maxresorb® inject is a unique four-phasic injectable bone graft paste with controlled resorption properties. The water-based paste contains nano hydroxyapatite (HA) particles and is mixed with small maxresorb® granules (60% HA/40% β-TCP) 1,2. The very small HA particles provide an extensive surface for cell-biomaterial interactions, which leads to rapid resorption, thereby promoting new bone formation. In addition, the contained maxresorb® granules help to maintain the volume over time. maxresorb® inject is non-hardening and ready to use.
Owing to its specific composition, the viscous properties of maxresorb® inject allow perfect shaping, molding, fitting and complete bonding to the surrounding bone surface of the defect. The syringe allows direct and easy application to the defect site. maxresorb® inject is not hardening in situ, therefore the paste enables a very fast vascularization of the defect while providing an osteoconductive scaffold for the migration of bone forming cells. Once applied, maxresorb® inject is gradually replaced by new bone.
maxresorb® inject is particularly suitable for the regeneration of smaller defects that do not require extra volume stability. In these cases, the specific composition of maxresorb® inject offers an extensive surface area that promotes cell-biomaterial interactions, thus leading to a rapid remodeling of the particles.
IMPLANTOLOGY, PERIODONTOLOGY AND ORAL AND CMF SURGERY
Regeneration of small/contained defects
Gap-filling in combination with other bone substitutes
maxresorb® inject must always be covered with a membrane in order to stabilize the material and facilitate undisturbed bony regeneration.
maxresorb® inject is designed for regeneration of smaller defects that do not require a distinct- or long-term volume stability. In these cases it provides simplified handling compared to the application of particulate materials. However, for larger augmentations maxresorb® inject is not the material of choice due to insufficient stability, i.e. fast resorption. The main component of the material (83.5 %) is a water-based paste containing nanosized HA particles which are resorbed within ~6-8 weeks.
maxresorb® inject can be applied directly into the defect through the syringe. It is also possible to form it before application onto the defect, or to insert it with the help of a spatula.
Mixing of material
The paste is ready to use, but it can also be mixed with blood, autologous bone or bone substitute materials.
Please make sure that maxresorb® inject is stored at the recommended storage temperature (5-30°C). The main component of the bone substitute material is a water-based paste with nanosized HA particles. Elevated temperatures will cause water evaporation, resulting in drying of the paste. Likewise, freezing of the water component may result in changes of the material properties that cannot be reversed.
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The evolution of injectable bone regeneration materials started with the development of calcium phosphate cements in the 80’s 3, 4. Cements are usually produced by mixing calcium phosphate powder with an aqueous solution. They create the possibility for several minimal invasive therapies of bony defects and offer an easier handling in many indications. Following application, hardening occurs in vivo.
Putties like maxresorb® inject offer two significant advantages over cements: First, as a non-hardening material, they do not represent a barrier against ingrowing blood vessels and bone tissue. As a result, they are quickly and completely integrated into the newly formed bone and are subject to natural remodeling. Secondly, due to their large surface area, the nano HA particles have a high biological activity and thus an osteostimulative effect. The adhesion of bone and bone precursor cells is promoted. On the one hand, this promotes rapid formation of new bone, and on the other hand, rapid degradation of the particles is supported, creating additional space for ingrowing bone tissue.
Unlike other products, maxresorb® inject is not hardening in situ. This enables rapid vascularization of the material and defect as well as migration of bone forming cells. In contrast, hardening bone putties are often associated with low tissue integration due to the formation of a solid body that prevents cell and vessel penetration into the material. Due to its non-hardening characteristics, maxresorb® inject always has to be covered with a barrier membrane to stabilize the material and facilitate undisturbed bony regeneration according to the concept of guided bone regeneration (GBR).
The main component of maxresorb® inject is a water-based paste with nano HA particles in which maxresorb® granules are embedded. The maxresorb® granules help to maintain the volume to a certain extent, but due to their relatively low content within the paste, maxresorb® inject does not provide sufficient stability for predictable regeneration of larger defects. To increase stability, maxresorb® inject can be mixed with a slowly resorbable material such as cerabone® or maxresorb®.
Directly following application the water dissolves leaving behind nano HA particles and maxresorb® granules (60% HA/40% β-TCP). The nano HA particles exhibit a high biologic activity because of their large surface, meaning a strong interaction with bone forming cells as well as macrophages and osteoclasts. The small particles are resorbed very fast (~6-8 weeks), but also promote fast new bone formation in the resulting free spaces. At the same time the contained maxresorb® granules provide a scaffold for the migration of bone forming cells and the deposition of new bone matrix. β-TCP will resorb within ~3-6 months, HA within ~2-3 years. maxresorb® inject is gradually replaced by newly formed bone.
Guide Bone substitute materials
Which product is most suitable for your indication, what are the alternatives and what do you have to pay particular attention to when using it? Our experts have compiled the most important information for you.
Laschke et al. 2007. Injectable nanocrystalline hydroxyapatite paste for bone substitution: in vivo analysis of biocompatibility and vascularization. J Biomed Mater Res B Appl Biomater.; 82(2):494-505.
Huber et al. 2009. Evaluation of a novel nanocrystalline hydroxyapatite paste and a solid hydroxyapatite ceramic for the treatment of critical size bone defects (CSD) in rabbits. J Mater Sci Mater Med.;19(1):33-8. Epub 2007 Jun 14.
Habraken et al 2016. Calcium phosphates in biomedical applications: materials for the future? Materials Today, 19(2), 69-87.
Fernandez de Grado et al. 2018. Bone substitutes: a review of their characteristics, clinical use, and perspectives for large bone defects management. J Tissue Eng. 2018;9:2041731418776819.