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Autogenous bone grafting

Periodontitits is a multifactorial disease which leads to progressive loss of periodontal tissues including the alveolar bone. Since autogenous bone grafting has been considered as the gold standard referring to the lowest incidence of graft rejection, this ppt gives an insight about the autogenous bone grafts that can be used in periodontal defects.

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Autogenous bone grafting

  1. 1. 1Dr. Kritika Jangid
  2. 2. Dr. Kritika Jangid (MDS- Periodontics and Implantology) 2Dr. Kritika Jangid
  3. 3. CONTENTS • BONE • BONE LOSS IN PERIODONTAL DISEASE • AUTOGENOUS BONE GRAFTS 3Dr. Kritika Jangid
  4. 4. 4Dr. Kritika Jangid
  5. 5. Circumferential lamellae 5Dr. Kritika Jangid
  6. 6. Concentric lamellae 6Dr. Kritika Jangid
  7. 7. OSTEON 7Dr. Kritika Jangid
  8. 8. Interstitial lamellae 8Dr. Kritika Jangid
  9. 9. •outer "fibrous layer" and • inner "cambium layer" (or "osteogenic layer"). P E R I O S T E U M 9Dr. Kritika Jangid
  10. 10. Are responsible for formation, resorption and maintenance of osteoarchitecture • Osteogenic cells • Osteoprogenitors • Preosteoblasts • Osteoblasts • Osteocytes • Bone lining cells • Osteoclast B O N E C E L L S 10Dr. Kritika Jangid
  11. 11. 11Dr. Kritika Jangid
  12. 12. WHAT HAPPENS IN PERIODONTAL DISEASE??? 12Dr. Kritika Jangid
  13. 13. Extension of inflammation from the marginal gingiva into the supporting periodontal tissues Invasion of the bone surface and the initial bone loss Gingivitis Periodontitis Bone loss in periodontal disease 13Dr. Kritika Jangid
  14. 14. Pathways of inflammation 14Dr. Kritika Jangid
  15. 15. • Page & Schroeder- range of effectiveness of dental plaque to induce loss of bone is within about 1.5 to 2.5 mm. • Acc to Loe & co-workers – 8% severe periodontal diseases, yearly loss of attachment 0.1-1mm – 81%moderate periodontitis, CAL 0.05-0.5mm – 11%mild Periodontitis, 0.05-0.09mm Radius of Action 15Dr. Kritika Jangid
  16. 16. PLAQUE PRODUCTS BONE PROGENITOR CELLS OSTEOCLASTS BONE DESTRUCTION GINGIVAL CELLS AGENTS 1. 2. 3. 5. 4. ACT AS COFACTOR DIRECT CHEMICAL ACTION Hausmann,1974 Mechanism of Action 16Dr. Kritika Jangid
  17. 17. BONE DESTRUCTION PATTERNS IN P.DISEASES • Horizontal bone loss • Osseous defects • Vertical/Angular defects 17Dr. Kritika Jangid
  18. 18. VERTICAL/ANGULAR DEFECTS 18Dr. Kritika Jangid
  19. 19. • Osseous Craters • Bulbous Bone Contours • Reverse Architecture 19Dr. Kritika Jangid
  20. 20. • Ledges • Furcation Involvements 20Dr. Kritika Jangid
  21. 21. 21Dr. Kritika Jangid
  22. 22. • GRAFT is defined as the portion of tissue removed from one site and placed at another, either in same or in another individual in order to repair a defect caused by operation , accident or disease. 22Dr. Kritika Jangid
  23. 23. History • Job Van Meekeren 1668 – Performed the first heterologous graft by inserting a segment of dog’s skull into the skull of an injured soldier • Duhamel in 1743 – Periosteum has a pivotal role in osteogenesis • Leopold Ollier in 1861 – Osteogenetic capability of periosteum to autologous and homologous grafts 23Dr. Kritika Jangid
  24. 24. • Zoltan Hegedus in 1923 – Portion of tibia grafted to the labial surface of the mandibular anteriors [1st recorded human autogenous bone graft in periodontics] • Buebe and Silvers 1936 – Used boiled cow bone powder to successfully repair intrabony defects • Forsberg in 1956 – Ospurum [ox bone ] • Melcher in 1962 – Anorganic bone [ bovine bone ] – Allogenic freeze-dried bone – introduced in early 1970 • Schallhorn in 1980 – Grafting successful for 20 years with daily plaque control by patients & supervised periodontal maintenance program. • Bower’s in 1989 – Bone grafting enhances regeneration of new attachment aparartus 24Dr. Kritika Jangid
