maxgraft® bonebuilder is made of cancellous human donor bone. maxgraft® bonebuilder originates from femoral heads (taken during hip endoprosthesis surgery) of living donors in certified procurement centers in Europe.
It is produced at the Cells+ Tissuebank Austria (C+TBA) situated in Krems (Austria), a non-profit organization aiming to provide allogenic bone grafts for orthopedic and dental regeneration.
The planning phase is dependent on the quality and complexity of the scan and the amount of additional information given during order submission. Usually, the first design proposal is provided to the surgeon after 1 week. In case of feedback loops and adaptations, this process might be prolonged. The design will be changed according to the surgeon’s demands as often as necessary without additional charges. The final design confirmation needs to be provided by the responsible surgeon by submission of the written order form. Then, maxgraft® bonebuilder will be produced and shipped within 4–5 weeks.
The maximum size for each block is 23 x 13 x 13 mm. In patient cases with multiple or larger defects, several blocks can be designed and used. This is due to technical reasons; for milling of the blocks in the CNC milling machine the blocks are fixed on one end in the machine. To avoid fractures during milling a maximum size was defined based on the experience of the producing tissue bank C+TBA.
maxgraft® bonebuilder should be rehydrated briefly before fixation by placing the block inside a disposable syringe filled with a sterile saline solution and creating a vacuum to remove excess air trapped within the block. An instructional video is available at the botiss youtube channel and the botiss website or can be requested at firstname.lastname@example.org.
If possible, mix the saline solution with the exudate serum obtained from preparing autologous platelet-rich fibrin (PRF) matrices. Rehydration may be useful, especially for blocks with large and complex dimensions by enhancing the adaptability of the material to the specific defect site.
maxgraft® bonebuilder should be fixated at the recipient site with osteosynthesis screws- preferably flat-headed screws to avoid perforation of the surrounding soft tissue. No self-tapping screws should be used to prevent breakage of the block. The application of excessive force might cause damage to the block graft. Screw position and screw length can be estimated by the surgeon using the 3D-PDF to perform measurements. . For most defects, screws with a diameter of 1.2–1.5 mm and a length of 8–11 mm are suitable. Countersinking the bold head of the screw into the block is recommended as the head may irritate the soft tissue; a diamond bur can be used to create the countersink.
The allograft needs to be immobile for optimal contact between the local bone and the allograft. In order to prevent perforation of the soft tissue, all sharp edges need to be removed; a diamond bur can be used for this process. It is essential to avoid any contact with saliva while handling the bone block to reduce the risk of contamination.
No, as this depends on the correct surgical screw position and screw length chosen by the surgeon based on the intraoperative clinical situation and position of anatomical features such as nerves and blood vessels. Characteristics such as block thickness and screw position can only be estimated by the responsible surgeon when using the 3D-PDF.
For GBR procedures, the use of barrier membranes is of utmost importance. Resorbable collagen membranes act as temporary barriers against ingrowth of fast proliferating fibroblasts and epithelium into the defect, maintaining the space for controlled bone regeneration. In combination with maxgraft® bonebuilder, the use of Jason® membrane – a pericardium membrane that provides a naturally long barrier function – is recommended.
No, maxgraft® bonebuilder is indicated for two-stage alveolar ridge augmentation. Depending on the location, type and extent of the defect, healing times are approximately six months.
The volume loss after augmentation varies and is also dependent on the defect size and geometry. For horizontal single tooth reconstructions with cancellous maxgraft® blocks minimal volume loss has been documented (Kloss et al 2018). Other authors have published an average volume loss using cancellous allogenic blocks of about 5-10% (approximately 0.5 mm) (Nissan et al 2011). However: Volume loss in combined vertical and horizontal defects may be higher and is influenced by a number of different factors.
Nissan, J., Ghelfan, O., Mardinger, O., Calderon, S., & Chaushu, G. (2011). Efficacy of cancellous block allograft augmentation prior to implant placement in the posterior atrophic mandible. Clinical Implant Dentistry and Related Research, 13(4), 279–85.
Kloss FR, Offermanns V, Kloss-Brandstätter A. Comparison of Allogeneic and Autogenous Bone Grafts for Augmentation of Alveolar Ridge Defects – a 12-Month Retrospective Radiographic Evaluation.; 2018. doi:10.1111/clr.13380.
Mr. Goran Nikoloski
+49 30 20 60 73 98 35
We offer the printing of individual 3D models.
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