• To promote regeneration of bone loss due to periodontal disease or tooth extraction using synthetic material.
• Bioactive, particulate, ceramic materials have been shown to be very effective.

Uses

• To treat vertical infrabony osseous defects caused by periodontal disease Periodontal disease.
• Filling endodontic-periodontic lesions Periodontal pockets.
• Filling traumatic periodontal defects.
• Filling intraosseous flaws related to pulpal floor or lateral root perforations.
• Filling tooth extraction site defects to maintain vertical height and width of the alveolar ridge.
• To produce supporting bone for loose teeth (combined with splint to solid tooth).
• Repairing fractures of the mandible when bone graft material is needed.

Advantages

• Rapidly bonds with living tissues (within 3 days) → security in defect site.
• Incorporates into the bone matrix without eliciting a foreign body response.
• Acts as a scaffold for bone production → rapid (from 7 days), extensive osteoproduction.
• In vitrostudies have demonstrated that the material actively stimulates osteoblast proliferation and differentiation.
• Bending strength and stiffness comparable to normal bone within 3 months.
• Completely replaced by normal bone/soft tissue within 18 months.
• Promotes gingival re-attachment and limits epithelial downgrowth → reduced periodontal pocket depth.
• Repairs and restores periodontium.
• Easy to use: easy to mix and manipulate, does not migrate from surgical site, adapts excellently to defect.
• No special site preparation required - material will bond even when not dry or blood-free.
• Bacteriostatic - allowing placement in areas of infection with good results.
• Hemostatic (mechanically).
• Radio-opaque allowing immediate and long-term observations.

Disadvantages

• Adequate post-operative home care isessentialto the satisfactory outcome of the technique.

Technical problems

• Requires good surgical technique.
• Careful case selection important.

Alternative techniques

• Freeze-dried demineralized bone grafts.
• Biologically active materials.
• Alloplastic materials.
• Guided tissue regeneration with/without graft material.
• Conservative treatment → spontaneous granulation.

Time required

Preparation

• Dependent upon site and extent of defect to be filled.

Procedure

• Dependent upon site and extent of defect to be filled.

Decision taking

Criteria for choosing test

• Should not be used in cases which:
  • Are receiving chronic anticoagulation therapy.
  • Are receiving immunosuppressive medication which may cause bone destruction/suppressed osteoblastic activity.
  • Have had or are undergoing irradiation of the jaw.
  • Are poorly controlled insulin-dependent diabetics Diabetes mellitus.
  • Have any existing condition or disease which will interfere with good mucosal and bone healing.
• Do not use where:
  • Endodontic or pulpal disease exists.
  • Mobile teeth are present, without stabilization.