Centers for Oral Care
No. 15 -- 19Jan2017
Fellow of the Academy of Veterinary Dentistry
DonDeForge100@gmail.com and DoctorDeForge@yahoo.com
Consil® Synthetic Bone Graft Particulate has been utilized at Silver Sands Veterinary Center and at the Centers for Oral Care, for years, in periodontal and osseous defects. Originally earmarked in alveolar ridge maintenance following extraction and treatment of infrabony osseous defects, its scope of utilization has broadened significantly through the years. Consil® is an osteoconductive bioactive device used for grafting osseous defects.
Consil® has expanded into oral trauma care with oral orthopedic applications, repair of oronasal fistulas, and filling of defects after mass or cyst removal from the oral cavity. The clinical and radiographic findings demonstrate that the Bioglass® particles are progressively replaced by bone. Whenever a tooth is extracted, nature will remove the bone that used to encompass this structure. The alveolar or supportive bone is lost leaving behind cortical bone. This can be arrested with bone grafting.
Consil® particulate material has been found to be hemostatic through a mechanical effect. Following the placement of Bioglass®, soft tissue and bone bleeding decrease significantly. This allows for excellent visualization of tissues during the placement of sutures. Combined with Radiowave Radiosurgery [4.0 M Hz- Ellman International] technology, the field of vision is literally blood free. A second positive finding is that epithelial down growth is limited to the point where it meets the adherent collagen fibers overlying the restored bone. The collagen attaches to the most superficial particles immobilizing them. It has been shown that Bioglass® is bacteriostatic allowing placement in infected sites with positive results.
All bone grafting sites must be pre-radiographed, osseous surgery performed when indicated, and lavaged with normal saline 0.9% before the Consil® bone alloplast is placed. After placement of bone alloplast, there must be a combined out-patient recheck[s] as well as multiple oral radiograph appointments to assure that the area is healing properly. The patient must be monitored to be sure that no hard chewing occurs. Leash walking is advised. If infection in the bone is suspected, a broad spectrum antibiotic that will kill both aerobes and anaerobes is advised for 30 days post treatment. As with all bone surgery, analgesic protocols are essential for up to three weeks post-surgery. Because there is no subjective pain, “bad or hidden” pain must be treated for a minimal time period. This analgesic program is continued as necessitated.
The placement of the bone graft is not painful but the cutting of bone is painful and must be appreciated with pain control systems. Failure or “wash out of the bioactive glass will occur with advancement of plaque bacteria. Therefore, all bone grafting procedure success is strongly linked to compliance by the owner to effective anti-plaque homecare treatments, on a daily basis, as recommended by the veterinarian or veterinary dentist placing this material.
Bone alloplast [i.e. Consil®-Bioglass® is recommended for use after all extraction procedures in the canine and feline. As stated, pre-extraction and post-extraction radiology is paramount. In the distal mandible, this is extremely important, in toy breeds, because of the possibility of already existent incomplete pathologic fractures. These incomplete fractures can accelerate to complete fractures with forceful extraction techniques. Pre-radiology of the sites allows the practitioner to call the owner and inform them of this pathology and get permission for extraction with informed consent. The client may ask for referral to a veterinary dentist at this juncture.
Consil® is available as the original bone graft particulate and also as a Putty Synthetic Bone Graft. The Consil® Putty is a premixed composite of the bioactive calcium-phospho-silicate particulate and a synthetic, absorbable binder. The absorbable binder is a combination of polyethylene glycol and glycerin. The Consil® Putty device, as described by the manufacturer, requires no mixing or preparation prior to application.
The Consil® Putty has been found extremely beneficial in areas where there are no true physical osseous borders for retention. A prime site for oral usage is in the anterior mandibular symphysis. After radiography and osteoplasty with copious irrigation, the putty can be modeled to fit the confines of the site. It holds position perfectly until mucoperiosteal flaps are secured with absorbable sutures. Post radiography shows the same excellent bone healing as noted with the bone graft particulate. The Consil® Putty Bone Graft should be used in combination with internal or external orthopedic fixators if the symphysis is unstable. It should not be used to support load-bearing defects. As stated above, standard procedures in pain control, infection control, and plaque prevention must be followed to show success with this product. Post radiology follow-up[s] in 6-12 months is essential in all bone augmentation procedures. All Guided Bone Regeneration procedures should only be accomplished by veterinarians after successful training in orthopedics and GBR techniques.
See the photo essay below visualizing the usage of the Consil® Synthetic Bone Graft in the anterior mandible. Questions: E-Mail Dr. Don DeForge at DonDeForge100@gmail.com or write Silver Sands Veterinary Center-Milford Veterinary Hospital and Centers for Oral Care-17 Seemans Lane, Milford, CT. 06460