Tissue grafting /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in

continuing dental education , training dentists

in all aspects of dentistry and offering a wide

range of dental certified courses in different

formats.

Indian dental academy provides dental crown &

Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit

www.indiandentalacademy.com ,or call
0091-9248678078

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  • 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. TISSUE GRAFTINGBIOLOGICAL CONSIDERATIONS OF AUTOGENOUS & HETEROGENOUS GRAFTS www.indiandentalacademy.com
  • 3. INTRODUCTION Surgeons do not heal tissue; they merely place it where nature can heal it.  DEFINITION  TYPES OF TISSUE GRAFTS www.indiandentalacademy.com
  • 4. WHAT IS BONE GRAFT ? www.indiandentalacademy.com
  • 5. Classification of bone grafts  Four types of bone grafts : • Autograft or autogenous graft • Allograft or homograft • Xeno graft or hetrograft • Alloplast www.indiandentalacademy.com
  • 6. AUTOGENOUS BONE GRAFTS  Advantages  Disadvantages www.indiandentalacademy.com
  • 7. Clinically, grafts can be classified : • Site of origin :  Extra oral  Intra oral • Graft anatomy :  Cortical  Cancellous  Corticocancellous • Vascular autografts :  Free tissue transplants  Pedicle flaps www.indiandentalacademy.com
  • 8. SITE OF ORIGIN EXTRA ORAL SITES INTRA ORAL SITES www.indiandentalacademy.com
  • 9. GRAFT ANATOMY  Cortical  Cancellous  Corticocancellous  Bone slurry www.indiandentalacademy.com
  • 10. CORTICAL BONE GRAFT  Cortical bone grafts have strictly limited clinical applications.  Primarily used in area where there is great mechanical stress www.indiandentalacademy.com
  • 11. Cancellous bone graft www.indiandentalacademy.com
  • 12. Corticocancellous bone graft www.indiandentalacademy.com
  • 13. POTENTIAL FUNCTIONS OF BONE GRAFT :  Osteogenic activity  Osteoconductive activity  Osteoinductive activity  Vascularity www.indiandentalacademy.com
  • 14. OSTEOGENESIS www.indiandentalacademy.com
  • 15. DIFFERENT FORMS OF BONE GRAFTS  VASCULARISED GRAFT  NON –VASCULARISED GRAFT www.indiandentalacademy.com
  • 16. OSTEOINDUCTION  Chemotaxis  Mesenchymal cell proliferation  Mesenchymal cell differentiation  Cartilage into the bone www.indiandentalacademy.com
  • 17. Growth factors  Platelet derived growth factor  Transforming growth factor  Insulin like growth factor  Endothelial growth factor  Fibroblast growth factor www.indiandentalacademy.com
  • 18. BONE MORPHOGENETIC PROTEIN  MARSHALL R. URIST  Functions of BMPs  Types of BMPs www.indiandentalacademy.com
  • 19. OSTEOCONDUCTION  Creeping substitution www.indiandentalacademy.com
  • 20. Healing of autograft: • Inflammation • Revascularization – 2x time for Cancellous grafts due to porosity • Osteoinduction • Osteoconduction • Remodeling www.indiandentalacademy.com
  • 21. Healing of allograft:  OSTEOINDUCTION  OSTEOCONDUCTION- “Creeping substitution” www.indiandentalacademy.com
  • 22. FACTORS IMPORTANT FOR SUCCESSFUL INCORPORATION OF AUTOGENOUS BONE GRAFT Revascularisation Structure & biomechanical features Rigid fixation of the graft Local growth factors Embryological aspect www.indiandentalacademy.com
  • 23. Factors affecting revascularisation     Recipient bed environment Graft microarchitecture Rigid fixation periosteum www.indiandentalacademy.com
  • 24. GRAFT MICROARCHITECTURE www.indiandentalacademy.com
  • 25. Rigid fixation of the graft www.indiandentalacademy.com
