to achieve maximum bone formation without damaging the adjacent healthy tissue.
Blocks
The use of bone blocks allows the surgeon to preserve the adjacent teeth and avoid the need for repositioning, especially for onlay procedures. During the initial surgical procedure, the patient is anesthetized and a broad based mucoperiosteal flap is raised. A ridge defect is identified and the desired site for placement of an implant is exposed.
The graft site is prepared with several perforations to expose the medullary canal and expedite revascularization. The freeze-dried allogeneic block graft is rehydrated and positioned in the defect area. Holes are drilled into the block to allow for proper fixation with a lag screw technique. The graft is covered with a non-crosslinked collagen membrane (CopiOs® Pericardium Membrane, Zimmer Biomet Dental) and simple interrupted sutures are placed.
A canine study performed by Thoma et al25, compared the results of rhBMP-2/ACS under a titanium mesh and rhBMP-2/ACS with or without a cancellous block allograft (MinerOss; Geistlich Pharma). They reported that in both corticocancellous and cancellous blocks, rhBMP-2 and ACS resulted in significantly higher new bone formation than with or without the allograft. The xenogeneic bovine and equine Geistlich Bio-Oss blocks demonstrated histologically similar results. The authors conclude that the allogeneic block graft is an excellent option for onlay augmentation of the alveolar ridge and that more studies will be needed to verify long term outcomes.
HA/TCP
We offer HA/TCP granules with a high porosity (83%). They are gamma sterilized and have a porous structure that facilitates bone ingrowth. They are used in conjunction with autografts or as a stand alone product for bone augmentation.
The use of bioceramics, especially a combination of hydroxyapatite (HA) and b-tricalcium phosphate (TCP), as a three-dimensional scaffold for bone regeneration has been well established. These materials have superior mechanical properties and biocompatibility compared with pure cancellous bone.
A 50:50 mixture of HA/TCP and cancellous bone has been shown to be osteoinductive in a canine ulnar model. Moore et al16 showed that this material can be used as an impaction graft extender, resulting in better clinical outcomes compared to pure cancellous bone in a canine posterolateral spinal arthrodesis for idiopathic scoliosis.
In vitro and in vivo evaluation of these materials show good cell adhesion and proliferation with minimal degradability of the biomimetic HA coating. Histological evaluation with H&E and alizarin red staining showed that the TCP/HA/SMC construct demonstrated a higher number of new calcified nodules in both the in vitro and in vivo systems than the HA-SMC construct, demonstrating close cell-cell and cell-material interaction during differentiation. Scanning electron micrographs also showed that HA/TCP scaffolds are able to support the development of extracellular matrix (ECM) vesicles and collagen fibres in SMCs during differentiation.
