cerabone®has been successfully applied in millions of patients in regenerative dentistry and has been in use for more than 20 years in various medical applications (e.g. craniofacial surgery, oncology and hand and spine surgery).
UNIQUE
PRODUCTION PROCESS
cerabone® is produced from the femoral heads of cattle by a unique 1200°C manufacturing process utilizing heat and water only (free of chemical additives).
100% PURE
BONE MINERAL
The processing removes all organic components resulting in a bone mineral with exceptional purity1.
PORES &BIOACTIVE SURFACE
The human-like bone structure of cerabone® with its three-dimensional pore-network and bioactive surface promotes the adhesion and invasion of bone forming cells resulting in complete integration of the granules into newly formed bone matrix2.
SUPERIOR HYDROPHILICITY
The interconnected pores and rough, extremly hydrophilic surface of cerabone® support the adhesion of proteins from the blood3.
DEPOT-EFFECT .
The 100% pure natural bone mineral acts as a calcium reservoir slowly releasing calcium ions for bone remodeling4. The rough surface continuously binds and releases signaling molecules providing a long-term depot-effect.
predictable long-term CLINICAL OUTCOME
Retrospective analyses* have demonstrated long-term stability of cerabone® with cumulative implant survival rates of 98.73 – 100%5-9.
*with mean follow-ups of 12 – 65.93 months and dental implants placed in solely cerabone®-grafted sites or sites augmented with cerabone® in combination with autologous bone
100% PURE BONE MINERAL
The long-term success of cerabone® is based on its excellent osteoconductive properties and exceptional purity achieved by a unique 1200°C temperature treatment processing.
cerabone® is manufactured from the femoral heads of cattle by a unique high temperature treatment processing free of chemical additives utilizing heat and water only. Through this sophisticated processing a bone mineral with exceptional purity and a high degree of crystallinity is formed. In contrast to non-sintered bovine bone grafts, no remnants of water and calcium carbonate are present1.
Due to its three-dimensional pore network and rough surface, cerabone® supports blood clot formation and a fast and efficient penetration with fluids, blood and proteins as demonstrated by its excellent hydrophilic properties. Signaling molecules from the blood are bound and gradually released from the particles, thereby cerabone® provides a long-term depot effect.
The high crystallinity ensures a controlled and slow release of calcium ions to the surrounding tissue . So cerabone® also acts as a calcium reservoir important for bone remodeling.
Both the high degree of crystallinity and the phase purity provide ultimate volume stability.
Histomorphometrical analysis of human biopsies evaluating the resorption of cerabone® have found only limited evidence for material degradation such as phagocytosed particles of the biomaterial10. Once implanted, cerabone® particles will only be resorbed superficially and can be found in the augmentation area after years thereby providing permanent structural support.
Cellular osseous integration
Following implantation, different cell types involved in the wound healing cascade and growth factors originating from the wound area bind to the surface of the cerabone® granules. Subsequently, precursor cells differentiate into osteoblasts and start to produce new bone matrix. After a few months (6-9 months), the cerabone® particles are integrated into the newly formed bone matrix and the surface is completely covered by new mineralized bone resulting in a long-term stable bone situation11.
Dental implants placed in solely cerabone®-grafted sites or sites augmented with cerabone® in combination with autologous bone have demonstrated long-term stability of the augmented sites with cumulative implant survival rates of 98.73 – 100% by mean follow-ups of 12 – 65.93 months post-operative5-9 .
cerabone® is available as granules or block. The cerabone® granules come in eight different volumes of small (0.5 – 1.0 mm) and large (1.0 – 2.0 mm) granule sizes. The cerabone® block is available in a standardized size of 20 x 20 x 10 mm.
SMALL PARTICLES
Small cerabone® particles are particularly advantageous for contouring, e.g. for augmentation in the aesthetic region or to fill remaining gaps when a block grafting is performed. Small particles are also preferably used for the regeneration of smaller defects and intraosseous defects.
LARGE PARTICLES
Large cerabone® particles are favorable, if large volume defects (e.g. sinus floor elevation) are filled. In addition to the higher volume, there is more space between the large particles, which enables a better revascularization of bigger defects.
cerabone®SMALL granules
Art.-No.
