Hard Tissue regeneration CeraOss® HYA – The innovative 2-in-1 combination of bovine bone and hyaluronic acid
Clinical Cases The final crowns were placed one month later. Aesthetic results with healthy soft tissue conditions were achieved. Radiological control showed stable bone levels around the implant shoulders after seven months. Clinical examination showed complication-free wound healing at one-week post-operation. After six months, the implants were exposed to insert the healing abutments. Optimal implant position was confirmed by CBCT control. Implant placement with simultaneous bone augmentation Eleni Kapogianni, Berlin (Germany) Preoperative situation: Cone beam computed tomography (CBCT) revealed vertical and horizontal bone losses in regions 16 and 17. The soft tissue flap was raised and two CONELOG® PROGRESSIVE- LINE implants were placed. CeraOss HYA was combined with autologous bone chips to form a bone graft with advantageous consistency and sticky texture. The bone graft was used to fill the volume around the implants for simultaneous guided bone regeneration. Resorbable collagen membrane (Argonaut™) was applied to stabilize the graft and to prevent the ingrowth of the connective tissue into the defect site. Tension-free wound closure was achieved by horizontal mattress sutures and single button sutures.
The implant was exposed eight weeks post-operation to place the healing abutment. Graft particles were visible since the osseointegration of bovine bone needs about six months to complete. Favorable soft tissue healing was observed one week later. Radiological control showed stable bone conditions around the implant shoulder. Post-operative radiological inspection confirmed the correct position of the implant. The healing process progressed without complications and healthy soft tissue was observed after four weeks. The augmentation site was covered with a resorbable collagen membrane (Argonaut™) to stabilize the graft material and prevent the ingrowth of the connective tissue. Restoration of peri-implant bone level after tooth extraction Dr. Rafael Block Veras, Baden-Baden / Bühl (Germany) Preoperative situation: Cone beam computed tomography showed lesions and extensive bone resorption around tooth #46. Tooth extraction was decided due to the progressive furcation defect and the aborted dental crown. Occlusal view of the bone defect after tooth extraction. Immediate implant placement was performed upon consultation with the patient. CeraOss HYA was hydrated to form a "sticky bone" with ideal handling properties and was further mixed with autologous bone. The bone graft was used to fill the void volume around the implant shoulder.
A view of the clinical situation after covering the surgical site with Argonaut. Tension-free primary closure of the periosteal flap was achieved by suturing. Post-surgery radiographic control confirmed the correct position of the implant. After implant placement, CeraOss HYA was introduced into the sinus cavity via the lateral window. The lateral defect was also augmented with CeraOss HYA. A resorbable collagen membrane (Argonaut) was placed to cover the surgical site. A first layer of the bone substitute material was introduced into the maxillary sinus then the implant (CAMLOG® PROGRESSIVE- LINE) was placed. One-stage sinus lift with simultaneous lateral augmentation Prof. Dr. Dr. Daniel Rothamel, Mönchengladbach (Germany) Preoperative situation: Cone beam computed tomography revealed a reduced bone height in the region of the missing tooth #26. The buccal view of the upper jaw shows the lateral defect in the alveolar process. The lateral window approach was applied to access the maxillary sinus. The Schneider membrane was carefully elevated and a collagen membrane (Argonaut™) was placed underneath to prevent its perforation. Upon addition of a saline solution and mixing, CeraOss HYA forms a sticky bone inside the original blister. The consistency of the sticky bone facilitates its application and helps accelerate the surgical procedure.
Primary wound closure was achieved by tension-free sutures. Post-surgery radiographic control showed stable fixation of the augmentation site. The titanium mesh and the membrane were removed six months later and the implant was inserted. The implant was finally restored after a healing period of an additional six months. The membrane was first placed in the soft tissue pocket … … then passed over the titanium grid and further stabilized by periosteal sutures. A synthetic and non-resorbable membrane (PermaPro™) was cut to the shape of the defect before application. Horizontal and vertical bone augmentation in the posterior mandible Dr. Marius Steigmann, Neckargemünd (Germany) Preoperative situation: Cone beam computed tomography revealed unrestorable tooth #36. The bone defect resulting from the tooth extraction was first designed as a 3D model. A large bone defect was visualized upon elevation of the peri- osteal flap. Occlusal view of the bone defect after tooth extraction and periosteal flap elevation. CeraOss HYA was hydrated with saline solution to form the sticky bone. The bone graft was first applied to fill the defect then a titanium mesh was positioned over the augmentation site and fixed with osteosynthesis screws.
