[11]basic of bone grafting and graft materail [ 13 ] (3).pptx
1. Basic of bone grafting and
graft materials
Dr.Ahmad Jawed “Safi”
Safi dental Academy
2. Introduction
Bone grafting is a surgical procedure replacing
missing bone in order to repair bone defects
Bone usually has the ability to regenerate
completely but requires a very small defect space
or some sort of scaffold called ‘bone graft’ to do
so.
Most bone grafts are expected to get resorbed
and replaced as the natural bone heals over a few
months time
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3. Continue…
Bone grafting is the process of surgically
placing autogenous bone or bone substitutes
to repair bone defects or to regenerate
desired bone volume for successful
placement of an implant adequate size and
the desired axis
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4. Biological mechanism of bone
formation at the grafted site
Osteoconduction
Osteoconduction occurs when the bone graft
material serves as a scaffold for new bone growth
that’s perpetuated by the native bone
Osteoblasts from the margin of the defect that’s
being grafted utilize the bone graft material as a
framework upon which to spread and generate
new bone
At the very least, a bone graft material should be
osteoconductive
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5. Continue…
Osteoinduction
Osteoinduction involves the stimulation of
osteoproginator cells to differentiate into osteoblasts
that then begin new bone formation
The most widely studied type of osteoinductive cell
mediators are bone morphogenetic proteins (BMPs)
A bone graft material that’s osteoconductive and
osteoinductive does not only serve as a scaffold for
currently existing osteoblasts but also triggers the
formation of new osteoblasts, theoretically promoting
faster integration of the graft
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6. Continue…
Osteopromotion
Osteopromotion involves the enhancement of
osteoinduction without the possession of
osteoinductive properties
For example, enamel matrix derivatives have
been shown to enhance the osteoindcutive effect
of demineralized freeze-dried bone allograft
(DFDBA), but they will not stimulate de novo bone
growth alone
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7. Continue…
Osteogenesis
Osteogenesis occurs when vital osteoblasts
originating from the bone graft material
contribute to new bone growth along with
bone growth generated via the other two
mechanisms (osteoconduction and
osteoinduction)
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8. Composition of natural bone
Hydroxyapatite and collagen form the major
part of the human bone while water, minerals
and proteins remain minor elements
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10. Types of bone grafts
The autogenous bone remains the gold
standard for bone augmentation procedures but
the need of another surgical site to harvest the
bone, inadequate bone volume availability, donor
site morbidity, etc. are problems attendant to the
use of autogenous bone
To overcome these problems, bone substitutes
alone or mix with autogenous bone have very
successfully been used in intra oral bone
augmentation procedures
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12. Autologous/autogenous bone
graft/autograft
The bone graft, which is harvested from the
patients own body and immediately used to
graft the osseous/ridge defect is called the
autogenous bone graft
Autogenous bone remains the ‘gold standard’
for bone augmentation procedures, as it
forms the bone by all three mechanisms of
bone formation (osteoconduction,
osteoinduction, and osteogenesis)
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13. Continue…
Moreover, the use of autogenous bone as the
graft also reduces the cost of the procedure
The drawbacks of using autogenous bone are
the need for another intra-oral or extra-oral site to
harvest the bone graft
donor site morbidity,
increased time of surgery
The need for a skilled surgeon to harvest the graft of
desired volume, dimension, and quality
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14. Donor sites
Intraoral and extra oral sites have been used
as donor sites to harvest autogenous bone,
depending on volume and quality of bone
graft required
Intra oral sites
Mandibular syphysis
Mandibular ramus/bucal shelf
Maxillary tuberosity, etc.
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16. Advantages
Less risk of graft rejection because the graft is
originated from the patients own body
It has all three new bone regeneration
properties - osteoconductive, osteoinductive
and osteogenic.
Reduced cost of procedure
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17. Disadvantages
An additional surgical site is required to harvest
autograft, in effect adding another potential
location for postoperative pain and complications
Donor site morbidity
Skilled approach is required to harvest the graft of
desired volume and dimensions
Increased time of surgery
Resorbs faster, if used in an area of low oxygen
like the maxillary sinus
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18. Bone graft substitutes
Allograft
Xenograft
Synthetic bone graft/alloplastic bone graft
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19. Allograft
The bone graft which is harvested from
cadavers, processed in bone banks to make it
usable in the human body is called allograft
(e.g. Grafton)
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20. Types of bone allograft
Fresh or fresh frozen bone [ FFB]
Freeze-dried bone allograft (FDBA)
Demineralized freeze-dried bone allograft
(DFDBA)
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21. Xenografts
The bone which is harvested from the animals
(bovine source), processed in bone banks to
make it usable in the human body
Thus, these bone substitutes have their origin
from a species other than human, such as
bovine (e.g. Bio-Oss)
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22. Advantages of Bio-Oss
Superior handling characteristics
Promotes revascularization and clot stabilization
Facilitates bone formation by providing an
exception osteoconductive scaffolding
Effective space maintenance
Optimal integration
Effective bone regeneration
Prevent newly formed bone from rapid resorption
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24. Synthetic bone graft/alloplastic
bone graft
The bone graft which are created from the
synthetic source (ceramics) such as calcium
phosphate (e.g. hydroxyapatite and tricalcium
phosphate), bioglass and calcium sulphate
Alloplastic grafts are often made of hydroxyapatite
or other naturally occurring and biocompatible
substances with mechanical properties similar to
those of bone
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26. Growth factors
Growth factor enhanced grafts are produced using
recombinant DNA technology
They consist of either human growth factors or
morphogens (BMPs in conjunction with a carrier
medium, such as collagen)
The implant surgeon can also extract the growth
factors such as platelet-rich plasma (PRP),
plasma rich in growth factor (PRGF), or platelet
rich-fibrin(PRF) from the patients venous blood
just before surgery and mix in the graft to enhance
its bone regeneration properties (Fig 13.4 A & B)
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