Synthetics HA, TCP, minerals

Wheaton cosmetic dentist Bryan Bauer

Biphasic calcium phospahte bioceramics like HA (slow) and TCP (fast)
Nanobone by Artoss – nanocrystalline HA embedded in silica gel matrix
IngeniOs HA by Zimmer – Synthetic Hydroxyapatite
Bone Ceramic by Straumann – biphasic calcium phosphates “not simply a mixture of HA and TCP, but is chemically synthesized as a composite to ensure homogenous distribution of the two phases”  Graft buccal of immediate implant in anterior
Healos by Orapharma – 70% type 1 collagen with HA on collagen fibers

Synthograft – pure phase Beta-Tricalcium Phosphate

PepGen P-15 –  synthetic biomimetic of the 15 amino acid sequence of Type-I collagen
IngeniOs B-TCP by Zimmer – synthetic 100% silicated β-TCP
Osteon by Dentium –  70% HA + 30% β-TCP
Osteon II by Dentium – 70% β-TCP and ???
Dentagen by SAS – calcium sulfate hemihydrate
Dental Putty by Novabone – bioactive synthetic bone graft dental (calcium phosphosilicate in binder)
BONDBONE by Mis – biphasic calcium sulfate Calcium sulfate is the graft material with the longest proven history in bone augmentation procedures. It has been used for more than 110 years
in orthopedic, plastic surgery, oncologic, and maxillofacial surgery. It is one of the most studied and documented materials in clinical literature. Calcium sulfate is highly biocompatible and, since it is entirely replaced by bone, is biodegradable, having the ability to promote bone formation.

Calcium sulfate is available in three different phases: i.e. hemihydrate (CaSO4 * 1/2H2O), dihydrate (CaSO4·2H2O), and anhydride (CaSO4). When exposed to water, anhydrite readily transforms to the more commonly occurring gypsum, (CaSO4·2H2O) by the absorption of water. This transformation is reversible, with gypsum or calcium sulfate hemihydrate forming anhydrite by heating to ~200°C under normal atmospheric conditions.The hemihydrate phase has two different forms, alpha and beta, that differ by their crystalline structure and their hardness. The anhydride phase
is not used in bone augmentation procedures.

Bone augmentation is done in either the hemihydrate phase, the dihydrate phase, or a combination of both. When using calcium sulfate in its hemihydrate phase, it has cement properties.

Calcium sulfate hemihydrate transforms into dihydrate when it encounters water or aqueous solution, forming a solid mass in a process called setting. Therefore, once the material is implanted in the defect area, it is always in the form of dihydrate. Yet, due to the fact that blood and saliva prevent complete crystallization, the material formed has partial crystallinity, offering poor compressive strength. In that case, the implant can be washed out during the procedure, while the obtained results of the implantation are unpredictable.

The advantage of using calcium sulfate in its hemihydrate form is its cement like properties. The disadvantage of the hemihydrate form is the fact that the material cannot set in the
presence of blood and saliva.  In order to overcome the disadvantages of the dihydrate form of calcium sulfate, companies offer calcium sulfate in a post-setting form, i.e., dihydrate. The crystallization is performed within a controlled environment in the lab or plant, and then the material is ground into granules or plates. Now the clinician can use the material directly in its dihydrate phase without concern for improper crystallization or poor mechanical properties. However, the trade-off is the fact that the material is neither moldable nor cementable.  In order to overcome those drawbacks, we at Augma Biomaterials created biphasic calcium sulfate under the commercial name BondBone®. The biphasic calcium sulfate overcomes its predecessors by
providing moldability and cementability properties even in the harsh environment of blood and saliva. The setting is fast presenting a solid dihydrate mass, which offers the clinician outstanding handling properties.

The idea behind the development of biphasic calcium sulfate was to avoid adding any additives, polymers, or accelerators in order not to change or interfere with the purity of the material and its
efficient and known clinical characteristics. BondBone® is a pure calcium sulfate composed of the two phases, hemihydrate and dehydrate, in a granulated powder form. Therefore, it does not contain additives.  In addition, hemihydrate together with dihydrate always transforms into dihydrate. Thus the defect will always be implanted with the calcium dihydrate form during the post-setting phase.