subperiosteal implant

1. Copy Right 2023
Graft less implant
Dentistry concept

2. Thanks for
Every body make
this dream come true

3. Dr.Islam Kassem
BDS,MSc,MFDS RCS Ed, MOMS RCPS Glasg
FFD RCSI,FDS RCPS GLasg
Senior Consultant OMFS
Head of OMFS Alamin Hospital
IMAXFAX center

4. Our team

5. • There is no conflict of interest in this lecture
• I have no monetary benefit from this lecture.
• No implied sponsorship by any company to the
speaker
• all photographed patients were treated by the
speaker and consented for photographing and
public publishing

9. Details please

10. E-log book
M implant Diploma

12. WHAT IS GRAFT ?
A viable tissue that after removal from
a donor site is implanted with in a
recipient tissue is then restored
repaired & regenerated.

13. WHAT IS GRAFTING ?
Procedure used to replace /
restore missing bone or gum
tissue.

14. WHAT ARE BONE GRAFTS?
Bone grafts are the materials used for
replacement or augmentation of the bone.
Food and Drug Administration (FDA) regulates
bone grafting materials

15. OSTEOINDUCTION
• A chemical process by which molecules
contained in the graft(bmp)convert the
neighbouring cells into osteoblasts which
in turn form bone.
• Process by which graft material is
capable of promoting
- osteogenesis
- cementogenesis - new PDL
(Urist & McLean)

16. A graft, a biomaterial or a
substance is osteo inductive when
implanted in a non osseous
environment called as an ectopic site,
bone formation occurs.

17. OSTEOGENESIS
represents all the steps & processes leading to bone
formation. This term has been used by some authors to
de
fi
ne bone grafts capable of forming bone through
osteoblastic cells contained in the transplanted graft
OR
the process of bone formation, which begins with either
osteoblasts in the patient's natural bone or from surviving
cells in the bone graft that is placed.

18. OSTEOCONDUCTION
• A physical e
ff
ect by which the matrix of
the graft forms a scafold that favours
outside cells to penetrate the graft and
form new bone.
• The Graft material acts as a passive
matrix like a trellis or sca
ff
olding for new
bone to cover over itself.
( Urist & colleagues )
•

19. • Process also known as Trell's e
ff
ect
• occurs with the ingrowth of capillaries in
the new connective tissue.
• A material is osteoconductive when its
structure & its chemical composition
facilitate new bone formation from existing
bone.

20. OSTEOSTIMULATION - “The
stimulation of osteoblast proliferation
and di
ff
erentiation as evidenced
during in vitro osteoblast cell culture
studies by increased DNA content and
elevated osteocalcin and
alkalinephosphatase levels”
FDA 2005

21. CONTACT INHIBITION
The process by which the graft
material prevents apical proliferation
of epithelium
(Ellegaard & colleagues 1972)

22. INDICATIONS FOR GRAFTS
Deep Intraosseous Defects
Tooth Retention
Support for Critical Teeth
Bone Defects Associated With Aggressive
Periodontitis
Esthetics (Shallow Intraosseous Defects)
Furcation Defects

23. OBJECTIVES OF BONE GRAFTING
• probing depth reduction
• clinical attachment gain
• bone
fi
ll of the osseous defect
• regeneration of new bone,
cementum, and periodontal ligament
•

24. ADVANTAGE
• Potential regeneration of non correctable
periodontal defect.
• By reconstructing the periodontium, it is possible to
reverse the disease process.
• Increased tooth support, improved function, and
enhanced esthetics are concomitant results of
successful bone graft therapy

25. DISADVANTAGE
Increased t/t time
Longer postop t/t
Autograft requires 2 site
Inc. postop care
Variability in repair & predictability Greater expense
Availability
( Mellonig 1992)

27. technology can help?

