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Hom-Lay Wang and Boyapati reported on the importance of reducing or removing micromovements on a graft surface. Their PASS principles highlighted the importance of primary closure, angiogenesis, graft stability and space as critical defining principles for hard tissue development.
It follows that selecting a highly porous bone graft achieves one of these steps. Choosing one that is able to stabilise itself (without a membrane) simplifies placement for the clinician and archives one of the other goals.
Placing such a graft in direct contact with a bleeding surface, especially one that is decorticated increases stem cell infill into the graft – especially so one that is fully resorbing.
GRANULATION TISSUE IMPACTS RESORBABLE BONE GRAFTS MORE
Non-resorbing grafts (mineralised allograft/xenograft/biphasic synthetic) present less space for new cells to occupy. This significantly reduces their capacity to generate maximum new bone compared to a fully adsorbing bone graft. However, initially, at least the space occupation of a non-adsorbing graft limits the negative impact of granulation tissue as there is less space for this unwanted tissue to proliferate.
The impact of this became apparent when discussing first cases with a predecessor of today’s fully adsorbing Powerbone Dental Putty with KOL users of non-resorbing grafts. These experienced clinicians were not able to achieve the quick healing anticipated. Close investigation noted a scar-like tissue in the space where the immature bone was expected highlighting the importance of removing these cells beforehand if we are to reach maximum healing potential with a fully absorbing bone graft.
‘Soft tissue invasion’ described in the hypothesis underpinning GBR with membranes is likely to be the ‘scar tissue‘ formed when granulation tissue is not removed.
Dr Efrain Kfir (Israel) had already developed a tool to prepare the bony surfaces and remove this unwanted granulation tissue. His idea, to incorporate large rough-cut diamonds was commercialised after evaluation with a team of opinion leaders and integrated into the protocol as an effective tool to assist site preparation ahead of placement of a bone graft, implant, or both.
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 Degranulation Buss Kit contains four burrs:
Each burr has rough-cut diamonds embedded on its surface which “grab” tissue at the same time as ‘polish’ the bone bed. The burrs are reusable and autoclavable. A small bore suction tube is included which helps remove collected soft tissue from the diamond head in a 2-handed technique. It is recommended to replace burrs after 25 applications to ensure efficient operation.
Benefits of Degranulation
Facilitate Healing. Removal of granulation tissue from the site helps facilitate the healing process by allowing new bone to form and reducing the risk of infection.
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.
Minimize Patient Discomfort. Degranulation can minimize patient discomfort by reducing the need for more invasive procedures such as curettage or flap surgery.
Increased Efficiency. Degranulation increases the efficiency of dental procedures by reducing the time and effort required for granulation tissue removal.
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.
| 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 |
A short animation illustrates the use of Degranulation burrs.
To purchase
Degranulation Burr Kit
https://restore-surgical.co.uk/product-category/regen-store/degranulation/
Powerbone Dental Putty
Clinical images courtesy Dr. Minas Leventis. https://dentalexelixis.co.uk/about-us
Give us a call or Ask via what’s app:
+44 7800990131
Email Implant Store on ask@implant-store.co.uk
Email Regen Store on ask@regen-store.co.uk
*VAT is charged on UK-delivered orders. Exports are nil VAT.
Access a bespoke 30-minute one-on-one session to discuss site preparation and material science for post-extraction socket management.