It seems like every company out there is trying to reinvent bone grafting techniques. Usually in cases like what I am going to show you is either done by a block graft and screwed in from a donor sight, or the area is done by Khoury technique where you take a block graft section that screw that in to the area with screws and leave a space in between the block and the ridge then fill in the space with autogenous bone you collect from using a bone scraper by Salvin or another company. Another way is using a custom bone graft made by Straumann. That then is fixated to the ridge and closed. Another way, is the bone ring by Straumann, which I still need to take the training. With the bone ring, I could graft and also place my implant at the same time. Another way is to put tenting screws and then graft with allograft and a membrane using titanium mesh or not. Lets not forget about the tunnel technique where you make an incision in the mucosa, free up the connective tissue around the area to be grafted, scrape the bone in the area to get it to bleed, insert a resorbable membrane when it is rigid, graft in between to the ridge, then suture up the mucosa.
Today’s patient was actually a patient in Concord M2 in 2017. He ended up being a patient that his defect was so bad that Dr. Engel who was working with the doctor I believe stepped in to help clean and grafting was not done do to basically a 2 wall defect and that Dr. Engel could see the IAN.
The area healed for over a year and here are PA’s monitoring the healing.
The material I am going to use in this case is called Augma Bone Apatite. It is a synthetic osteoconductive bioresorable bone graft cement composed of Biphasic Calcium Sulphate and HA particles in a powder form.
It claims that you will be able to place and stabilize the graft in less than a minute. That you will be able to place or load implants within 3 months. Finally that no membrane placement is required. That all sounds great but it sounds to good to be true. We will see. So lets talk about the case.
Cone beam was taken of the area and it was determined the width of bone was not ideal unless you placed the implant and had an extremely large crown.
Even though you have a wide enough space to place and implant it still would leave the patient with a huge lingual shelf. It would resorb in time, but the implant to crown ratio would leave a huge contact space on the mesial that would be difficult to clean. I suggested to the patient that we should do a bone grafting for the area but looking at patient and giving him his options he decided that he wanted to try the Augma Bone Cement.
Area was numbed, full thickness flap was reflected.
Area was decorticated to get blood flowing.
Augma bone cement was taken and sterilized package was opened up.
Take your finger and hold the one side when you push the plunger to mix the material to prevent the bone cement from going everywhere. Push the plunger to the blue line. Then place your graft.
After you place the graft you have a three minute working window. Take a sterile gauze and put pressure on the graft for three seconds. This condenses the graft and helps you form the shape you want.
According to what Augma says you do not need a membrane. If you look at the video on youtube it shows placing a membrane. Since this is not autogenous bone, I went with a membrane. In fact I went with a resorbable then on top I placed a non-resorbable just in case the stitches ripped open. I was able to achieve a tension free closure. Augma says you do not need tension free closure. If your stitches rip and the area opens up I feel you could lose the graft. I went with tension free closure backed up my a non resorbable membrane.
The patient came back in two weeks for suture removal and he looked fine. No problem and he said minimal discomfort throughout the healing. The patient then called me a week later and he said the area felt like it was opening up. The non resorbable membrane was in tact and the tissue looked pink with just a little inflammation.
I will remove the membrane in another 3 weeks. I took a mini CT scan of the area after 3 weeks to see how the graft is doing and it looked like this.
Pre op width was 3.8 mm and post op length was 10.6 mm We will see if such a simple procedure done can improve a patients ridge horizontally and vertically. I will monitor the patient over the next three months and we will see if Augma bone cement holds true to its claim. My go to is tenting and placing a 50;50 mix of xenograft and allograft. After placement I add a resorbable membrane and tension free primary closure. I-PRP is normally used.