29. Human bone
Autogenous grafts (autografts)
Extraoral
Intraoral
Allogenic grafts (allografts)
Fresh frozen bone
Freeze-dried bone allografts
Demineralized freeze-dried
bone allografts

30. Bone substitutes
Xenogeneic grafts (xenografts)
Bovine-derived hydroxyapatite
Coralline calcium carbonate Alloplastic grafts
(alloplasts)
Polymers Bioceramics
- Tricalcium phosphate
- Hydroxyapatite Bioactive glasses

31. IDEAL CHARACTERISTIC OF BONE
GRAFT
• Nontoxic
• Nonantigenic
• Resistant to infection
• No root resorption or ankylosis
• Strong and resilient
• Easily adaptable
• Readily and su
ffi
ciently available
• Minimal surgical procedure
Stimulates new attachment

32. AUTOGRAFTS
•
fi
rst bone replacement grafts reported for
periodontal applications
• ‘‘Gold Standard’’ for bone grafting procedures
• Rich source of bone & marrow cells
• osteogenic potential
•

34. BASED ON INDUCTIVE POTENTIAL
Extraoral—hip marrow
Fresh
Frozen Intraoral
Osseous coagulum—bone blend Tuberosity
Extraction sites
Osseous coagulum Continguous autograft

35. Go Digital Equal
more safety
www.mrread.ca

36. EXTRAORAL SITES
• Schallorn (1967/ 1968) introduced use of autogenous” HIP
MARROW “Grafts (illiac crest marrow) in t/t of periodontal
defects.
• highest inductive potential
• Obtained using a Turkell bone trephine

38. EXTRAORAL CANCELLOUS BONE &
MARROW
• Cushing (1969 )--- extraoral
cancellous bone & marrow o
ff
er the
greatest potential new bone growth.
• In 1968 Schallhorn obtained this
material either from anterior or
posterior iliac crest.

39. Iliac Autografts -
Data from human & animal studies
support its use, & the technique has
proved successful in bony defects with
various numbers of walls, in furcations.
It is generally agreed that extraoral
cancellous bone and marrow from the
iliac crest o
ff
er the greatest
osteogenic potential.

40. Advantages:
Greatest induction potential for osseous
regeneration
Su
ffi
cient quantities for extensive defects.
May be stored for future use.

41. Disadvantages:
Additional surgical insult to the patient.
additional expense i.e. orthopedic surgeon or
hematologist.
Potential for root resorption with fresh material.

42. COMPLICATION
Schallhorn R.G (1972) described the post operative problems
associated with iliac bone grafts postoperative infection
exfoliation
sequestration
varying rates of healing
root resorption
rapid recurrence of the defect

43. WHICH BONE TO USE....? ? ? ? ? ?
• Cortical bone is recommended rather
than cancellous bone -------- American
Academy of Periodontology
• cancellous bone is more antigenic
• cortical bone contains more bone matrix
and consequently more osteoinductive
components

44. Calverial
Bone

45. BONE GRAFT
TECHNIQUE

46. ANTIBIOTIC COVERAGE
Tetracycline-type drugs are the antibiotics of choice for immediate
postsurgical plaque suppression due to their broad spectrum of activity,
attraction to healing wound sites and concentration in GCF.
They are administered in therapeutic doses for the
fi
rst 10 days following
surgery or until the patient can practice proper plaque control in the area

47. FATE OF BONE GRAFT
Once the material is placed in the bony defect it may act in a number
of ways which may decide the fate of the graft material.
The various possibilities include:
• Bone graft material may have no e
ff
ect at all.
• The bone graft material may act as a sca
ff
olding material for the
host site to lay new bone.
• The bone graft material may itself deposit new bone because of
its own viability.

48. • Vitamin deficiency in adolescent , review article ,
• Europtian J of pediatric 2014 Kassem et at

50. It’s an old story
Friction support implant

51. •Surgically driven
•

53. •Work
fl
ow
•

54. Minute in planning save hour
In surgery
•

55. Teeth driven

60. Take home massage
Egyptians create the standards,
The world follows

61. •Islam Kassem
• ikassem@dr.com
• 00201559900333
• Slide share
• Pub med
• Researchgate