  25. 25. Vittorio Putti [1912] Principles considered as the basis of modern science of grafting 1. Ability to be critical 2. Uniformity in graft integration 3. Osteogenic potential of periosteum 4. Biological capacity of treated grafts 5. Quality of tissue in which graft is placed 6. Mechanical characteristics of grafts and it’s fixation 25Dr. Kritika Jangid
  26. 26. Ideal bone graft should ……. Gross [1997] 1. Be biocompatible 2. Serve as scaffold [framework for new bone formation] 3. Be resorbable in the long term & have the potential for replacement by host bone 4. Be osteogenic 5. Be radiopaque 6. Be easy to manipulate 7. Non Allergenic 8. Not support the growth of pathogen 26Dr. Kritika Jangid
  27. 27. 9. Hydrophilic [to attract & hold the clot in a particular area] 10. Availability in particulate & molder forms 11. Microporous 12. Have high compressive strength 13. Have a surface amenable to grafting 14. Act as a matrix or vehicle for other materials 27Dr. Kritika Jangid
  28. 28. • Reattachment Reunion of root and connective tissue separated by incision or injury • New attachment Formation of new cementum with the insertion of new connective tissue fibers about a tooth surface previously exposed to bacterial plaque. Epithelial attachment – by long junctional epithelium • Regeneration The formation of new bone, new cementum and PDL about a tooth surface previously exposed to bacterial plaque. • Repair The healing of a wound by tissue that does not fully restore the architecture or the function of the part i.e.; scar tissue . -Melcher (1976) 28Dr. Kritika Jangid
  29. 29. TYPES OF BONE GRAFTS • Autograft: A tissue graft transferred from one position to a new position in the body of the same individual. • Isograft: A tissue graft taken from one individual and transferred to another individual of the same genetic make. Eg: Identical twins • Allograft: A tissue graft between individual of the same species but of non –identical genetic. • Xenograft: A tissue graft between members of differing species i.e animal to man. • Alloplast: A synthetic bone graft material, a bone graft substitute. 29Dr. Kritika Jangid
  30. 30. 30Dr. Kritika Jangid
  31. 31. • Osteogenesis Formation or development of new bone by cells contained in the graft :eg –autogenous graft. • Osteoconduction Physical effect by which the matrix of the graft forms a scaffold that favors outside cells to penetrate the graft and form new bone. Eg; Alloplasts • Osteoinduction Chemical process by which molecules contained in the graft (BMP’s) convert the neighboring cells into osteoblasts , which in turn form bone • Osteopromotion When the grafted material does not possess the property of osteoinduction but enhances osteoinduction by promoting new bone formation. For eg: Enamelmatrix derivatives do not stimulate de novo bone growth alone, but when used with DFDBA, enhances the osteoinductive effect of DFDBA. 31Dr. Kritika Jangid
  32. 32. INDICATIONS • Two walled intra bony defect • Three walled intra bony defect • Grade II, III Furcation involvement • Ridge augmentation • Sinus lifting procedure • Regeneration around implants • Socket conservation • Filling donor side bone defects 32Dr. Kritika Jangid
  33. 33. 33Dr. Kritika Jangid
  34. 34. 1. Considered the GOLD STANDARD among all the graft materials 2. Gives more predictable results 3. Contains live osteoblasts and osteoprogenitor stem cells and heal by osteogenesis 34Dr. Kritika Jangid
  35. 35. Graft Procurement Bone Trap Trephine Bur Bone Shaving Suction Trap 35Dr. Kritika Jangid
  36. 36. INTRA-ORAL SITES • Healing extraction wounds • Bone from edentulous ridges • Bone trephined from the jaw without damaging the roots • Bone removed during osteoplasty or ostectomy • Mental and mandibular retromolar areas • Maxillary tuberosity • Exostoses 36Dr. Kritika Jangid
  37. 37. EXTRA- ORAL SITES • Hip marrow grafts – from iliac crest • Gerdi’s tubercle – from tibia 37Dr. Kritika Jangid
  38. 38. BONE GRAFTS HARVESTED FROM INTRA-ORAL SITES • Cortical Bone Chips • Osseous coagulum • Bone Blend • Intra oral Cancellous Bone Marrow Transplants • Bone swaging 38Dr. Kritika Jangid
