Prof. Dr. Dr. Rothamel: Of course we can observe complications with cerabone®, even if they are rare. But: Infection is NEVER a problem of the bone substitute material (they are sterile!), but a problem with handling. Both Bio-Oss® and cerabone® particles might be not completely integrated in newly formed bone at time of re-entry (more a result of the membrane), and in this case cerabone® is more visible since it is a bit whiter. The indications for Bio-Oss® and cerabone® are quite the same.
Dr. Steigmann: There are failures with every material; however, most of them are due to poor soft tissue management. In every case of using xenografts and opening, we find granules not integrated in the new bone.
PD Dr. Dr. Kämmerer: There are always failures possible, but I do not see any relevant difference to Bio-Oss®. Sometimes observed free particles in case of cerabone® I have found not to be relevant for the clinical outcome.
Dr. Maghaireh: No real failure with cerabone® so far as I am having great results with layering technique concept I have been following for the last few years. I strongly believe that failures and disappointments are usually attributed to techniques. Clinicians need to understand biology and the limitations of xenograft in general. For example, they should not use cerabone® pure in ridge augmentation and then go ahead and place the implant within four to six months, thinking they will get high degrees of remodeling. Also, it is highly recommended that we use the correct type of membrane according to the size of the defect. I personally prefer a well-stabilized Jason® membrane to provide good protection for the GBR and minimize risk of perforation and cerabone® particles migration.
Dr. Papi: I had a couple failures with cerabone®, especially on the first cases. When looking for possible causes I must admit that they were not related to the material (they were caused by patients not following post-operative instructions, such as brushing in the surgical area, not following the antibiotic therapy or not using chlorhexidine, therefore exposing and compromising the healing of the graft).
I have been using cerabone® since 2015, and I honestly have a very high success rate, also stressing the indication of the material, such as performing re-entry surgery at four months. In many of these cases, I found several separate granules on top of the grafted area but this is not a problem you just remove the most superficial ones and you can place your implant.
When using cerabone®, you should obtain a primary wound closure and carefully instruct patients to follow your recommendations; there are no “special instructions” for using cerabone®. It is very simple and straightforward, you just need to follow the basic principles of GBR.