Bond Apatite: Bone Graft Cement

Protocols: Please be sure to read our protocols Section below for important advice on using Bond Apatite. The videos below also provide important tips and training.

Radiographic appearance: Due to the replacement of the cement into the patients own bone, the Radiographic appearance will vary during the healing period.

• During graft placement – Radiopaque
• 2-3 weeks post op – Radiolucent
• 12 weeks post op – Radiopaque

Bond Apatite Key Benefits

• Easy to prepare & Use! Delivered in a dual-chamber, prefilled syringe, containing the granulated powder and physiological saline.
• Self-setting cement, with an ability to attach to and set at the work site and to bond to granular bone substitutes, preventing them from moving.
• Membrane coverage is advisable but not essential
• Biocompatible
• Convenient to work with and shape – significantly reduces treatment time and makes the clinician’s work easier.
• Exactly the same as MIS 4Matrix. ¹

Bond Apatite®  is a combination of biphasic calcium sulfate with a formula of hydroxyapatite granules. This is a cement-based osteoconductive composite, synthetic bone substitute that is used for bone reconstruction in a range of dental applications and is intended for filling, augmenting and reconstructing the wide diversity of defects in the maxillofacial bones.

Bond Apatite® is FDA cleared and CE approved. Bond Apatite® is delivered in a dual-chamber, prefilled syringe, containing the granulated powder and physiological saline. Mixing the powder component with the liquid in the driver results in a viscous composite that is suitable for injection into the graft site.

Compared to prior versions of the driver, in which additional accessories had to be used to inject the saline into the driver’s head, this new development of the Bond Apatite® driver ensures easy and more convenient handling by the clinician.

Bond Apatite Clinical Applications

• Sinus floor augmentation

• Periodontal bone defects

• Dehiscence; fenestrations

• Alveolar ridge augmentation

• Horizontal defect (and crest widening)

• Filling bony defects pre implant placement

• Filling of cyst cavities

Bond Apatite Protocols and Tips

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  • Socket grafting with 4 bony walls

    Option 1 - Without flap reflection

    • No need to raise a flap.
    •  Extract the tooth and prepare the socket for grafting.
    •  Eject the cement into the socket.
    •  Press firmly over the cement for 3 seconds using dry sterile gauze and finger pressure. Do not use an instrument to push and compact the cement into the bottom of the socket. (If the interdental space is too narrow to accommodate direct finger pressure on the sterile gauze, then a mirror handle or similar instrument can be applied on top of the gauze).
    • Protect the cement by covering it with a collagen sponge and secure the sponge in place to the surrounding soft tissue by an initial suture thereafter with a cross stitch above. During the initial stage of healing, the cement should not be left exposed.

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    Option 2 - With flap reflection:

    • Before Flap reflection perform short mesial oblique vertical incision (up to 2 mm into the mobile mucosa).
    •  Raise full thickness flap, minimally as needed to expose the entire defect – (Do not perform any manipulation to get tension free flap. No horizontal dissection release cuts, and no brushing. the flap should be with tension during closure and not tension free).
    • Extract the tooth and prepare the site for grafting.
    • Cement application Eject the cement into the site. Place dry sterile gauze and press firmly for 3 seconds on the buccal and occlusal aspects.
    • Reposition the flap for maximal closure by stretching it directly above the cement (exposure of 2-3 mm is fine, but no more than that).

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  • Socket grafting (single or multiple extractions) when the buccal plate is missing and the bony walls frame exists.
    
    • Before Flap reflection perform short mesial oblique vertical incision (up to 2 mm into the mobile mucosa).
    • Raise full thickness flap, minimally as needed to expose the entire defect – (Do not perform any manipulation to get tension free flap. No horizontal dissection release cuts, and no brushing. the flap should be with tension during closure and not tension free).
    • Extract the tooth and prepare the site for grafting.
    • Cement application: Eject the cement into the site. Place dry sterile gauze and press firmly for 3 seconds on the buccal and occlusal aspects.
    • Reposition the flap for maximal closure by stretching it directly above the cement (exposure of 2-3 mm is fine, but no more than that).

