Hom-Lay Wang and Boyapati PASS principles show the importance of Primary closure, Angiogenesis, Space maintenance and graft Stability in hard tissue regeneration.
Selecting a highly porous bone graft creates more space for Angiogenesis. Choosing one that is form stable (i.e. not a granule) achieves Stability, simplifies handling and means no membrane is needed for containment.
Resorbing Bone Grafts
Resorbing grafts, especially those that are also highly porous, present even more space for new cells to occupy and increase their capacity to generate new bone compared to a non-resorbing or slow-resorbing graft like a mineralised xenograft, mineralised allograft or biphasic synthetic.
Granulation Tissue Challenge
If not removed, granulation tissue can quickly take up the space intended for new bone, reducing the advantage of fully resorbing materials. This became apparent to the author when discussing cases with a developmental graft in the hands of users familiar with slow or non-resorbing grafts. These experienced clinicians were not able to achieve the new bone levels achieved by others. Close investigation noted a scar-like tissue in the space where the immature bone was expected, highlighting the importance of removing these cells.
Dr Efrain Kfir (Israel) had partly developed a tool to prepare the bony surfaces using rough-cut diamonds. After testing with the KOL group, these became integrated into the protocol of subsequent fully resorbing synthetics such as ethoss and further refined materials such as Powerbone Dental Putty.
Degranulation Burrs – the perfect solution.
Degranulation burrs provide the perfect solution for fast and effortless removal of unwanted granulation tissue at the same time as freshening up the bone bed before grafting – especially so in a post-extraction socket. Graft site preparation is optimised in a controlled and predictable way, and sloughy granulation tissue is ‘pulled’ off the bone without harm. In doing so, we can be confident our implant or graft is placed – without challenge and in direct contact with healthy bleeding bone.
Each burr has rough-cut diamonds embedded on its surface, which “grab” tissue at the same time as ‘polishing’ the bone bed. The burrs are reusable and autoclavable. A small-bore suction tube is included, which helps clean granulation tissue from the diamond head in a 2-handed technique during use. It is recommended to replace burrs after 25 applications to ensure efficient operation.
Benefits of Degranulation
Increased Efficiency. Degranulation increases the efficiency of dental procedures by reducing the time and effort required for granulation tissue removal.
Facilitate Healing. Removal of granulation tissue from the site helps facilitate the healing process by allowing new bone to form unchallenged. The risk of infection is also reduced.
Improve Implant Placement. Degranulation can improve the accuracy and success of implant placement by providing a clear view of the extraction site and removing tissue obstacles that might interfere with implant placement.
Minimise Patient Discomfort. Degranulation can minimise patient discomfort by reducing the need for more invasive procedures such as curettage or flap surgery.
Versatility of Degranulation Burrs
Degranulation Burrs are a versatile and adaptable tool for dental professionals. The embedded diamond-headed burrs can be used in implantology, periodontal, endodontic and root removal for maximum safety when working near anatomical structures. See the following table for recommended speeds and the need for irrigation.
| TISSUE | SPEED | IRRIGATION |
| Granulation / Soft Tissue Removal | 1,500 | No |
| Hard Tissue Prep (Bone or Root | 2,500 | Yes |
| Root Fracture / Amputation (Small Burr only) | 20,000 | Yes |
Video Illustration – Degranulation Burrs
See the YouTube-hosted video animation which illustrates the use of Degranulation burrs.
Note on Decortication
Placing a graft in direct contact with a bleeding surface improves healing. Using a Decortication Drill to puncture the marrow space encourages stem cell infill, which accelerates healing further.
TO PURCHASE A DEGRANULATION KIT, VISIT REGEN STORE HERE
TO PURCHASE POWERBONE DENTAL PUTTY, VISIT REGEN STORE HERE
TO PURCHASE A DECOTICATION DRILL, VISIT REGEN STORE HERE.
