This document summarizes different types of bone grafts that can be used for craniofacial reconstruction. It discusses autografts, which are obtained from the patient's own bone, including cancellous bone grafts from the iliac crest or cortical bone grafts from the calvarium. The mechanisms by which bone grafts incorporate into the recipient site, including osteoconduction, osteoinduction and osteogenesis, are described. Factors that influence graft incorporation such as graft type, vascularity of the recipient site, and fixation are also reviewed.
bone graft /certified fixed orthodontic courses by Indian dental academy Indian dental academy
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.
The defect angle is defined as the angle between the bony wall of a defect and the long axis of the tooth. Defects with angles of 25 degrees or less have been shown to gain more attachment than defects with angles of 37 degrees or more. Anorganic bovine bone (ABB) is a bone graft material that is osteoconductive and readily available. It consists of a hydroxyapatite skeleton that retains a high porous structure similar to cancellous bone and integrates well with host bone. PepGen P-15 is a composite graft material that mimics the organic and inorganic components of autogenous bone through anorganic bovine-derived hydroxyapatite and a synthetic 15 amino acid peptide (P-15) identical
This document summarizes a seminar on bone grafts in hard tissue reconstruction. It discusses the properties, indications, advantages, and disadvantages of various types of bone grafts including autogenous, allogenous, xenografts, and alloplasts. It also describes the principles of bone grafting, factors affecting graft incorporation, classification of grafts, and their mode of action. Specifically, it provides details on autogenous bone grafts including their sources, advantages, and types based on histologic features and vascularity.
The document discusses bone grafts and bone substitutes. It provides background on the history and development of bone grafting, including the early use of autografts. It defines different types of bone grafts such as autografts, allografts, and synthetic bone grafts. It describes various forms bone grafts can take, including cortical, cancellous, and corticocancellous grafts. Autografts are described as the most preferred option as they integrate well with the recipient site. Indications for bone grafting and factors affecting graft incorporation are also summarized.
- The document discusses bone harvesting techniques for various donor sites including the chin, mandibular ramus, maxillary tuberosity, and intraoral vs extraoral sites. Key details are provided on indications, anatomy, harvesting procedure, complications, and principles of autogenous bone graft healing for each donor site. Autogenous grafts are considered the gold standard due to their osteogenic, osteoinductive and osteconductive properties.
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
00919248678078
The document discusses different types of bone grafts. Autografts, which are bone grafts taken from one site of a patient's own body and transplanted to another site, are still considered the best option. Autografts can incorporate, revascularize, and withstand mechanical stresses well over time. Allografts, which are bone grafts transplanted between two genetically unrelated individuals of the same species, are becoming more widely accepted but do not completely vascularize. A variety of graft forms and sources are discussed including cortical, cancellous, corticocancellous grafts as well as some newer options like vascularized grafts.
Bone grafting is a surgical procedure that places new bone or a replacement material into spaces between broken bones or bone defects to aid in healing. It is used to repair complex fractures, spinal fusions, and defects from injury or surgery. Bone grafts work by osteogenesis, osteoinduction, and osteoconduction to encourage new bone growth. Autografts using the patient's own bone are most effective but limited in supply, while allografts from donors and synthetic grafts are also options. Preparation involves tests to determine graft needs and surgeons use various techniques to place the graft material. Risks are usually minor but can include pain, infection, or nerve damage at the donor site. Most bone grafts successfully
bone graft /certified fixed orthodontic courses by Indian dental academy Indian dental academy
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.
The defect angle is defined as the angle between the bony wall of a defect and the long axis of the tooth. Defects with angles of 25 degrees or less have been shown to gain more attachment than defects with angles of 37 degrees or more. Anorganic bovine bone (ABB) is a bone graft material that is osteoconductive and readily available. It consists of a hydroxyapatite skeleton that retains a high porous structure similar to cancellous bone and integrates well with host bone. PepGen P-15 is a composite graft material that mimics the organic and inorganic components of autogenous bone through anorganic bovine-derived hydroxyapatite and a synthetic 15 amino acid peptide (P-15) identical
This document summarizes a seminar on bone grafts in hard tissue reconstruction. It discusses the properties, indications, advantages, and disadvantages of various types of bone grafts including autogenous, allogenous, xenografts, and alloplasts. It also describes the principles of bone grafting, factors affecting graft incorporation, classification of grafts, and their mode of action. Specifically, it provides details on autogenous bone grafts including their sources, advantages, and types based on histologic features and vascularity.
