maxresorb®

INNOVATIVE BIPHASIC CALCIUM PHOSPHATE

Very rough and hydrophilic surface

100% synthetic and resorbable

IDEAL OSTEOCONDUCTIVE PROPERTIES

maxresorb® is an innovative, safe, reliable, and fully synthetic bone substitute material that is characterized by controlled resorption and outstanding handling characteristics. maxresorb® is composed of 60% slowly resorbing hydroxyapatite (HA) and 40% fast resorbing beta-tricalcium phosphate (β-TCP) 1,2. The unique synthesis-based production process ensures a completely homogenous distribution of both mineral phases. The special composition of maxresorb® promotes fast formation of new vital bone, and ensures a controlled resorption without volume loss of the augmented site.

ULTRA-HIGH INTERCONNECTED POROSITY

The osteoconductivity of maxresorb® is based on a network of interconnecting pores, a very high overall porosity of approx. 80% as well as its very rough surface 3, 4, 5. The nano-structured surface facilitates the adsorption of blood, proteins, and stem cells and promotes cell differentiation and osseous integration. maxresorb® is thus an ideal scaffold for the migration of bone forming cells and binding of signaling molecules, which can accelerate tissue integration and regeneration 6, 7.

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maxresorb® offers a reliable alternative to xenogeneic bone substitute materials in a variety of indications.

IMPLANTOLOGY, PERIODONTOLOGY AND ORAL AND CMF SURGERY

  • Sinus lift
  • Ridge augmentation
  • Intraosseous defects
  • Extraction sockets
  • Osseous defects
  • Furcation defects
Choice of particle size

Small maxresorb® particles (0.5 – 1.0 mm) allow good adaptation to surface contours; they are especially useful for lateral augmentations or to fill voids when working with autologous bone blocks. For sinus lift and extensive augmentations the use of large maxresorb® particles (0.8 – 1.5 mm) is recommended. The increased space between the large particles enables a better vascularization and improves the regeneration of larger defect

Hydration

maxresorb® granules can be applied dry or wet. Hydration in blood or sterile saline solution facilitates the handling and application of the granules, as they adhere to each other. The excellent hydrophilicity of maxresorb® permits rapid hydration.

Compaction of the granules

To provide space for the regenerative process, only gentle compression of the particles is recommended. It allows for revascularization and osseointegration of the bone grafting particles by the three-dimensional pore network of maxresorb®.

Stabilization of the granules

maxresorb® granules should always be covered by a membrane in order to immobilize the particles at the augmented site and to prevent soft tissue ingrowth into the bone defect. When treating defects outside the ridge contour, a fixation of the membrane by pins or screws can be advantageous.

Healing time and re-entry

Although clinical results demonstrate a somewhat faster regeneration of defects treated with maxresorb®, it is recommended to follow the same treatment protocol as for bovine materials. Accordingly, re-entry after ridge augmentation or sinus lift procedures with maxresorb® should be performed 6 months post-operatively. This time can be shortened for the regeneration of smaller defects or by mixing with autologous/allogenic bone.

Mixing with autologous bone

Mixing of maxresorb® with autologous bone adds a biological activity (osteoinductive and osteogenetic properties of autologous bone) and support faster regeneration and improved formation of new bone.

  • 60% HA/40% β-TCP
  • Osteoconductive
  • Ultra-high interconnected porosity
  • Volume and mechanical graft stability
  • Very rough and hydrophilic surface
  • 100% synthetic and resorbable

Product Specifications

Art.-No. Particle Size Content
20005 0.5 – 1.0 mm (S) 1 x 0.5 ml
20010 0.5 – 1.0 mm (S) 1 x 1.0 ml
20105 0.8 – 1.5 mm (L) 1 x 0.5 ml
20120 0.8 – 1.5 mm (L) 1 x 2.0 ml

Distribution

With our international network of distribution partners, we are near you in over 100 countries worldwide. In addition to our 360° productportfolio, we offer service, scientific advice and exchange, training and events directly on site from a single source.

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SPECIFIC FACTS

Having a similar chemical composition to that of the human bone, calcium phosphate ceramics are characterized by an excellent biocompatibility and no foreign body reactions. In particular, the advantages of calcium phosphates lie in their bioactive and resorption properties, which allow them to support the attachment and proliferation of bone cells, thus undergoing a natural remodeling; this process involves osteoblasts and osteoclasts and is characterized by an initial integration of the material into the surrounding bone matrix followed by a gradual degradation. The most used calcium phosphates are hydroxyapatite (HA), alpha-tricalcium phosphate (α-TCP) and beta-tricalcium phosphate (β-TCP). Typically, HA shows the slowest solubility, therefore providing the highest stability, while β-TCP demonstrates a higher solubility and faster resorption kinetics. maxresorb® is a homogenous biphasic biomaterial containing 60% HA and 40% β-TCP.

