Doug Kase
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 ALCIUM
SULFATE has an impact on surgical endodontics and repairs of perforations,
both resorptive and unintentional iatrogenic in origin. In everyday life
we find calcium sulfate all around us. Just look at a sheetrock and plaster
wall. It’s a calcium salt that is used for a variety of purposes, including
building materials, as a desiccant, in dentistry as an impression material,
cast, or dye, and in medicine for immobilizing casts. It exists in various
forms and states of hydration. For example, plaster of Paris is a mixture
of powdered and heat-treated gypsum.
In its hemihydrate form (calcium sulfate hemihydrate),
it can be used as a bone graft material. The product BoneGen®, sold
by the company Bio Lok, caught my eye as I wandered down the aisles at
the Greater New York Dental Meeting. The use of calcium sulfate in
bone regeneration dates back more than 100 years. It has been extensively
studied for bone regeneration purposes in many animal models and human
clinical studies in the United States and Europe. BoneGen, when implanted
in the body, completely resorbs and leaves behind a calcium-phosphate--based
osteoconductive scaffold that enhances bone regeneration. According to
the company’s literature, this product inhibits non-osteogenic cells, stimulates
blood vessel growth in filled defects, is totally resorbable, safe and
osteoconductive. It also allows secondary intention healing, can be mixed
with other bone graft materials, works as a hemostat, is easy to handle
and place, and is inexpensive. BoneGen (calcium sulfate hemihydrate) is
indicated for use by itself in bone regenerative techniques, mixed with
other suitable bone filling agents to prevent particle migration in an
osseous defect, and to provide a resorbable barrier over other bone graft
materials.
These characteristics are ideal for a material that can
be placed into an osseous defect associated with an apical lesion that
is subsequently enlarged when performing an apicoectomy. The fact that
it is initially hemostatic is a great advantage when trying to control
bleeding from the apical bony crypt during an apicoectomy. The hemostasis
allows for better visualization during root prep and retrograde filling.
The fact that it inhibits non-osteogenic cells in combination with its
osteoconductive and osteogenic properties should help to prevent the formation
of an “apical scar,” which indicates a non-pathologic fibrous tissue and
incomplete bone fill.
Since MTA cement has increased the success rate
of root perforation repair, BoneGen is a perfect barrier to pack the MTA
against. It can be pushed through a perforation into the bone beyond the
root or even into a bony defect, and once it sets it will act as a matrix
against which we can pack our MTA. An additional use in endodontics would
be to plug an open apex and provide a barrier against overfills and extrusions.
It also can be used in post-extraction alveolar bone issues, periodontal
defects, and implant placement.
Thus I had the pleasure of receiving my order and
quickly learning to use the material for an apicoectomy on a maxillary
bicuspid. The surgery was uneventful, and thus far BoneGen has lived up
to its promises of ease of use, hemostasis, and filling of the osseous
defect. The following are the product instructions for use during an apicoectomy:
Following root resection, apply a layer of BoneGen into the
crypt and compress with gauze, thus obtaining hemostasis. Prepare the root
end cavity and place the retrograde filling. Then fill the crypt with BoneGen,
placing in layers and in slight excess. Wet the final layer with FAST SET
liquid in order to allow for rapid hardening, and then suture.
I have used it in a perforation repair as well, and
it also seemed to do what was promised. Unfortunately, I can’t report any
long-term results yet, for it’s too short an interval for a post-operative
follow-up. So far though, BoneGen gets five out of five stars.
January-March 2006
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FIGURE 1: BoneGen packaging.
FIGURE 2: BoneGen is supplied
in sterile single-use packets.
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