Q: Dr. Eppley, I noticed that you also do reconstruction using bone cements.I had sagittal split osteotomy a couple years back which left my face unbalanced and my mandibular angles too small. I’d like to restore balance to my face without the bottom face turning too square. I’m not keen on using plastic implants. So, does hydroxyapatite make a good material for restoring facial contours for the mandible? Unlike bone grafting, it doesn’t resorb, and is comparatively easy to mold.. or so I have read.
A: Of the many materials available for facial bone augmentation, hydroxyapatite has a long history dating back over twenty-five years as a granular bone onlay material. This is a syringe method where the granules are introduced through an open intraoral approach with limited dissection. They do not resorb and are relatively easy to place. Confining them to the desired location was always an issue but it can be an effective method. Hydroxyapatite today is better known as a bone cement and has been widely used for cranial reconstructions in infants as well as adults. It needs to be mixed and applied in an open method as the setting of the material is very technique sensitive. It is not use very often as a facial augmentation material as it works best when used in an inlay bone defect that has borders. would not use bone or hydroxyapatite cement as this material composition is too difficult and unpredictable to place outside of an open cranioplasty where its setting/curing is more assured.
Hydroxyapatite granules, and a very similar material known as HTR granules, can be used for a small amount or moderate amount of mandibular angle augmentation.
Dr. Barry Eppley