Graftless open lateral sinus lift?

Possibly change your BTcP as we routinely load at 10- 12 weeks even with only 1 or 2 mm of residual bone achieving Osstell readings in the high 70 s. Not using a material whilst it may work is definitely not optimal as a scaffold is a big help and sealing the window with a material that sets is helpful as well . The TcPs we have core sampled ( dozens of cases ) and our animal studies indicate up to 80% of the material has turned over at 10 weeks . Pubmed our rabbit study . Peter

If you tent the membrane with the implant apex, all you need is L-PRF. There are several studies showing outstanding early healing and mineralization using autologous biologics alone (Z. Mazor and A. Simonpiere papers). Why use expensive alloplasts/allografts when you get a better biologic directly from the patient. My per case cost is always under $10 US, the patient appreciates not using tissue bank or synthetic bone substitutes, and you get 100% vital bone in the graft site. One additional reason I use it is that there is a near total absence of infectious events post-grafting. RJM

Hi Dr Young like all cars are different , so are BTcP materials , the size and porosity are critical in their performance . I only use very small windows using Dask and prefer lateral as quick , easy and safe ( No tears in 4 and a half years doing a case or 2 per week ) so no membranes as the materials I use set due to a CaSo4 element and are thus stable . We feel that membranes may inhibit the healing process and thus I have not used 1 in the last 13 years . I agree Robert , about L-PRF and have seen a lot of great work with internal lifts using it with very impressive results . In fact I have invited Dr Choukron to come to speak to my group in London in 2 weeks time. But the 10 Dollars bill does not include the cost of the centrifuge and the training which must be factored in as well as the time ..... The BTcp ( with Caso4 ) is fully bio-absorbed over time and is Biocompatible and bacteriostatic ( I too have never had an infected sinus case )... Many different ways and materials which all work well in different hands Peter

Bob, Well said!

For about a year we have been using PRF with autogenous bone taken from the patients 3rd molar area...the bone growth in the sinus cavity has been dramatic to say the least. I know a lot of folks (doctors) will not like the second surgical site...but my patients don't seem to mind at all...when it is explained to them honestly and correctly.

I use fully synthetic calcium triphosphate gratf material (Vital) and no issuse - complete bone conversion and no islands of xenograft floating around

I want to make a reflection: when one extracts a tooth, which happens in the alveoli? It is filled with blood and occurs a clot that it starts the entire process of new bone. This must also happen when placed an implant within the breast, forms a clot and the implant makes a tent that keeps Snaider membrane and is organized a clot.

Peter, Thank you. It means a lot coming from you. It still sinking in. The AAID a is a wonderful organization. You keep up the good work!

Hi all Where can I buy this material in the USA. I have searched everywhere. Is bone bond from MIS the same product? Thanks

Sadly, not unless in the Orthopedic area ( Genex ) , the US market is not really interested in the synthetic route as much as Europe is at the moment but I feel this will change soon . You do have a very good Synthetic material company run by the very knowledgable Greg Steiner ( Steiner Laboratories , Hawaii ) a poster on this site , google it. Yes Bond Bone ( MIS) and Dentogen are very CaSo4s but you need to mix them with other materials to optimise results . Regards Peter

Below is some information that I hope everyone will find useful about synthetic bone grafts in the US market. This is not meant to be an exhaustive discussion of these materials, but simply a basic intro. Basically, there are a handful of types of synthetic grafts available: Calcium Sulfate, Carbonate Apatite derived from animal bone, and Synthetic Calcium Phosphate materials (e.g., β-tricalcium phosphate, (β-TCP), and hydroxyapatite). Calcium Sulfate for dental use is available in the US under the brand name Dentogen. Dentogen has been around for many years, and has been the subject of numerous positive studies. Most clinicians in the US will mix DentoGen with allograft (e.g. mineralized cortical-cancellous bone particles), especially when used for larger defects, or even with another slower resorbing synthetic. BondBone is also Calcium Sulfate, so it's basically the same as Dentogen. The only difference, as far as I can tell is the delivery mechanism, i.e. BondBone is sold as a syringe. A positive for Dentogen, is that it comes with a fast-set solution (4% potassium sulfate) that helps form a putty in an accelerated fashion. There is also a new generation of DentoGen, called NanoGen, which is smaller particle size and has an advantage of being sustained release with a slower rate of resorption as compared to the original medical grade calcium sulfate. If you are interested in DentoGen and Calcium Sulfate in general, you can read more about it at DDSGadget.com. Under the DentoGen product you can see a list of research papers on Calcium Sulfate, as well as some case studies. If you run a search on OsseoNews.com, you can also find alot of discussions on synthetic grafts. DDSGadget.com also carries another synthetic bone graft from Collagen Matrix, called, SynOss, which is a synthetic calcium phosphate composite. There is a putty version of SynOss which is calcium phosphate plus Type I collagen. On the product page there are two case studies you can see for SynOss. In the US, β—tricalcium phosphate (β-TCP), is sold under the brand name, CeraSorb. It is sold by a company called Curasan/Riemser. There are numerous other synthetic bone grafts available in the US. Some clinicians like Bio-Oss. Bio-Oss is porous anorganic bone mineral with carbonate apatite derived from bovine bone. Bio-Oss is sold by Geistlich. Collagen Matrix recently introduced a new product called MatrixOss, which is a porous anorganic bone mineral with carbonate apatite derived from porcine cancellous bone (re: Bio-Oss is bovine and MatrixOss is porcine). In general, the comparison of different synthetic bone grafting materials for dentistry is based on the relative resorption time of the materials, with some materials having a much higher resorption rate than others (e.g. calcium sulfate, resorbs more quickly than other synthetic grafts). Obviously, the resorption rate will dictate the clinical application of different synthetic materials, as well as which materials may be used in combination with the synthetic graft to provide ideal results (e.g. mixing with allograft or another synthetic graft, like DentoGen + β-TCP). Another important requirement for synthetic bone grafts is related to the pore structure of the material. Some research indicates that highly porous material provides a higher degree of osteo-conductivity. Finally, there are issues related to the surface morphology of the synthetic material on a microscopic level, as surface morphology can help facilitate cell adhesion and migration. There are numerous studies on PubMed related to the three factors mentioned above, and of course, there are many other aspects to synthetic bone grafts that I have not covered here due to space/time constraints. A quick search on PubMed will provide an abundance of research articles for further study. Hope this is all helpful.

I have tried the synthetics over the years but I get the best results in my hands with cortical- cancellous human bone. I just prefer the feel I get in the newly regenerated bone when I place the implant. Just my personal preference.

HI CRS , I used to use Allografts for many years , but the new synthetics and concepts are a game changer in ease of use , consistent predictable results and patients love them as well .... no donor stuff . Cores also show over 50 % new woven bone at 10 weeks ! , we are slowly getting to understand more about what we can achieve . Regards Peter