Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Presented By
Dr. M. Shiva Shanker
III Year Post Graduate Student ,
Dept of Periodontics, Mamata Dental College.
Contents
• Introduction
• History
• Terminology
• Classification of bone grafts
• Objectives of bone grafts
• Ideal characteristics of bone grafts
• Advantages and disadvantages
• Allogenous bone grafts
• Procurement
• Bone graft technique
• Combination procedures
• Recent advances
• Conclusion
• References
Introduction
History
• Hegedus in 1923 – transplanted autogenous bone from the tibia
to the jaws to treat advanced pyorrhea. First recorded human
autogenous bone graft in periodontics.
Bone Alloplastic
Auto grafts Allografts substitutes
Xenogratfs
grafts
Bioactive glass
Bovine derived
Fresh frozen HA coralline
Extraoral bone calcium Polymers
carbonate
Freeze dried
Intraoral Bioceramics
bone
Demineralized
Tricalcium
Freeze dried
bone phosphate
Hydroxyl apatite
•Dense, non
porous, non
resorbable.
•Porous, non
resorbable
•Resorbable, HA
desired at low
temperature
Rose classification
Calcium
Autograft Allograft Dentin
sulfate
Calcium
Xenograft Cementum
sulfate HA
Bioactive
Coral
glass
Polymers
RATIONALE and CLINICAL OBJECTIVES
• Nontoxic
• Non antigenic
• Resistant to infection
• No root resorption or ankylosis.
• Strong and resilient.
• Easily adaptable.
• Readily and sufficiently available.
• Minimal surgical procedure.
• Stimulates new attachment
Advantages Of Bone Grafts
• Host incompatiability
• Potentially contaminated specimens resulting in
recipient site infection and potential
transmission of disease from donar to recipient
of the allograft
BONE BANKING
• Blood Serology
• Microbiology
• Autopsy
• Excision of Bone Allografts
Frozen Iliac Cancellous bone
Antigenicity
• Antigenicity of the donor material arises with any dental/medical
procedure using tissues derived from human donors.
• In humans, chromosome 6 contains the MHC, which codes for the
human lymphocyte antigens.
• These antigens are expressed on the cell surface of nearly every
nucleated cell in the body and represent the primary stimulus for
transplant rejection when HLA mismatches occur between donor
and recipient.
• Detection of donor specific anti HLA antibody formation in a patient
receiving allografts is an important measure of the clinical
immunogenicity of the respective graft material.
Risk of disease transmission
• The potential for disease transfer particularly viral
transmission and even more particularly HIV is a
crucial factor associated with use of bone allografts.
• First case of HIV transmission through allogenic
bone was reported in 1988.
• Most frequently used methods of assuring graft
sterility is irradiation.
• Smith et al reported that, even at doses at which
tissue quality begins to be compromised, irradiation
failed to be virucidal for HIV type 1.
Human Bone Allograft Tracking
• Patient selection:
• Defect selection
• Remove all etiologic factors
• Flap design with a plan for closure
• Degranulation of defect and flap
• Root preparation.
• Encourage a bleeding bony surface
• Condense graft materials well
• Good tissue coverage
• Periodontal dressing
• Antibiotic coverage
• Post surgical care
Various forms
• Sizes: 10 x 7 x 6 mm, 20 x 7x 6 mm
Encore
• The first particulate
dental bone grafting
product combining
mineralized and
demineralized bone in a
single vial
• Periomix
• Demineralized Bone Matrix
with cancellous chips
< 0.7 mm.
Combination procedures