INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com
TISSUE GRAFTINGBIOLOGICAL CONSIDERATIONS
OF AUTOGENOUS &
HETEROGENOUS GRAFTS

www.indiandentalacademy.com
INTRODUCTION
Surgeons do not heal tissue; they merely
place it where nature can heal it.
 DEFINITION
 TYPES OF TISSUE

G...
WHAT IS BONE GRAFT ?

www.indiandentalacademy.com
Classification of bone
grafts
 Four types of bone grafts :
• Autograft or autogenous graft
• Allograft or homograft
• Xen...
AUTOGENOUS BONE GRAFTS
 Advantages

 Disadvantages

www.indiandentalacademy.com
Clinically, grafts can be classified :

•

Site of origin :
 Extra oral

 Intra oral

•

Graft anatomy :
 Cortical
 Ca...
SITE OF ORIGIN
EXTRA ORAL SITES
INTRA ORAL SITES

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GRAFT ANATOMY
 Cortical
 Cancellous

 Corticocancellous
 Bone slurry

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CORTICAL BONE GRAFT
 Cortical bone grafts have strictly limited clinical

applications.
 Primarily used in area where th...
Cancellous bone graft

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Corticocancellous bone
graft

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POTENTIAL FUNCTIONS OF BONE
GRAFT :
 Osteogenic activity

 Osteoconductive activity
 Osteoinductive activity
 Vascular...
OSTEOGENESIS

www.indiandentalacademy.com
DIFFERENT FORMS OF BONE
GRAFTS
 VASCULARISED GRAFT
 NON –VASCULARISED GRAFT

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OSTEOINDUCTION
 Chemotaxis

 Mesenchymal cell proliferation
 Mesenchymal cell differentiation
 Cartilage into the bone...
Growth factors
 Platelet derived growth factor
 Transforming growth factor

 Insulin like growth factor
 Endothelial g...
BONE MORPHOGENETIC PROTEIN
 MARSHALL R. URIST

 Functions of BMPs
 Types of BMPs

www.indiandentalacademy.com
OSTEOCONDUCTION
 Creeping substitution

www.indiandentalacademy.com
Healing of autograft:
• Inflammation
• Revascularization
– 2x time for Cancellous grafts due to
porosity
• Osteoinduction
...
Healing of allograft:
 OSTEOINDUCTION

 OSTEOCONDUCTION-

“Creeping substitution”

www.indiandentalacademy.com
FACTORS IMPORTANT FOR
SUCCESSFUL INCORPORATION OF
AUTOGENOUS BONE GRAFT
Revascularisation
Structure & biomechanical featur...
Factors affecting
revascularisation





Recipient bed environment
Graft microarchitecture
Rigid fixation
periosteum

...
GRAFT MICROARCHITECTURE

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Rigid fixation of the graft

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periosteum

 Fibrous layer
 Cambium layer

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Embryological aspects
 Membranous bone

 Endochondral bone.

www.indiandentalacademy.com
SKIN GRAFTING
Involves the removal of skin from one site and
reattachment at another site.

www.indiandentalacademy.com
CLASSIFICATION OF SKIN
GRAFTS

Andreasi; Clinics of Dermatology 2005 : 332-337
www.indiandentalacademy.com
CLASSIFICATION OF SKIN
GRAFTS

Andreasi; Clinics of Dermatology 2005 : 332-337
www.indiandentalacademy.com
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-...
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SPLIT THICKNESS SKIN GARFTS
INDICATIONS

Temporary coverage for a wound
 Large defect coverage too large for FTSGs

www....
Disadvantages Relatively poor cosmetic result
 Contraction
 Abnormal pigmentation

www.indiandentalacademy.com
FULL THICKNESS SKIN GRAFT
INDICATIONS To avoid functional deformity
 To achieve good cosmesis
 When there is insufficie...
ADVANTAGES Resists contraction
 Good colour match
 Good texture

 Use in children

www.indiandentalacademy.com
WOUND PREPARATION

www.indiandentalacademy.com
BOLUS DRESSING

1. Ensure that there are no blood clots underneath the graft.
2. Inner layer of petrolatum gauze is applie...
VARIATION OF THE BOLSTER TIE DOWN DRESSING

www.indiandentalacademy.com
PHASES OF SKIN GRAFT
SURVIVAL
 Plasmatic imbibition-

Hubscher & Goldman
Clemmesen
Smahel

www.indiandentalacademy.com
GRAFT REVASCULARIZATION
Autografts and allografts.

Bert -

“abouchement”

Thiersch - “inosculation”
Garre - made the f...
Factors influencing graft
viability:
 Blood supply to recipient bed

 Microcirculation on the surface of the
recipient b...
www.indiandentalacademy.com
Skin Graft “Take.”