The document discusses bone grafts and bone substitutes. It provides background on the history and development of bone grafting, including the early use of autografts. It defines different types of bone grafts such as autografts, allografts, and synthetic bone grafts. It describes various forms bone grafts can take, including cortical, cancellous, and corticocancellous grafts. Autografts are described as the most preferred option as they integrate well with the recipient site. Indications for bone grafting and factors affecting graft incorporation are also summarized.
- The document discusses bone harvesting techniques for various donor sites including the chin, mandibular ramus, maxillary tuberosity, and intraoral vs extraoral sites. Key details are provided on indications, anatomy, harvesting procedure, complications, and principles of autogenous bone graft healing for each donor site. Autogenous grafts are considered the gold standard due to their osteogenic, osteoinductive and osteconductive properties.
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
00919248678078
The document discusses different types of bone grafts. Autografts, which are bone grafts taken from one site of a patient's own body and transplanted to another site, are still considered the best option. Autografts can incorporate, revascularize, and withstand mechanical stresses well over time. Allografts, which are bone grafts transplanted between two genetically unrelated individuals of the same species, are becoming more widely accepted but do not completely vascularize. A variety of graft forms and sources are discussed including cortical, cancellous, corticocancellous grafts as well as some newer options like vascularized grafts.
Bone grafting is a surgical procedure that places new bone or a replacement material into spaces between broken bones or bone defects to aid in healing. It is used to repair complex fractures, spinal fusions, and defects from injury or surgery. Bone grafts work by osteogenesis, osteoinduction, and osteoconduction to encourage new bone growth. Autografts using the patient's own bone are most effective but limited in supply, while allografts from donors and synthetic grafts are also options. Preparation involves tests to determine graft needs and surgeons use various techniques to place the graft material. Risks are usually minor but can include pain, infection, or nerve damage at the donor site. Most bone grafts successfully
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Bone grafting is a surgical procedure used to fill bone defects caused by trauma, tumors, or infections. There are three main types of grafts: autografts which use the patient's own bone, allografts which use cadaver bone, and synthetic grafts. Autografts are considered ideal as they possess osteoconductivity, osteogenicity, and osteoinductivity, but they require a separate donor site surgery. Allografts do not require donor site surgery but risk immune rejection. The graft incorporation process involves inflammation, new bone formation, and remodeling of the graft to become living bone. Cancellous grafts incorporate more quickly than cortical grafts.
Harvesting of bone from the iliac cres /certified fixed orthodontic courses b...Indian dental academy
Welcome to Indian Dental Academy
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 has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
application of bone graft in dentistryOmar Mabrouk
Bone grafting involves transplanting bone material from one site to another to aid bone regeneration. There are several types of grafts including autografts, allografts, xenografts, and alloplasts. Autografts are considered the gold standard as they are osteoinductive, osteoconductive, and osteogenic, but require a second surgical site. Allografts risk disease transmission. Bone graft healing relies on revascularization, with cancellous grafts replacing with new host bone within a year, while cortical grafts take longer. Grafting has various applications including alveolar ridge preservation and augmentation, maxillary sinus lifts, and distraction osteogenesis. Complications can include membrane perforation
Bone Grafts /certified fixed orthodontic courses by Indian dental academy Indian dental academy
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
00919248678078
The document summarizes bone grafting procedures. It discusses the properties of bone grafts including osteoinduction, osteoconduction and osteogenesis. It describes different types of grafts such as autografts, allografts, xenografts and alternatives like calcium phosphate ceramics. Autografts are ideal but have morbidity risks. Allografts have limitations due to processing but are commonly used. Demineralized bone matrix and mesenchymal stem cells are discussed as promising alternatives.
Bone replacement grafts are widely used to promote
bone formation and periodontal regeneration.