An ideal bone regeneration material should be slowly resorbed while new bone matrix is formed. The basic principle of maxresorb® and, more in general, of biphasic calcium phosphates, is to achieve a balance between the properties of hydroxyapatite (HA) and beta-tricalcium phosphate (β-TCP). Pure β-TCP resorbs quite fast due to high solubility and therefore, may not offer sufficient volume stability for larger augmentative procedures. On the other hand, pure synthetic HA resorbs very slowly and some studies have demonstrated the inferior osteoconductivity of synthetically produced HA when used alone. By mixing HA and β-TCP the advantages of both materials are combined to achieve a material with good osteoconductive as well as resorption properties 8. Studies have shown that the optimal HA/ β-TCP ratio lies between 65:35 and 55:45 1, 2, 9. Therefore, maxresorb® with its biphasic composition of 60% HA and 40% β-TCP offers and optimal balance between resorption and stability. Bone regeneration materials based on mixtures of HA and β-TCP have been successfully applied in dental regenerative surgery for more than 20 years.

maxresorb® exhibits a controlled remodeling within about 2 to 3 years. Following implantation, the particles are first integrated into the forming bone, but then are gradually resorbed and remodeled. The β-TCP component remodels within 3-6 months while the HA component resorbs much slower within >2 years.

In particular, pure ß-TCP resorbs very rapidly, i.e. within a few weeks from the initial insertion. In contrast, pure synthetic HA is characterized by a very slow resorption and sometimes soft tissue encapsulation. Thus, the combination of HA and ß-TCP in maxresorb® offers the advantages of both materials, with a final biomaterial that shows excellent osteoconductivity. While the fast resorption of β-TCP (within about 3 months) quickly offers space for new bone formation, the HA component provides volume stability for an extended time period (resorption within 2-3 years).

  • maxresorb® is a 100% synthetic, thus very safe biomaterial (not even theoretical risk of disease transmission with regard to raw material)
  • Its use is not restricted by dietary or religious conflicts
  • Valid synthetic alternative to xenografts with regards to indications and handling
  • Composition and structure of synthetic bone grafts can be designed to obtain optimal material characteristics:
    • The micro-/macrostructure of maxresorb® is rationally designed to provide the ideal properties of a bone substitute, naming high porosity, interconnected pores and very rough, hydrophilic surface
    • Owing to its synthetic, biphasic composition, maxresorb® is characterized by a controlled resorption and full remodeling potential. After about 2-3 years the material will be replaced by patients’ own bone
Guide Bone substitute materials

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  1. Gauthier et al. (1999). Elaboration conditions influence physicochemical properties and in vivo bioactivity of macroporous biphasic calcium phosphate ceramics. Journal of materials science. Materials in medicine 10:199–204.
  2. Schwartz et al. (1999). Biphasic synthetic bone substitute use in orthopaedic and trauma surgery: clinical, radiological and histological results. Journal of materials science. Materials in medicine 10:821–825
  3. Rothamel et al. 2009. Wissenschaftlich-experimentelle Untersuchung des biphasischen Knochenersatzmaterials Ossceram nano: Oberflächenstruktur, Biokompatibilität und Hartgewebsregeneration. Z Oral Implant 5/2009.
  4. Trajkovski et al. 2018. Hydrophilicity, Viscoelastic, and Physicochemical Properties Variations in Dental Bone Grafting Substitutes. Materials (Basel). 11(2):215.
  5. Calvo-Guirado JL, Ramírez-Fernández MP, Delgado-Ruíz RA, Maté-Sánchez JE, Velasquez P, de Aza PN. Influence of biphasic β-TCP with and without the use of collagen membranes on bone healing of surgically critical size defects. A radiological, histological, and histomorphometric study. Clin Oral Implants Res. 2014 Nov;25(11):1228-1238.
  6. Eriberto Bressan et al. Donor Age-Related Biological Properties of Human Dental Pulp Stem Cells Change in Nanostructured Scaffolds. PLOS One, Nov 2012, VOl 7, Issue 11; e49146.
  7. Fujioka-Kobayashi M, Schaller B, Zhang Y, Kandalam U, Hernandez M, Miron RJ. Recombinant human bone morphogenetic protein (rhBMP)9 induces osteoblast differentiation when combined with demineralized freeze-dried bone allografts (DFDBAs) or biphasic calcium phosphate (BCP). Clin Oral Investig. 2017 Jun;21(5):1883-1893.
  8. Manjubala et al. Bioactivity and osseointegration study of calcium phosphate ceramic of different chemical composition. J Biomed Mater Res. 2002;63(2):200-8.
  9. Nery et al. 1992. Tissue Response to Biphasic Calcium Phosphate Ceramic With Different Ratios of HA/βTCP in Periodontal Osseous Defects. Journal of Periodontology, 63(9):729–735.