Just like its sibling for trauma indications, the new Norian reinforced is a moldable, biocompatible, calcium-phosphate bone cement with added reinforced fibers that sets at body temperature (Click here for the full article). It is indicated for repairing or filling craniofacial defects and craniotomy cuts with a surface area no larger than 25 cm. Other indications include the restoration or augmentation of bony contours of the craniofacial skeleton (including the frontoorbital, malar, and mental areas), such as burr-hole voids and other craniofacial defects.

Although calcium phosphate cements have been used for some time as a treatment for cranial defects with easy administration via injection or manual placement, the occasional experience of early fragmentation and failure to set have led surgeons to refrain from using it in many cases. The vast majority of failures tend to occur early in the initial setting time, especially as an effect of dural pulsations. In order to address this reinforcing fibers and a sodium hyaluronate-based solution were added to the formula of the existing Norian CRS. The fibers, consisting of a 82:18 polylactide:glycolide copolymer, reinforce the ceramic when setting at body temperature and result in a resistance against cracking during the setting phase, whereas the sodium hyaluronate solution has been added in order to enhance mixing and handling properties.

Norian reinforced is not intended for use in the spine and should not be used in the presence of active or suspected infection. Just like the former Norian CRS there are two available delivery forms: Norian reinforced is an injectable paste that is mixed with an automatic mixer, Norian reinforced fast-set putty is manually mixed with a cup and spatula.