collacone® max

collacone® max is made of porcine collagen and hydroxyapatite (HA) / beta-tricalcium phosphate (ß-TCP), e.g., maxresorb®. The collagen extraction procedure involves multi-stage cleaning processes that effectively remove all non-collagenous proteins and antigenic components.
maxresorb® granules are produced by mixing hydroxyapatite and beta-tricalcium phosphate (60%/40%) in a ceramic slurry; this ensures an equal distribution of the two calcium phosphate phases. The collagen solution is mixed with maxresorb® granules to form a homogenous mixture that is molded into cone shape.

Immediately after tooth extraction, the socket fills with blood and a coagulum is formed.
Within a week, invading vascular, immune- and connective tissue cells remodel the clot into granulation tissue that is successively replaced by a provisional matrix. Mineralizing processes, starting from the socket walls, lead to the formation of new, woven bone that gradually fills the socket and is eventually replaced by mature lamellar bone.
When the socket heals naturally, the bundle bone, i.e., the bone that surrounded the tooth, quickly resorbs and the socket loses its shape. Once the newly formed bone remodels into mature bone, the ridge is further reduced. The reduced ridge and collapsed soft tissue may pose aesthetic problems as well as complicate implant placement.

The principal aim of socket preservation is to reduce the loss of alveolar bone and improve the aesthetic outcome of the final prosthesis. Preserving the bone volume prevents the need for additional augmentative procedures and enables stable implant installation. collacone® max is a composite material that helps to maintains the socket space and provides a scaffold
for bone ingrowth and new bone tissue formation.

Before application of collacone® max the socket should be cleaned carefully and thoroughly with a curette to remove all tissue remnants (and potential contaminants i.e. infection). It should be ensured that the socket is intact; in case of wall defects the additional use of a barrier membrane (i.e. Jason® membrane) has to be considered. Prior to use, the cone may be cut to size if required. collacone® max should be applied to the socket without compaction (no pressing), nor overfilling (collacone max should not exceed 1-2mm below bone level). The collacone® max may be applied to the surgical site in dry status, or briefly rehydrated in blood. Excessive rehydration of the cone prior to placement should be avoided.

To prevent migration of granules and ensure undisturbed healing a proper coverage of collacone® max is recommended. This can be achieved by repositioning the mucoperiosteal flap over the grafted site and suture it to obtain primary closure. If primary wound closure cannot be achieved completely, further mobilization of the flap (e.g. by incision through the periosteum) is needed. Alternatively, the socket can be sealed with an autologous soft tissue punch or a collagen matrix such as mucoderm® (mucoderm® punch). Open healing is possible, but may lead to insufficient regeneration/particle integration in the coronal part of the socket with loose particle encapsulated in the soft tissue.

To ensure complete integration of the material it is recommended to place implants earliest at 5-6 months post-op. In case of earlier re-entry the material might not be completely integrated. The patient’s health status and the indication are amongst the most critical factors that, beside the biomaterials applied, decide the time of healing and regeneration.