Bondbone (calcium sulfate alloplast) washing out: thoughts?

Whilst Bond Bone is a very good CaSO4 one has to be cautious about the manufacturers blurb , " Bi-phasic etc " it needs to be used in the manner that CaSO4 s are as an particulate "bonder" or a membrane. Mixing the hemi-hydrate with the di-hyrate component helps it to set but does not make it bi-phasic and thus when used in your situation ( socket graft ) needs to be mixed with a BTcP or highly porous HA synthetic graft material as patient dependant it will bio-absorb too rapidly thus not providing a scaffold for bone formation. Anther tip is to let the site heal for 3 weeeks then graft as you would have some soft tissue closure to reduce wash out. Peter

This is why I use a membrane on every socket graft I do. I don't rely on setting materials. Additionally, the mouth is a wild place. Who knows what your patients do with their tongue after they leave your office.

I have used synthetics in areas the implant placement is not critical, even when allografts are used if packed too densely you get good space maintenance but less quality bone. In an esthetic area my materials of choice are allograft with an esthetic primary closure or a Teflon membrane to get guided tissue. You get a great result. Remember that the lateral incisor area is thin and difficult to restore, often a connective tissue graft is often necessary for esthetics. This graft will have to be redone, I let the wound granulate in, open a flap and restore as above seeing how much buccal plate collapse you have. I don't understand he rationale for using a synthetic in this esthetic area. I feel that the practioner has to use discretion in selection of restorative materials based on result not ease of placement or cost. I often hav to redo these type of cases but I don't want to offend my referring doctors ( general and specialists) work. Believe me I have had failures and had to do revisions so please don't take this as a criticism just sharing my experience. Good luck

Calcium sulfate will never set in an extraction site. Calcium sulfate is water soluble and needs to be dehydrated for set to occur and this never happens in an extraction socket. Greg Steiner Steiner Laboratories

After 10 years and 1,500 synthetic grafts without the use of a traditional membrane I feel I am beginning to understand concepts that are utilised by our Orthopedic friends.Greg you can get CaSo4 to set which we showed in research at the EAO last year although I generally use poly lactide coated BTcP products where obvoiusly soft tissue closure cannot be achieved.. Technique is everything I routinely place implants in large defects sometimes even without primary stability and load at 10 weeks . The body wants to heal if we work with it. We have cores , micro CT even Synchrotron CT studies. Interesting area , as I say sometimes just because I cannot climb it does not mean that it cannot be done. Peter

Peter, thank you.

Peter uses Infuse

Dear OMFS , stiil banned here in Europe ,maybe wisely..... Do not really need it anyway, I prefer not to cross species any work on my patients. Regards Peter

Infuse -----a bit expensive, yields very soft bone and the inflammatory reaction can have serious consequences. The bond bone most likely washed out because the patient did not follow post op instructions or it was poorly contained. When using any graft material, the patients marrow blood has to be incorporated.

Peter If you can get pure calcium sulfate to set in an extraction site you are defying the laws of chemistry. Calcium sulfate has a high Ksp and will not participate unless dehydrated after mixing. If you put mixed calcium sulfate in a closed container it will never set. An extraction site is a closed container infused with water. We use calcium sulfate in the lab and in the clinic when we want something to wash out in physiologic conditions. If you are modifying calcium sulfate or adding something to it to get it to set then it is not calcium sulfate. I would enjoy seeing the cited research. Aloha Greg Steiner Steiner Laboraotires

Hi Greg as you know Bond Bone is a mixture of Hemi and Di-hydrate which appears to help in this setting where there is generally an excess of blood . This as you know can be achieved with "normal" CaSO4 by using some and mixing it into you second mix which is in fact what BB is. I will send you the research we did when I get back from the US next week . Regards Peter

Hi Greg , agreed on the mixing as that is what I do daily and that is what I warned the poster about. You are in an enviable position in Hawaii as weather not great. Regards Peter

Any graft material can wash out if exposed to the oral environment. To solve this problem for our grafts we developed Socket Seals and they should solve the problem you are having with calcium sulfate. Greg Steiner Steiner Laboratories