SynthoGraft™ Technique Video

Hello, my name is Mauro Marincola and I am a dentist from Italy. I practice in Rome and I’m an associate professor at the University in Cartagena. In this video I shall introduce you to SynthoGraft, which is a biocompatible and resorbable synthetic granular ceramic made of beta tricalcium phosphate. It is used as a substrate for oral and maxillofacial bone regeneration or augmentation. The calcium phosphate based ceramics chemically interact with bone tissue and the resulting reaction between the biomaterials and host results in a gradual release of calcium and phosphate ions, which results in a higher osteoblastic activity for the generation of new bone. Several varieties of beta tricalcium phosphate are now commercially available, however, they are not all equal in their bone regeneration capabilities. Beta tricalcium phosphate differences can profoundly affect the rates and quality of bone regeneration as well as the rate of their resorption as it is being replaced by the patient’s bone during the healing process. SynthoGraft’s unique shape with micro and nanoporosity provides increased initial stability along with rapid vascularization and maximum bone regeneration when mixed with the patient’s blood. An important aspect of working successfully with SynthoGraft is how the material is manipulated. Now I shall tell you about the different techniques that I have used to consistently achieve excellent bone regeneration. The first step is to use an anesthetic without epinephrine, since we need sufficient bleeding at the surgical site to collect the patient’s blood with a syringe. Secondly, using a periosteal elevator, the collected blood is thoroughly mixed with the SynthoGraft granules for a few minutes in a dappen dish until the SynthoGraft is saturated with blood and a homogeneous putty like consistency of the material is achieved. Complete saturation of SynthoGraft is important for activation and releasing of the calcium and phosphate particles during the early stage of the surgical healing. Confirmation of a proper putty like consistency is seen by the materials ability to adhere to the periosteal elevator. The material is placed over the bony defect in incremental layers rather than in one application. Each incremental layer is compressed with a periosteal elevator. The excess blood is either absorbed within a SynthoGraft or through compression with the gauze. In cases where autogenous bone has been harvested, it should not be mixed with SynthoGraft, but rather used as a primary graft layer over the bony defect and subsequently with layers of SynthoGraft incrementally placed until the desired level of bone augmentation is achieved. Membranes may be used with SynthoGraft and are particularly useful for larger bone defects. Membranes are not necessary for smaller defects. For lateral sinus lift procedures SynthoGraft is prepared and manipulated in the same manner as it is for bony defects. However, once its consistency is putty like it is transported to the surgical site with a graft delivery instrument. The use of this instrument is fundamental to achieve a mechanically stable graft within the sinus cavity. Normally the mesial aspect of the sinus cavity is filled first, then the distal aspect, before completely filling the central region. The use of a resorbable collagen membrane is advantageous and recommended for lateral sinus lift augmentations. Wetting the resorbable membrane with the patient’s blood facilitates its handling capabilities as it is placed over the antrostomy. Finally, resorbable sutures are used to close surgical sites. Hopefully, my presentation will benefit you and your patients. Thank you for watching.