Particle Size
Content
1510
0.5 – 1.0 mm
1 x 0.5 ml
1511
0.5 – 1.0 mm
1 x 1.0 ml
1512
0.5 – 1.0 mm
1 x 2.0 ml
1515
0.5 – 1.0 mm
1 x 5.0 ml
cerabone®LARGE granules
Art.-No.
Particle Size
Content
1520
1.0 – 2.0 mm
1 x 0.5 ml
1521
1.0 – 2.0 mm
1 x 1.0 ml
1522
1.0 – 2.0 mm
1 x 2.0 ml
1525
1.0 – 2.0 mm
1 x 5.0 ml
cerabone® block
Art.-No.
Dimension
Content
1722
20 x 20 x 10 mm
1 x block
PORES & BIOACTIVE SURFACE
Geometry and topography are crucial for a bone grafting material to be integrated and/or resorbed during the body’s natural healing process. To form new bone matrix following the implantation of the bone substitute, regenerative cells must settle down, proliferate and differentiate. During these events, their constant supply with nutrients is essential requiring the formation and spreading of blood vessels in the bone graft.
Interconnected porosity and pores of different sizes provide space for angiogenesis and bone matrix deposition, while a structured surface morphology allows for adhesion of pluripotent cells being the starting point for bone regeneration.
cerabone® by its unique material properties provides this cell-friendly environment thus efficiently supporting the osseous regenerative process. cerabone® is a highly porous bone grafting material with a porosity of ~65-80% and a mean pore size of ~600-900 μm12. Macropores enable a fast ingrowth of blood vessels and bone-forming cells, while micropores support quick blood uptake by the capillary effect.
Scanning electron microscopic pictures (SEM) demonstrate the highly structured surface of cerabone®. It facilitates the adhesion of signaling proteins and cells from the blood. Adhering osteoblasts can initiate the formation of bone matrix, leading to the osseous integration of the particles.
SUPERIOR HYDROPHILICITY
Blood efficiently penetrating the particles is essential for osseous integration of the bone grafting material as it delivers all the biological information necessary for wound healing and bone formation.
For instance, it provides stem cells capable of differentiating into osteogenic cells forming new bone tissue. Signaling molecules dissolved in the blood plasma orchestrate pro- and anti-inflammatory processes taking place following the implantation of a biomaterial. The interplay of both processes is considered crucial for the long-term stable integration and/or resorption of the bone substitute material.
The rough surface and interconnected pores of cerabone® provide optimal conditions for all the important components of blood to invade the particles. It leads to an excellent hydrophilicity, which was shown to be superior as compared to other bone grafting materials3. The strong capillary effect enables a fast and efficient penetration with fluids, blood and proteins into the three-dimensional trabecular network of the particles, thereby promoting their osseous integration.
In addition, the excellent hydrophilic properties of cerabone® enable a convenient handling of the particles as they stick well together after hydration.
DEPOT-EFFECT
cerabone® provides a biological and mineral depot, which both support the bony regenerative process.
The biological depot-effect is given by the host’s proteins and nutrients interacting with the cerabone® particles. Pre-clinical analyses have demonstrated that signaling molecules from the blood are bound and gradually released from the particles, thereby cerabone® provides a long-term depot effect13. Thus, cytokines and other chemotactic proteins are delivered to the augmentation site, which recruit stem cells for the differentiation into osteoblasts, and cells of the innate immune system involved in early wound healing.
The mineral depot-effect is mainly attributed to calcium and is provided by the unique chemical composition of cerabone®. During the maturation of the bone and its transition from rather weak woven to mechanically strong lamellar bone, the mineralization process requires substantial amounts of minerals such as calcium ions. Once collagen fibrils and other organic components are secreted and deposited by osteoblasts, minerals precipitate. The high crystallinity of cerabone® supports the mineralization of the forming bone as it ensures a controlled and slow release of calcium to the surrounding tissue, thus cerabone® acts as a constant calcium reservoir important for the bone remodeling process14.
Calcium release determined using atomic absorption spectroscopy4
The integration of cerabone® into newly formed bone matrix is the result of complex biological events taking place following its implantation.