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  • Lateral Augmentation /crest and ridge widening protocol: Defects with no bony walls frame 
    
    • Raise a flap: The flap should be minimally reflected in order to expose the entire grafted site. (The vertical cuts should be 2-3 mm into the mobile mucosa) Do not perform any horizontal periosteal dissection for release.
    • Prepare the site for grafting
    • Cement application: Apply the cement and press firmly for 3 seconds to adapt to the defect using sterile dry gauze. If needed, apply additional layer to obtain desired volume (slightly overfill). Press firmly with the dry sterile gauze for 3 seconds after each layer.
    • Flap Closure: Reposition the flap by stretching it directly above the cement for maximal closure (up to 2-3 mm of graft exposure is fine but not more than that).

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  • Sinus Lift Lateral Approach.
    
    • Activate the syringe and wait 1 minute before application.
    • Eject the cement into the sinus cavity through the sinus lateral window until 2/3 of the sinus is filled (During cement dispersion in the sinus cavity, if needed tap gently above the material with a sterile dry gauze to absorb the excess of fluid and blood).
    • For filling the last 1/3 and closing the sinus window. After activation of the cement (Do not wait 1 minute, eject it immediately into the site, place sterile dry gauze, press firmly for 3 seconds, and close the flap.

• Sinus Lift Crestal Approach.
  
  • Activate the syringe. After activation, eject the material into a dish and let it set for 3 minutes. Use the syringe as a carrier (Any other bone carriers can be used as well).

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  • Radiographic appearance
  • ** Due to the replacement of the cement into the patient own bone the Radiographic appearance is different as well .
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  • a. During graft placement –Radiopaque

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  • b. 2-3 weeks post op –Radiolucent

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  • c. 12 weeks post op- Radiopaque

Bond Apatite: Additional Tips

Socket grafting

In cases of four bony walls socket grafting, eject the material into the socket, and press frmly with dry guaze above the material; however, do not use any tool to push the material toward the apex as you are used to when working with granules (doing so will exert pain to the patient).

In case of socket grafting, if you choose not to refect the flap, do not leave the material exposed to the oral cavity. The material should be protected with a collagen sponge or a membrane which must be stitched together with the surrounding tissue (lack of physical graft protection will cause material and volume loss).

Periodontal Defects

In cases of periodontal defects, prior to graft placement, thorough debridement by scaling and root planning should be done. In cases of tooth mobility, the teeth must also be stabilized before graft placement.

Dehiscence and Fenestrations

The cement should be placed above the bone and the exposed threads of the new placed implant or above the exposed root after scaling and root planning. Remember to slightly overfill in order to compensate for graft shrinkage during the healing process. The cement is not indicated in cases when there are implant threads exposure of a previously (old) placed implant. In such cases, the outcome might be compromised as with any other grafts.

Lateral Augmentations & Crest Widening

Hard tissue preparation and soft tissue release should be done before activation of the cement (Decortication is optional). Place the cement into the augmented area and slightly overfll. Then press above firmly with dry gauze for 3 seconds to stabilize the material. You might shape, if required, and press again for 3 seconds. At this point, close the fap. (In large lateral augmentation cases we recommend to use additional horizontal mattress sutures for better soft tissue stabilization above the graft). Membrane coverage is not essential as long as your soft tissue is well stabilized, completely closed, and well sutured.

Vertical Augmentation 

In your first few cases, we defnitely do not recommend to use the material for vertical augmentations. After gaining experience with the cement, vertical augmentation can be done only if you are familiar with vertical augmentation techniques. As well, you must remember it is obligatory to use a rigid graft stabilization techniques (such as rigid bariers) to protect the cement from lateral movments during the healing phase. If you place the graft without rigid stabilization, your outcome will be completely compromised.

Sinus Lift 

Open sinus lift 

In a small to medium sized sinus cavity, you can use Bond Apatite® for fillng the sinus cavity and window closure as well (no need for membrane). In larger sinus cavities, it is less comfortable since you will need to place the material by incremental steps. In such cases, we recommend you to use your prefereable granules to fill 2/3 of the sinus, and the last 1/3 fll with Bond Apatite® cement as a graft enhancer and for window closure. This will save you time, save membrane cost and will enrich the sinus with ions of calcium.

Close sinus lift 

Due to the large size of the syringe opening, it is not recommended to eject directly the material from the syringe into the drilled cavity. The graft can be ejected into a dish and should be left for 3 minuets to set, and then can be crushed into small fragments that will be used in such case.

1. 4Matrix is a registered trademark of MIS Implants.