CeraOss HYA is a grafting material that combines the benefits of using natural cancellous bovine bone (CeraOss) with the advantageous liquid binding capabilities of hyaluronic acid. While bone particles provide an osteoconductive scaffold and ensure permanent volume stability, on the other hand, sodium hyaluronate forms a viscous solution after hydration, which leads to the particles being bound into a connected mass with a malleable consistency. This improves handling and facilitates the application of the material to the bone defect. CeraOss HYA therefore provides an ideal synergy between user friendliness and longterm graft stability. CeraOss HYA – "Sticky Bone" out of the blister Product features* Simplified grafting procedures Upon hydration with saline solution or blood, CeraOss HYA forms a malleable mixture with a sticky consistency that facilitates the usability of the bone graft and expedites the surgical procedure. [1, 2] Human-like bone structure The bone particles have a porosity of ~65–80% and feature a three-dimensional network of macropores (favoring the ingrowth of blood vessels and bone-forming cells) and micropores (facilitate fluids uptake by the capillary effect). Further, the rough surface of the bone particles facilitates the adhesion of osteoblasts and signaling proteins and contributes to osseous integration of the bone particles. [3, 4] Enhanced angiogenesis Chorioallantoic membrane assay revealed that sodium hyaluronate promotes vascularization of bone grafts in vivo. [5] Increased cell activity Improved viability, proliferation, and migratory activity were observed when human osteoblasts were cultured in vitro with CeraOss HYA in comparison to a similar bone substitute material without hyaluronate. [6] Support of bone regeneration Hyaluronic acid supported the formation of mineralized and non-mineralized bone matrix. [8] Permanent volume stability The bone particles only exhibit superficial resorption thus providing permanent structural support that is particularly valuable in the aesthetic region or to preserve the ridge contour. [9, 10] Mixing CeraOss HYA with auto- or allografts prevents accelerated resorption and ensures long term volume stability. [11] Safe Potential infectious agents such as bacteria, viruses and prions are removed from the bovine bone by a process that include a high temperature treatment step (>1200 °C). [12] On the other hand, sodium hyaluronate is produced biotechnologically by fermentation excluding adverse reactions against animal-derived materials. Biocompatible and non-immunogenic In vivo analysis demonstrated that the inflammation and immune response to hyaluronate-containing grafts were comparable at all time points to the control group (a similar bone graft without added hyaluronate). [13] Resorbable biopolymer Sodium hyaluronate resorbs naturally by enzymatic degradation, as confirmed by histological evaluation two weeks post implantation. [13] Efficient in peri-implantitis therapy A randomized controlled clinical study has shown a statistically significant vertical bone gain at the mesial, distal, and oral implant sites when peri-implantitis bone defects were augmented with hyaluronate-containing bone grafts. Improved implant stability, manifested by greater ISQ values, were observed at 3- and 6-months post-operative. [14] * Studies conducted using cerabone® and cerabone® plus, botiss bone substitutes that are identical to CeraOss and CeraOss HYA, respectively. Quick Guide "Hydration of CeraOss HYA": www.biohorizonscamlog.com/ceraoss-hya
