A Paradigm Shift in Bone Grafting
The Do's and Don’ts of SteinerBio Bone Graft Products
SPECIFICATIONS FOR SOCKET GRAFTING
Socket Graft: a packable putty, used when all walls remain after extraction (graft comes in a tray)
Socket Graft Injectable: a non-packable putty, used when all walls remain after extraction, inject and cover (graft comes in a syringe)
Socket Graft Plus: a packable putty, used for all socket grafting situations including missing walls and small ridge augmentations (graft comes in a tray)
These bone grafts are not intended to set up after placement and should be covered immediately with a d-PTFE membrane after the sockets have been filled.
After tooth extraction, do not manipulate the socket wall other than to remove granulation tissue. The less trauma, the quicker the healing process and the less pain your patient will experience. (see Atraumatic Extraction Method)
If using Socket Graft Injectable, follow the same steps as above, but since it is an injectable, it does not require packing. Simply fill the socket and cover with a d-PTFE and remove the membrane after 1 month. If extra graft material is available, overfill the socket and use the membrane to displace any extra graft material. This will fill any voids that may be present.
The inflammation caused by foreign proteins in these membranes and sutures will compromise SteinerBio bone graft products. (see Sutureless Membrane technique)
Due to the osteogenic properties in our bone grafts, bone regenerates more quickly than other bone grafts, giving the clinician the ability to place their implants 1 month after grafting or at membrane removal. However, if you are new to these products, we recommend waiting 3 months after grafting to place your implants. This will allow you to become familiar with the characteristics and handling of the material. (see 1-month Implant Placement)
Evaluating implant placement via torque is worthless with SteinerBio grafts. The reason SteinerBio bone graft products do not require torque when seating the implant is because during the process of osteogenesis, as the osteoblasts are secreting osteoid, the osteoid gets placed onto the implant surface creating bone to implant integration. During the process of torquing, the bone gets damaged and the bone that produces torque will be resorbed and replaced. SteinerBio graft materials produce integration when floating the implant in graft material with no bone contact. Superior integration comes from superior osteoblast vitality, not the hardness of the bone in contact with the implant during placement. (see Implant Floated in Graft)
The less trauma caused to the socket during extraction, the quicker the healing process and the less pain and inflammation your patients will have afterwards. When you apply force to the tooth, that force is transmitted into the bone. The bone does not bend or flex when you force out a tooth- it is fracturing. Bone absorbs force via microfractures that you do not see but millions of these fractures is what allows the socket to expand and the tooth to be removed. Everyone of the microfractures creates an inflammatory response that results in resorption of the damaged bone and then repair of the microfracture. If the extraction is traumatic, the resorption of the microfractures can result in the loss of complete socket walls over the following weeks. When extracting a tooth, destroy the tooth but not the bone. (see Atraumatic Extraction Method)
Systemic antibiotics are indicated.
Other Specifications by Product
Sinus Grafting Using Sinus Graft
Use a minimally invasive small osteotomy technique and lift the membrane hydraulically via injection of Sinus Graft. Minimally invasive surgery is always superior (if a large lateral window is required, use Ridge Graft Kit to regenerate the sub-antral maxilla). After the sinus membrane is lifted, place your implants at time of lift and load them 3 months later. All SteinerBio materials have been proven to produce implant integration to the grafted site of the implants making delayed implant placement unnecessary.
(see Steiner Sinus Lift)
If you perforate the sinus membrane, it is ok. The material will wash out the back of the patient’s throat and will not stay inside the sinus membrane due to its flowable viscosity. As long as the material remains underneath the perforated sinus membrane, you can still achieve the hydraulic lift. The sinus membrane will repair itself in a matter of days. If the membrane is destroyed, remove it from the floor of the sinus and fill with Sinus Graft and place implants. The sinus membrane over the graft is not needed. Simply use the flap created for the osteotomy and close it with sutures or Oral Bond (no sutures needed). Immediately after the lift, place your implants and load them in 3 months.
Note: Working time to place your implants after the hydraulic lift is about 30 minutes, the graft material will set inside the dry sinus. If the material sets, use your drill set to create the desired osteotomy for implant placement in order to avoid lifting the graft material off the floor of the sinus.
Immediate Implant Placement Using Immediate Graft and BioDensification
Create the osteotomy exactly at the angle you chose and fill the voids with graft material. When a large portion of the implant is not in bone, first fill the socket with BioDensification and then place your implant. Since Immediate Graft contains βTCP granules, it is not recommended to fill the apical portion of the osteotomy before placing the implant as the βTCP granules will interfere with the seating of the implant. Instead, Use BioDensification in the apical portion for filling all voids and then drive your implant into the filled osteotomy. Use Immediate Graft, which contains βTCP granules to fill the crestal portion of the voids and cover your implant with a d-PTFE or seal the gingiva with a healing abutment or temporary crown. If primary closure is possible, a membrane is not necessary. If the defects around an immediate implant are large, simply fill the socket with BioDensification and place the implant.
As with all of our bone graft products, BioDensification was also designed to cause integration to the implant surface. Therefore, when you remove your spinning implant, fill the osteotomy with BioDensification and replace your implant. The osteoblasts will migrate through the graft material and secrete osteoid onto the implant surface causing bone to implant integration saving your implant, having to regraft, sending your patient back home and waiting for the bone to regenerate the osteotomy site.
If the site has been previously grafted with a cadaver bone graft, the bone will never regain its vitality and you can expect poor results from any subsequent grafting procedure irrespective of the graft material used. If an implant was placed in a cadaver bone graft site and the implant is lost, all future implants will have a poor long-term prognosis. The only possible way to overcome this problem is to remove all of the sclerotic bone created by the cadaver bone graft. This requires aggressive bone removal.
Simple Ridge Augmentation Using Ridge Graft Kit
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