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This technique is not recommended.
Soft tissue grafting can be performed in this case.
The flap should be stretched in such case.
With Augma bone graft cement, no horizontal releasing incision is recommended to gain a tension-free flap. The flap should be under tension during the closure. Therefore, the flap should be minimally reflected according to the protocols, while the flap closure is accomplished by stretching.
The sutures do not have any influence on muscle engagement. The flap design and the way it is reflected, together with a lack of releasing incisions, are the factors that prevent muscle engagement.
The flap is the part that should not be connected to the muscles; therefore, the flap is minimally reflected, as explained in the protocols. The sutures are not the issue.
Do not perform any periosteum-releasing incisions. The protocols for Augma bone graft cement instruct to maintain tension on the flap during the closure. In this way, the flap is minimally reflected and stretched for closure.
A full-thickness flap is necessary.
I used bond apatite today for the first time and it didn’t harden at all at the surgical site, and kept almost flowable about 20 minutes.
How could that be?
In order for the material to harden properly it should be used as follows:
During activation the shaft of the syringe should be advanced until the first piston reaches the blue line. Then the cap is removed, and the material should be injected into the site. Immediately place on it a dry gauze, not too folded, simply in two layers. Then press strongly with a finger on top of the gauze for 3 seconds, and again with a periosteal elevator for an additional 3 seconds. That’s all you need to do and the material will set instantly. It will never be hard like a stone, but it is definitely stable. During suturing, if the material breaks, place a dry gauze on it and press for one second before continuing to suture.
If the material didn’t harden, it’s probably because the pressure with the gauze was not done immediately. As such, the crystals are soaked with blood and it will not set properly, and will be flowable.
Please see our online course for more instructions on proper use.