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The Journal of Implant & Advanced Clinical Dentistry
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Ziv what allograft are you using for your extractions
Dr. Mazor what allograft are you using for your extractions? Will you always mix it with CaSO4?
Type of Allograft mixed with CaSO4
Logan,
At the early days I was using DFDBA mixed with CaSO4 especially for perio defects based on the literature.
Nowadays and according to my long term experience i'm using only mineralized allografts such as: Puros,Regeneross etc.. mainly cortico cancellous
I have used them with and without CaSO4 with the same success. The advantage of mixing with CaSO4 is faster soft tissue closure over the CaSO4 in cases where no primary closure was planned.
Dr. Mazor dont you find the CaSO4 resorbs to quick?
In my hands I found it didnt make a good membrane. Capset tended to facture or resorb to quick. I think you definitely need to mix it with something to get the benefit.
Soft tissue loves it. I will put CaSO4 over the socket graft. Soft tissue grows right over it.
CaSO4 resorption
Logan you are absolutely right.CaSO4 will resorb in 6-8 weeks.In cases which are not 3 wall defects I will cover it with a membrane-like Cytoplast doing the Bartee technique.I use a material which hardens immediately and maintains the shape at least initially.In cases of large defects I will mix it with an allograft.
Ziv Mazor- Why not a collagen membrane?
Dr. Mazor why dont you use a collagen membrane? What is the advantage of the cytoplast?
Why not a collagen membrane
Dear Dr Silver
I was referring to cases of extractions when I leave the membrane exposed to the oral cavity.This is done in order not to shorten the vestibule and to gain keratinized tissue.The non resorbable ctyoplast membrane is taken out 30 days post extraction. A collage membrane exposed will resorb too quickly.
Dr. Mazor can you explain your rational in sockets?
I to like CaSO4 but I dont understand your rational. Why place only bio-oss if an implant isnt considered? Why not mix CaSO4 with a mineralized product like puros or FDBA? I find CaSO4 mixed with Puros turns over really well. What have you seen in your histology studies?
Rational for sockets
The goal of implant therapy is to place the implant in native bone and not in graft material.All of us have the experience of drilling in sockets previously grafted with Biooss and have the feeling of drilling in particles and not bone.Histologically we find 18-20% of vital bone in these sockets.On the contrary in sockets grafted with resorbable materials one will find three times as much vital bone and in some occasions 100%.Wouldn't we like to have our implants placed in that bone?
As for sinuses it seems that this is not an issue and all bimaterials are suitable.
Ziv couldnt agree with you more. What CaSO4 are you using?
Ziv I agree with you. Many times I go in a socket grafted with xenograft and the particles are flying out. I started using CaSO4 and I see a difference. Do you use calmatrix and calforma or do you use another? Do you always mix with FDBA? Looking forward to your balloon course. Brooke.
Type of CASO4 for Brooke
Hi Brooke
The one i'm using lately is called Bond Bone coming from Israel which will be soon in the US market.It's characteristics are much superior to the other CASO4 available in the market because of it's ability to harden within 1 minute and stabilize the augmented defect.
Please send me your email to mazor2@yahoo.com and I will forward you additional details.
Bone Graft Material: Question for Mazor
I totally agree with you with some exception:
1)For extraction defects- I use bio-oss
2) For big ridge defects- I prefer Regenaform.
3) For sinuses- Bovine to allografts.
Ziv look at Dr Pratt questions, what do you think of the issues with regenaform?
Bone Graft Material
For extraction defects I will use BioOss only if I need ridge preservation with no implant placement.Usually when implant is considered I would use a material capable of remodelling and transformed to native bone.My preference for sockets is Allografts and CASO4.If a buccal plate is missing I would use Biooss and a membrane only on the buccal surface to prevent resorption.
For sinuses- doesn't really matter what you're using-everything will work.
For large defects- Regenaform is my choice.
As for the bleeding- in order to prevent difficulties release the flap at the beginning of the procedure and by that you will have decreased bleeding while placing the Regenaform.
GBR Graft Materials: Lifenet FDBA or Puros Cortical
My mainstays are Lifenet FDBA or Puros cortical. Very easy to build out a ridge. I usually add PRP or PDGF to the graft for healing.
GBR Bone Graft Materials I like: Regenerform, Biooss, Puros
I myself favor Regenereform for GBR procedures works well for building up a ridge.
I like Bio-oss for Sinus and Extraction sockets.
I also like Puros for sockets and Sinus's as of of late.
I get consistent results every time.
GBR Bone Graft Materials: Regenaform, Biooss, Lifenet
I like Regenaform for GBR procedures works well for building up a ridge but still favor blocks.
Biooss for Sinus and Extraction sockets is a mainstay
I use alot of lifenet FDBA, awesome product.
Tenting screws can be critical.
Which material to choose
That is a subject that can fill up a full day.
There is a huge difference depending on the type of defect.
1)For extraction defects- Use any material that has the capability of remodelling because we would like vital bone. FDB or CASO4 or bTCP are my preferred ones.
2) For big ridge defects- I prefer Regenaform.
3) For sinuses- does not matter.From Bovine to allografts and alloplasts.
Ziv what do you like about regenaform?
What do you like about regenaform? What is your technique in mixing it. I used it a couple of times with mixed results. The block tended to break apart in the site that was bleeding. Any tips?