Natural hydroxyapatite with natural collagen

Introduction

Conventional bone grafting is done with autologous bone graft from iliac crest, which is still the gold standard. However, it involves another operative procedure, longer operating time and more trauma to the patient. The donor site becomes painful after healing.

has developed xenograft in the name of

. It is natural Hydroxyapatite with natural collagen and with naturally occurring trabecular pattern. It is very useful for bone repair and replenishment. It can be used in weight bearing areas.

One should remember that results of use of

may be inferior to autologous bone.

Description

is made of natural low crystalline Hydroxyapatite with collagen. It is available in form of granules, dowels and blocks. The shape can be changed by using Gigli saw and bone nibblers.

The information, given here, is not exhaustive and is for guidance only. The surgeon is best advised to use the method, which his own practice and discretion dictate to be best for the patient.

Contraindications

Presence of infection whether local or general, prohibits all kind of implantation procedures. Open wounds will not respond well with bone grafting surgeries.
Poor general health and metabolic deficiencies will not produce desired results.
Above mentioned contraindications are general. The surgeon must evaluate the individual patient for the risks involved.

Indications

is indicated in almost all the places where a bone graft is required. Following are some of the indicative uses specialty wise.
Neurosurgery: Lumber & cervical fusion, vertebral reconstruction, cranial reconstruction and other types of reconstructions.
Orthopedic Surgery: Lumber & cervical fusion, vertebral reconstruction, cranial reconstruction and other types of reconstructions, Cavity filling, osteotomy reconstructions, non union fracture and filling the gaps in cases of bone loss due to trauma.
Plastic Surgery: Maxillofacial reconstructions, bony augmentation, hand surgery & cavity filling.
Dental Surgery: Maxillofacial reconstruction surgery, periodontics, orthodontics and other areas requiring a bone graft.
Other Specialties: Where a bone graft is required.

Method of use

implantation is an implantation procedure. It carries a greater risk of infection because of large surface area. It is advisable to take all precautions necessary for an implantation procedure. Some of the points are given below:

It should be first procedure in the morning.
There should be minimum number of people inside the theatre (4persons). No scrub nurse
There should be minimum movement inside OT.
Procedure should be as fast as possible 20-50 minutes.
Use disposable mops only (it is a must).
Use disposable drapes.
Use incise drapes on incision sites.
Only 2-4 procedures in a day.
The grafting material should be opened only just before implantation.
Minimum handling of graft material.
Use skin staplers for skin closure.

After opening the site of implantation, obtain good hemostasis of the area. Scrap the walls of the cavity/defect. Remove all soft tissue from the cavity or defect. Harvest some bone and bone marrow from the same site by scraping and shallow drilling in the cavity. Incorporation of patients own bone and bone marrow provides BMP’s for bone healing and improves results. Larger cavity size needs larger percentage of patients own bone. Fill gap with RI STIN blocks or granules. Cover the gap with soft tissue. Gelatine foam sponge may be used to cover the granules and to prevent spilling of granules. Calcium phosphate cement (RIOSTIN CP Cement) may also be used to secure the granules and top the cavity.

Complications

Complications which may result from the use of this product include the risks associated with the medication and methods utilized in the surgical

procedure, as well as patients response, reaction or degree of intolerance to any foreign object implanted into the body.

Some complications specific to Precision are following:

The medical literature is full of hazards and complications associated with use of Calcium Hydroxyapatite. Some of the major hazards are infection, extrusion of grafted material, serous discharge, serous collection, hemorrhage, skin erosion and migration.

Warnings

Granules 10cc pack

Chips 10cc pack

Blocks Average Block size and qty

30 * 15 * 6mm 1no.
30 * 15 * 7mm 1no.
30 * 15 * 8mm 1no.
30 * 15 * 9mm 1no.
30 * 15 * 10mm 1no.
30 * 15 * 12mm 1no.
30 x 15 x 14 mm 1no.
30 * 15 * 16mm 1no.
30 * 15 * 18mm 1no.
30 * 15 * 20mm 1no.

Dowel Average Dowel size and qty. One

Dia 8, length 10 mm
Dia 10, length 12 mm
Dia 12, length 19 mm
Dia 13, length 19 mm
Dia 14, length 19 mm
Dia 15, length 19 mm
Dia 12, length 5 mm