Cellular Hyperplasia

MATURATION

Graft contraction

Pigment changes

Dermal Collagen Turnover

Epithe...
DONOR SITE HEALING
 SPLIT THICKNESS GRAFT

 FULL THICKNESS GRAFT

www.indiandentalacademy.com
1. INADEQUATE GRAFT BED – non viable tissue,
crushed material, foreign bodies, excessive
fibrosis, irradiation.
2. HEMATOM...
CONCLUSION

www.indiandentalacademy.com
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
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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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Tissue grafting /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. TISSUE GRAFTINGBIOLOGICAL CONSIDERATIONS OF AUTOGENOUS & HETEROGENOUS GRAFTS www.indiandentalacademy.com
  3. 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. 4. WHAT IS BONE GRAFT ? www.indiandentalacademy.com
  5. 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. 6. AUTOGENOUS BONE GRAFTS  Advantages  Disadvantages www.indiandentalacademy.com
  7. 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. 8. SITE OF ORIGIN EXTRA ORAL SITES INTRA ORAL SITES www.indiandentalacademy.com
  9. 9. GRAFT ANATOMY  Cortical  Cancellous  Corticocancellous  Bone slurry www.indiandentalacademy.com
  10. 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. 11. Cancellous bone graft www.indiandentalacademy.com
  12. 12. Corticocancellous bone graft www.indiandentalacademy.com
  13. 13. POTENTIAL FUNCTIONS OF BONE GRAFT :  Osteogenic activity  Osteoconductive activity  Osteoinductive activity  Vascularity www.indiandentalacademy.com
  14. 14. OSTEOGENESIS www.indiandentalacademy.com
  15. 15. DIFFERENT FORMS OF BONE GRAFTS  VASCULARISED GRAFT  NON –VASCULARISED GRAFT www.indiandentalacademy.com
  16. 16. OSTEOINDUCTION  Chemotaxis  Mesenchymal cell proliferation  Mesenchymal cell differentiation  Cartilage into the bone www.indiandentalacademy.com
  17. 17. Growth factors  Platelet derived growth factor  Transforming growth factor  Insulin like growth factor  Endothelial growth factor  Fibroblast growth factor www.indiandentalacademy.com
  18. 18. BONE MORPHOGENETIC PROTEIN  MARSHALL R. URIST  Functions of BMPs  Types of BMPs www.indiandentalacademy.com
  19. 19. OSTEOCONDUCTION  Creeping substitution www.indiandentalacademy.com
  20. 20. Healing of autograft: • Inflammation • Revascularization – 2x time for Cancellous grafts due to porosity • Osteoinduction • Osteoconduction • Remodeling www.indiandentalacademy.com
  21. 21. Healing of allograft:  OSTEOINDUCTION  OSTEOCONDUCTION- “Creeping substitution” www.indiandentalacademy.com
  22. 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. 23. Factors affecting revascularisation     Recipient bed environment Graft microarchitecture Rigid fixation periosteum www.indiandentalacademy.com
  24. 24. GRAFT MICROARCHITECTURE www.indiandentalacademy.com
  25. 25. Rigid fixation of the graft www.indiandentalacademy.com
  26. 26. periosteum  Fibrous layer  Cambium layer www.indiandentalacademy.com
  27. 27. Embryological aspects  Membranous bone  Endochondral bone. www.indiandentalacademy.com
  28. 28. SKIN GRAFTING Involves the removal of skin from one site and reattachment at another site. www.indiandentalacademy.com
  29. 29. CLASSIFICATION OF SKIN GRAFTS Andreasi; Clinics of Dermatology 2005 : 332-337 www.indiandentalacademy.com
  30. 30. CLASSIFICATION OF SKIN GRAFTS Andreasi; Clinics of Dermatology 2005 : 332-337 www.indiandentalacademy.com
  31. 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. 32. www.indiandentalacademy.com
  33. 33. SPLIT THICKNESS SKIN GARFTS INDICATIONS Temporary coverage for a wound  Large defect coverage too large for FTSGs www.indiandentalacademy.com
  34. 34. Disadvantages Relatively poor cosmetic result  Contraction  Abnormal pigmentation www.indiandentalacademy.com
  35. 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. 36. ADVANTAGES Resists contraction  Good colour match  Good texture  Use in children www.indiandentalacademy.com
  37. 37. WOUND PREPARATION www.indiandentalacademy.com
  38. 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. 39. VARIATION OF THE BOLSTER TIE DOWN DRESSING www.indiandentalacademy.com
  40. 40. PHASES OF SKIN GRAFT SURVIVAL  Plasmatic imbibition- Hubscher & Goldman Clemmesen Smahel www.indiandentalacademy.com
  41. 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. 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. 43. www.indiandentalacademy.com
  44. 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. 45. DONOR SITE HEALING  SPLIT THICKNESS GRAFT  FULL THICKNESS GRAFT www.indiandentalacademy.com
  46. 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. 47. CONCLUSION www.indiandentalacademy.com
  48. 48. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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