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Advancing the Science of Implantology

198-45 Foothill Avenue, Holliswood NY 11423

January 27, 2012

Dear Axel,
Bovine Bone is ceramic, because of the sintering process (heating) and chemical process to “deorganify” the
bovine bone (removing the organic components).
The product Bio-Oss may resorb in 20 to 30 years or longer, depending on the quantity the doctor placed in
your sinus. Find out how much was placed and how much was removed, if you don’t already know. The high
elastic modulus (mechanical property) of bovine may tear your Schneiderian membrane because it has sharp
corners and it is very strong. The material may come out from your nose because it is very dense; similar to
synthetic ceramic hydroxyapatites in this country in 1970-1980.
Since the osteoclast cells are not capable of removing the organic foreign material, giant cells and
macrophages will transport these small pieces of bovine bone to your larger filter organs (i.e. lymph nodes,
lungs and spleen) (Valen, Bollough and El Sharkawy). Your immune system may give up or be compromised
because of these cells being overworked trying to remove the Bio-Oss ceramic product over a long periods
of time.
Due to the product’s inability to resorb under normal conditions, the manufacturer instructs the doctors to pack
the Bio-Oss very lightly in the sinus. This method will produce fibrous tissue encapsulation of the material.
The reason for fibrous tissue encapsulation is the body’s defense mechanism, due to the materials’ negative
mechanical and chemical properties; the body is trying to defend itself from this foreign material. The fibrous
tissue results in a problem, as mentioned in a book by Ole T. Jensen, The Sinus Bone Graft, chapter 17 (Use
of Xenografts for Sinus Augmentation by Stuart J. Froum, Stephen S. Wallace, Sang-Choon Cho, and Dennis
P. Tarnow).
Dr. Froum reported “Histomorphometric studies at 6 to 12 months after grafting consistently report findings
of relative proportions of vital bone, connective tissue, and residual xenograft to be approximately 25%, 50%
and 25% respectively.” He further notes “As previously noted, xenografts have been shown to “resorb” slowly
and incompletely. For example, Piatelli et al 34 retrieved 20 biopsy specimens at time intervals ranging from
6 months to 4 years from sinuses augmented with 100% Bio-Oss. Findings at 6 to 9 months showed them to
be composed of about 40% marrow space, about 30% newly formed bone, and about 30% residual Bio-Oss
Please look at your white blood count. You will see it is very high. Leukocytes (white blood cells of the
immune system) is your body’s first defense mechanism, and they are currently being over worked! You need
a resorbable material. How much of the Bio-Oss was removed from your sinus and how was it removed? Do
you have a recent x-ray showing Bio-Oss radiopaque, much denser than the host bone?

Maurice Valen
Impladent Ltd.
718 465-1810

800 526-9343

Fax 718 464-9620

Corresponding References:
SJ Froum, SS Wallace, SC Cho and DP Tarnow. In Jensen OT, ed. The Sinus Bone Graft. 2nd ed Chicago, IL:
Quintessence, 2006: Chp 17; 211-219

Valen M and Ganz SD: Part I: A Synthetic Bioactive Resorbable Graft (SBRG) for predictable implant
reconstruction. J Oral Implantol, 28(4):167-177, 2002.

El Sharkawy HM, Meffert, RM. Biodegradation and Migration of Porous Calcium Phosphate Ceramics [thesis].
New Orleans, La: Louisiana State University School of Dentistry; 1987.

DiCarlo EF, Bullough PG. Biologic responses to orthopaedic implants and their wear debris. Clin Mat. 1992;

718 465-1810

800 526-9343

Fax 718 464-9620