CeraOss HYA – Benefits in bone regeneration Hyaluronic acid at a glance Exceptional hydrating properties Sodium hyaluronate is the conjugate base of hyaluronic acid, an anionic, non-sulfated glycosaminoglycan distributed widely throughout connective and epithelial tissues. Hyaluronic acid is one of the most hygroscopic molecules known in nature and can absorb 1000 times its weight in water. Upon hydration, hydrogen bonding occurs between water molecules and the adjacent carboxyl and N-acetyl groups. In this way, the hyaluronic acid binds the liquid and forms a viscous solution that holds the granules together and enables precise particle application. In the CeraOss HYA formulation, sodium hyaluronate therefore acts as a carrier for bovine particles. Structural formula of hyaluronic acid It is a biopolymer composed of repeating units of d-glucuronic acid and N-acetyl-d-glucosamine. The molecular weight of the polymer is dictated by the degree of polymerization (n). High-molecular hyaluronate has a longer degradation time and has an anti-inflammatory effect. [15] Bacteriostatic effects The application of hyaluronic acid in the form of membrane, gel, and sponges was shown to reduce bacterial contamination of surgical wounds and attenuate the risk of postsurgical infection yet promoting more predictable regeneration. [16] Hyaluronic acid in dentistry Hyaluronic acid is an essential component of the periodontal ligament matrix and influences cell adhesion, migration and differentiation via the binding proteins and cell-surface receptors. Benefits of hyaluronic acid have been reported throughout the healing process of periodontal wounds including inflammation, granulation tissue formation, epithelium formation and tissue remodeling. [17–22] It was also shown that hyaluronic acid induced earlier trabecular bone deposition in tooth sockets and stimulated the expression of osteogenic proteins including bone morphogenetic protein-2 and osteopontin. [23] Stimulates the formation of blood vessels in vivo [5] and improves the biological activity of osteoblasts in vitro. [6, 7] Improves bone regeneration. [14] Increases implant stability. [14] Randomized controlled clinical study on peri-implantitis reconstructive surgery The efficiency of CeraOss HYA in peri-implantitis reconstructive surgery was demonstrated in a randomized controlled clinical trial. At six months post-operative, patients treated with CeraOss HYA showed a significantly higher vertical bone gain at mesial, distal and oral implant sites compared to those treated with CeraOss (*p < 0.05) (Fig. 1). [14] 7 6 5 4 3 2 1 0 Vertical marginal bone gain (mm) * Bone substitute without hyaluronic acid CeraOss HYA Figure 1: 6-months post-operative vertical bone gain at oral implant sites
Rights to change reserved · M-1892-FLY-EN-INT-BHCL-00-062024 Ordering information Headquarters CAMLOG Biotechnologies GmbH | Margarethenstr. 38 | 4053 Basel | Switzerland Phone +41 61 565 41 00 | Fax +41 61 565 41 01 | info@camlog.com | www.biohorizonscamlog.com CeraOss® HYA, PermaPro™, Argonaut™, cerabone® and cerabone® plus are manufactured by botiss biomaterials GmbH. CAMLOG® and CONELOG® are registered trademarks of CAMLOG Biotechnologies GmbH. CeraOss®, PermaPro™ and Argonaut™ are trademarks of CAMLOG Biotechnologies GmbH. BioHorizons® is a registered trademark of BioHorizons. cerabone® is a registered trademark of botiss biomaterials GmbH. They may, however, not be registered in all markets. All rights reserved. Not all products are available in all countries. Art. No. Volume Particle size BM1015.1005 0.5 cm3 500–1000 µm BM1015.1010 1.0 cm3 500–1000 µm BM1016.1005 0.5 cm3 1000–2000 µm BM1016.1010 1.0 cm3 1000–2000 µm Biomaterials are excluded from exchange and return. Our services and deliveries are carried out exclusively on the basis of the General Terms & Conditions. References [1] Cerabone® plus usability test. [2] 78.5% of users reported easier or much easier application compared to particulate material without hyaluronic acid; Data on file: Customer survey among 156 clinicians. [3] Tadic et al. Comparison of different methods for the preparation of porous bone substitution materials and structural investigations by synchrotron μ-computer tomography. Mat.