Osteogen Plugs vs Other Plugs?
Collagen plug and graft combination products are becoming quite popular in dentistry. These products aim to simplify socket preservation by interlacing a standard collagen plug with synthetic graft or xenograft material.
The most popular product in this category continues to be the Osteogen Plug, which takes a collagen plug and fills it with OsteoGen non-ceramic crystals, a resorbable calcium apatite based graft (a non-ceramic production process yields a unique resorbable bone graft with a unique Ca:P ratio that is not a ß-TCP and not a non-resorbable dense ceramic HA). However, there are competing products to the Osteogen Plug, and very often we get questions about how the Osteogen Plug compares to similar collagen/graft combination products.
In this post, we will summarize all the alternative products and provide a brief summary of the differences between these products, and the Osteogen Plug, along with our final assessment.
Calcium Carbonate Plugs vs Osteogen Plugs
There are various collagen plugs that include calcium carbonate with the collagen plugs. Some brand names include: Osteoplug (Implant Direct), RegenerOss Plug ( Zimvie), and SocketPlug (Straumann).
The difference between these plugs and Osteogen, is that Osteogen is a calcium-apatite based bone graft, while these other products are calcium-carbonate based grafts. Without getting too technical, the point is simply that the chemical nature of the synthetic grafting material used in these products is different, and this has a substantial effect on the clinical performance of the calcium carbonate plugs vs the Osteogen Plugs.
Specifically, with the calcium carbonate-based plugs, as opposed to the Osteogen Plug, there are two main issues. Firstly, calcium carbonate has a longer resorption time (9 to 12 months), as compared to Osteogen (resorbs in 4 to 6 months), and this has significant implications for healing time and future implant placement.
Secondly, for some reason, combining the calcium carbonate with collagen yields a lighter collagen, which causes poor handling during socket preservation. Very often the calcium carbonate plug will fall apart due to its soft consistency, and because of this a membrane will likely be required with the calcium carbonate plugs or there is a risk that the graft can ooze out of the socket. The Osteogen Plugs, however, have a stronger collagen structure and for most clinical situations you will not need a membrane (please see the IFU for specific considerations regarding a membrane).
Our conclusion: Osteogen Plugs are preferred over other synthetic collagen plugs, due to the inherent chemical properties of Osteogen, which ultimately produce a better plug.
Non-Resorbable Xenograft Plugs vs Osteogen Plugs
Another group of plugs uses xenograft as the graft material that is combined with collagen. These are sold under various brand names, like MinerOss X Plug (BioHorizons) or NuOss XC (Ace Surgical). The assessment of these plugs vs Osteogen Plugs is a bit less clear.
As opposed to calcium carbonate plugs mentioned above, the collagen structure of the xenograft-based plugs is good. The main issue, therefore, is that they are using a non-resorbable xenograft as the graft material as opposed to Osteogen, which is a resorbable synthetic graft. Xenografts leave behind dense particles,and are not ideal to drill through when placing an implant. So while some clinicians prefer xenograft materials, they are not necessarily the material of choice for socket preservation.
Our conclusion: If your preference, in general, is to use a xenograft for socket grafting, then you might prefer xenograft plugs over the Osteogen Plugs. However, if you are not a fan of xenografts or don’t use them, then Osteogen Plugs should be your choice.
Cross-Linked Atelo-Collagen Plugs vs Osteogen Plugs
There is a product called FOUNDATION which is marketed as a bone filling augmentation material. Foundation is made of absorbable atelo-collagen. The atelo-collagen has been cross-linked by heat treatment in order to achieve biocompatibility, and presumably to improve the resorption profile. Foundation is not a bone substitute, but rather a collagen plug that is supposed to stimulate new bone growth.
The difference between Osteogen Plugs and Foundation is that FOUNDATION does not include any graft material whatsoever. In fact, the marketing materials clearly state that it is not a bone substitute, as mentioned above. Osteogen Plugs, on the other hand does contain a proven graft material, Osteogen, along with the collagen plug.
Our conclusion: It is generally beneficial to deliver an actual graft material to the extraction site, and as such, we recommend Osteogen Plugs over Foundation when you are reaching for a combo collagen + grafting product. In cases, where you do not need or want a graft, or you plan to use standard grafting materials (like cortical cancellous bone mix) a standard non-cross linked Collagen Plug is probably your best option.