  • 26. periosteum  Fibrous layer  Cambium layer www.indiandentalacademy.com
  • 27. Embryological aspects  Membranous bone  Endochondral bone. www.indiandentalacademy.com
  • 28. SKIN GRAFTING Involves the removal of skin from one site and reattachment at another site. www.indiandentalacademy.com
  • 29. CLASSIFICATION OF SKIN GRAFTS Andreasi; Clinics of Dermatology 2005 : 332-337 www.indiandentalacademy.com
  • 30. CLASSIFICATION OF SKIN GRAFTS Andreasi; Clinics of Dermatology 2005 : 332-337 www.indiandentalacademy.com
  • 31. G R A F T T H I C K N E S S A-THIN SPLIT THICKNESS(THIERSCH) GRAFT. B-SPLIT THICKNESS SKIN GRAFTS.(0.012-0.018 inch) C-THREE QUARTER SKIN GRAFTS. D-FULL THICKNESS SKIN GRAFTS. www.indiandentalacademy.com
  • 32. www.indiandentalacademy.com
  • 33. SPLIT THICKNESS SKIN GARFTS INDICATIONS Temporary coverage for a wound  Large defect coverage too large for FTSGs www.indiandentalacademy.com
  • 34. Disadvantages Relatively poor cosmetic result  Contraction  Abnormal pigmentation www.indiandentalacademy.com
  • 35. FULL THICKNESS SKIN GRAFT INDICATIONS To avoid functional deformity  To achieve good cosmesis  When there is insufficient skin to create a local flap  When distant flaps are inappropriate www.indiandentalacademy.com
  • 36. ADVANTAGES Resists contraction  Good colour match  Good texture  Use in children www.indiandentalacademy.com
  • 37. WOUND PREPARATION www.indiandentalacademy.com
  • 38. BOLUS DRESSING 1. Ensure that there are no blood clots underneath the graft. 2. Inner layer of petrolatum gauze is applied and the sutures are kept long. 3. Layer of fluffed gauze is applied and the sutures are tied. Assistant holds first loop to prevent slippage. 4. Avoid removal before 7 th day. www.indiandentalacademy.com
  • 39. VARIATION OF THE BOLSTER TIE DOWN DRESSING www.indiandentalacademy.com
  • 40. PHASES OF SKIN GRAFT SURVIVAL  Plasmatic imbibition- Hubscher & Goldman Clemmesen Smahel www.indiandentalacademy.com
  • 41. GRAFT REVASCULARIZATION Autografts and allografts. Bert - “abouchement” Thiersch - “inosculation” Garre - made the following observations… 1. 5 ½ hours- endothelial mitosis in host bed. 2. 9 hours - presence of inflammatory cells in the grafts. 3. 11 hours - invasion of white cells into the donor vessels 4. Third or fourth day- actual revascularization as an invasion of the graft by host capillary buds. www.indiandentalacademy.com
  • 42. Factors influencing graft viability:  Blood supply to recipient bed  Microcirculation on the surface of the recipient bed  Vascularity of the donor graft tissue  Contact between graft and recipient bed  Patient’s overall health www.indiandentalacademy.com
  • 43. www.indiandentalacademy.com
  • 44. Skin Graft “Take.” Cellular Hyperplasia MATURATION Graft contraction Pigment changes Dermal Collagen Turnover Epithelial appendages Innervation of skin Grafts Durability and Growth www.indiandentalacademy.com
  • 45. DONOR SITE HEALING  SPLIT THICKNESS GRAFT  FULL THICKNESS GRAFT www.indiandentalacademy.com
  • 46. 1. INADEQUATE GRAFT BED – non viable tissue, crushed material, foreign bodies, excessive fibrosis, irradiation. 2. HEMATOMA 3. MOVEMENT 4. INFECTION 5. TECHNICAL ERRORS SUCH AS • PLACEMENT OVER EPITHELIZING WOUNDS, • GRAFTS CUT TOO THICK OR THIN OR UPSIDE DOWN. 6. POOR STAGE OF GRAFTS. www.indiandentalacademy.com
  • 47. CONCLUSION www.indiandentalacademy.com
  • 48. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com