-wiss. u. Werkstofftech. 2004, 35, No. 4. [4] Seidel and Dingeldein 2004. cerabone® – Bovine Based Spongiosa Ceramic Seidel et al. Mat.-wiss. u. Werkstofftech. 35:208–212. [5] Kyyak et al. Hyaluronic Acid with Bone Substitutes Enhance Angiogenesis In Vivo. Materials (Basel) 2022. 15(11):3839. [6] Kyyak et al. The Influence of Hyaluronic Acid Biofunctionalization of a Bovine Bone Substitute on Osteoblast Activity In Vitro. Materials (Basel). 2021. 14(11):2885. [7] Qasim SSB, Trajkovski B, Zafiropoulos GG. The response of human osteoblasts on bovine xenografts with and without hyaluronate used in bone augmentation. J Biomater Sci Polym Ed. 2024 Apr;35(6):880-897. doi: 10.1080/09205063.2024.2311454. Epub 2024 Feb 12. PMID: 38346177. [8] Zhao, N., Wang, X., Qin, L., Zhai, M., Yuan, J., Chen, J., & Li, D. (2016). Effect of hyaluronic acid in bone formation and its applications in dentistry. Journal of biomedical materials research Part A, 104(6), 1560-1569. [9] Tawil et al. 2018. Sinus Floor Elevation Using the Lateral Approach and Window Repositioning and a Xenogeneic Bone Substitute as a Grafting Material: A Histologic, Histomorphometric, and Radiographic Analysis. Int J Oral Maxillofac Implants.33(5):1089-1096. [10] Riachi et al. 2012. Influence of material properties on rate of resorption of two bone graft materials after sinus lift using radiographic assessment. Int J Dent. 2012:737262. [11] Kloss et al. First Clinical Case Report of a Xenograft-Allograft Combination for Alveolar Ridge Augmentation Using a Bovine Bone Substitute Material with Hyaluronate (Cerabone® Plus) Combined with Allogeneic Bone Granules (Maxgraft®). J Clin Med. 2023. 12(19):6214. [12] Brown et al. New studies on the heat resistance of hamster-adapted scrapie agent: threshold survival after ashing at 600 degrees C suggests an inorganic template of replication, PNAS 2000. 97(7): 3418–3421. [13] Pröhl A et al. In Vivo Analysis of the Biocompatibility and Bone Healing Capacity of a Novel Bone Grafting Material Combined with Hyaluronic Acid. Int J Mol Sci. 2021. 22(9):48 [14] Rakašević et al. Reconstructive Peri-Implantitis Therapy by Using Bovine Bone Substitute with or without Hyaluronic Acid: A Randomized Clinical Controlled Pilot Study. J Funct Biomater. 2023 Mar 8;14(3):149. [15] Rayahin, J. E., Buhrman, J. S., Zhang, Y., Koh, T. J., & Gemeinhart, R. A. (2015). High and low molecular weight hyaluronic acid differentially influence macrophage activation. ACS biomaterials science & engineering, 1(7), 481-493. [16] Pirnazar P. et al. ’Bacteriostatic effects of hyaluronic acid. Journal of Periodontology 1999. 70:370-374. [17] Håkansson et al. Regulation of granulocyte function by hyaluronic acid. In vitro and in vivo effects on phagocytosis, locomotion, and metabolism. J Clin Invest. 198066:298–305. [18] Wisniewski HG, Vilcek J. TSG-6: An IL-1/TNF-inducible protein with anti-inflammatory activity. Cytokine Growth Factor Rev. 1997. 8:143-56. [19] Larjava et al. Characterization of one phenotype of human periodontal granulation-tissue fibroblasts. J Dent Res. 1989. 68:20-25. [20] Bartold PM, Page RC. The effect of chronic inflammation on gingival connective tissue proteoglycans and hyaluronic acid. J Oral Pathol. 1986. 15:367-74. [21] Bertolami CN, Messadi DV. The role of proteoglycans in hard and soft tissue repair. Crit Rev Oral Biol Med. 1994. 5:311-37. [22] Ruggiero et al. Hyaluronidase activity of rabbit skin wound granulation tissue fibroblasts. J Dent Res. 1987. 66:1283-7. [23] Mendes et al. Sodium hyaluronate accelerates the healing process in tooth sockets of rats. Arch Oral Biol. 2008. 53:1155-62.
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