  39. 39. Cortical Bone Chips • Nabers & O’Leary [1965 ] – shavings of cortical bone removed during osteoplasty & ostectomy • Large particle size • Potential for sequestration 39Dr. Kritika Jangid
  40. 40. OSSEOUS COAGULUM • R. Earl Robinson • Technique uses mixture of bone dust & blood • Small particles ground from cortical bone used • Sources: Lingual ridge on the mandible, exostosis, edentulous ridges, bone distal to the terminal tooth, bone removed from osteoplasty or ostectomy. 40Dr. Kritika Jangid
  41. 41. • ADVANTAGES: Additional surface area for interaction of cellular & vascular elements. Ease of obtaining bone from already exposed surgical site. • DISADVANTAGES: Inadequate materials for large defects. 41Dr. Kritika Jangid
  42. 42. BONE BLEND • Uses an autoclaved capsule & pestle. • Bone removed from pre-determined site , triturated in capsule to a workable , plastic like mass, & packed into bony defects 42Dr. Kritika Jangid
  43. 43. INTRA ORAL CANCELLOUS BONE MARROW TRANSPLANTS • From maxillary tuberosity Procedure: – Bone removed from curved or cutting rongeur. – Ridge incision distally from the last molar 43Dr. Kritika Jangid
  44. 44. • Edentulous area Procedure: – Raising a flap – Bone and its marrow are removed from curettes and back action chisels 44Dr. Kritika Jangid
  45. 45. • Healing sockets. Procedure: – After 8-12 weeks of healing – Apical portion used as donor material – Particals are reduced to small pieces 45Dr. Kritika Jangid
  46. 46. BONE SWAGING • Edentulous area near the defect required • Bone is pushed into the root surface without fracturing the bone at the base • Technically difficult 46Dr. Kritika Jangid
  47. 47. SOURCE OF INTRAORTAL BONE- Imp. • Predominantly , cortical in nature which is less osteogenic • Cancellous bone provides better osteogenic potential Dr. Kritika Jangid 47
  48. 48. Extra Oral Illiac Autografts 1. The use of fresh or preserved illiac cancellous marrow has been extensively investigated 2. Studies show that there was a mature PDL and about 2mm supracrestal new attachment formation 3. No longer in use owing to some problems such as 48Dr. Kritika Jangid
  49. 49. 1. Root resorption 2. Post operative infections 3. Tooth loss & sequestration 4. Varying rates of healing 5. Rapid recurrence of defects 6. Difficulties in procuring the graft material 49Dr. Kritika Jangid
  50. 50. Healing Of Autografts Four Stages : • Granulation Stage : When hematoma develops , an inflammatory response occurs and the formation of granulation tissue takes place • Callus Stage : Mesenchymal cell differentiates mainly into osteoblasts • Remodelling Stage : Hard callus tissue is replaced by lamella bone • Modelling Stage : Bone adapts to the structural demands due to functional stimuli 50Dr. Kritika Jangid
  51. 51. 7 days: Initiation of new bone formation 21 days: Cementogenesis 3 months: New PDL 8 months: Graft fully incorporated into the host with functionally oriented fibers between the bone and the cementum Maturation may take as long as 2 years [Dragoo 1972 ; Dragoo & sullivan 1973] 51Dr. Kritika Jangid
  52. 52. Autografts …….. Advantages 1. Promotes osteogenesis 2. Risk of disease transfer avoided 3. Easily procured Disadvantages 1. Inadequate material 2. Not comfort with hospitilization 3. Inflicting surgical trauma in other parts of the body 52Dr. Kritika Jangid
  53. 53. 53Dr. Kritika Jangid
  54. 54. 54Dr. Kritika Jangid

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Periodontitits is a multifactorial disease which leads to progressive loss of periodontal tissues including the alveolar bone. Since autogenous bone grafting has been considered as the gold standard referring to the lowest incidence of graft rejection, this ppt gives an insight about the autogenous bone grafts that can be used in periodontal defects.

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