The unique topographic and physico-chemical characteristics of cerabone® efficiently support blood clot formation and the proliferation of regenerative cells leading to predictable particle integration. Its non-resorbability, owing to its exceptional purity, provides stability of the augmented site on a long-term basis.
> 20 years clinical experience
in various medical applications
in > 90 countries
> 200 scientific contributions
REFERENCES
1 Tadic, D. and Epple, M. (2004), “A thorough physicochemical characterisation of 14 calcium phosphate-based bone substitution materials in comparison to natural bone”, Biomaterials, Vol. 25 No. 6, pp. 987–994.
2 Rothamel D, Schwarz F, Smeets R, Happe A, Fienitz T, Mazor Z, Zöller J. Sinus floor elevation using a sintered, natural bone mineral zzi 27(1) 2011
3 Trajkovski B., Jaunic, M., Müller W.H., Beuer F., Zafiropoulos G.-G. and Houshmand A. Hydrophilicity, Viscoelastic, and Physico chemical Properties Variations in Dental Bone Grafting Substitutes. Materials 2018, 11(2), 215.
4 Berberi A, Samarani A, Nader N, Noujeim Z, Dagher M, Kanj W, Rita Mearawi,1 Ziad Salemeh,1 and Bassam Badran2 Physicochemical characteristics of bone substitutes used in oral surgery in comparison to autogenous bone. Biomed Res Int. 2014;2014:320790.
5 Tawil G, Tawil P, Khairallah A. Sinus Floor Elevation Using the Lateral Approach and Bone Window RepositioningI: Clinical and Radiographic Results in 102 Consecutively Treated Patients Followed from 1 to 5 Years. Int J Oral Maxillofac Implants. 2016 Jul-Aug;31(4):827-34.
6 Cardaropoli D, Tamagnone L, Roffredo A, De Maria A, Gaveglio L. Preservation of Peri-implant Soft Tissues Following Immediate Postextraction Implant Placement. Part II: Clinical Evaluation. Int J Periodontics Restorative Dent. 2019 Nov/Dec;39(6):789-797.
7 Kamadjaja DB, Sumarta NPM, Rizqiawan A. Stability of Tissue Augmented with Deproteinized Bovine Bone Mineral Particles Associated with Implant Placement in Anterior Maxilla. Case Rep Dent. 2019 Oct 27;2019:5431752.
8 Lorean A, Mazor Z, Barbu H, Mijiritsky E, Levin L. Nasal floor elevation combined with dental implant placement: a long-term report of up to 86 months. Int J Oral Maxillofac Implants. 2014 May-Jun;29(3):705-8.
9 Khojasteh A, Hassani A, Motamedian SR, Saadat S, Alikhasi M. Cortical Bone Augmentation Versus Nerve Lateralization for Treatment of Atrophic Posterior Mandible: A Retrospective Study and Review of Literature. Clin Implant Dent Relat Res. 2016 Apr;18(2):342-59.
10 Barbeck M, Udeabor S, Lorenz J, Schlee M, Holthaus MG, Raetscho N, Choukroun J, Sader R, Kirkpatrick CJ, Ghanaati S.High-Temperature Sintering of Xenogeneic Bone Substitutes Leads to Increased Multinucleated Giant Cell Formation: In Vivo and Preliminary Clinical Results. J Oral Implantol. 2015;41(5):e212-22.
11 Tawil G, Barbeck M, Unger R, Tawil P, Witte F. 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. 2018 September/October;33(5):1089–1096.
12 Seidel P, Dingeldein E. cerabone® – Bovine Based Spongiosa Ceramic Seidel et al. Mat.-wiss. u. Werkstofftech. 2004
13 In vitro experiments from Prof. Dr. H. Jennissen and Dr. M. Laub University of Duisburg-Essen/Morphoplant GmbH
14 Riachi F, Naaman N, Tabarani C, Aboelsaad N, Aboushelib MN, Berberi A, Salameh Z. Influence of material properties on rate of resorption of two bone graft materials after sinus lift using radiographic assessment. Int J Dent. 2012;2012:737262.