Xenografts are grafts shared between different species.
Currently, there are two available sources of xenografts
used as bone replacement grafts in periodontics: bovine
bone and natural coral.
This document discusses the anatomy and types of bone grafts. It begins by describing the two types of bone tissue: cortical/compact bone, which forms the dense outer layer, and cancellous/spongy bone, which fills the interior. Bone grafting is then introduced as a surgical procedure to repair broken or defective bone using donor bone material. The document proceeds to explain the three key processes in bone graft incorporation: osteoinduction, osteoconduction and osteogenesis. It provides details on the types of bone grafts, including those based on donor origin (autograft, allograft, xenograft) and composition (cortical, cancellous). Risks, techniques and applications of different bone graft procedures are
SmartBone: the innovative bone substitute for oral surgery and maxillofacial ...SmartBone
SmartBone is a new hybrid bioactive bone substitute specifically developed for bone regeneration in reconstructive surgery.
SmartBone is produced by combining a bovine mineral bone matrix with bioactive resorbable polymers and cell nutrients. This new concept of composite biomaterial promotes a quick growth of the patient’s cells into SmartBone while its biopolymers degrade, providing perfect integration and osteogenesis.
Bone grafts and bone grafts substitutessiddharth438
This document summarizes different types of bone grafts and bone graft substitutes. It discusses autogenous bone grafts which are considered the gold standard but have limitations related to donor site morbidity. Allografts from cadaveric donors are also discussed. Bone graft substitutes described include ceramics like calcium sulfate and calcium phosphate, demineralized bone matrix, and growth factors like bone morphogenetic proteins which provide osteoinduction. The properties, advantages, and limitations of each type of graft and substitute are summarized.
This document discusses non-vascularized bone grafts. It notes that autogenous bone grafts are the gold standard for bony reconstruction of the jaws. Costochondral rib harvesting is described as a technique for obtaining bone grafts. The document outlines the advantages of autogenous bone grafts and principles of non-vital grafts, such as needing a blood supply from the recipient site. It provides details on harvesting and using costochondral rib grafts, including preoperative preparation, incision and procedure steps.
1) Autogenous cancellous bone graft is the gold standard but has drawbacks like donor site morbidity.
2) Allografts have risks of immune response and disease transmission but are more available. Demineralized bone matrix and ceramics are also options.
3) Composites of osteoconductive scaffolds with osteogenic cells or growth factors can enhance new bone formation compared to scaffolds alone. Bone marrow aspirate and synthetic carriers of BMPs show promise in composite grafts.
Bone grafts are used to repair bone fractures that fail to heal properly or require structural support. The document discusses various types of bone grafts including autografts, allografts, and bone graft substitutes. Autografts are considered the gold standard but have limitations of limited supply and donor site morbidity. Allografts and bone graft substitutes provide alternatives while avoiding complications of autograft harvesting.
1. The document discusses the history, principles, types, and mechanisms of bone grafts. It provides definitions of key terms like graft, flap, osteogenesis, osteoinduction, and osteoconduction.
2. The main types of bone grafts discussed are autogenous grafts, allografts, xenografts, alloplasts, and composite grafts. Autogenous grafts are considered the gold standard due to their osteogenic, osteoinductive and osteoconductive properties but require a second surgical site.
3. Allografts avoid a second surgical site but have reduced osteoinductive potential and risks of disease transmission or immune rejection. Growth factor based grafts and
Bone graft materials | Bone grafting in Implantation | Periodontal surgeries ...Dr. Rajat Sachdeva
Bone grafting is a surgical procedure that replaces missing bone in order to repair bone fractures that are extremely complex, pose a significant health risk to the patient or fail to heal properly.
It is beneficial in fixing bone that are damaged from trauma.Its also useful for growing bone around an implanted device.
Call us regarding Dental Treatment and Implants Placement:-
Dr. Rajat Sachdeva
+919818894041,01142464041
drrajatsachdeva@gmail.com
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Learn more:-
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
Bone grafting is a surgical procedure used to fill bone defects caused by trauma, tumors, infections, or other conditions. There are several types of grafts including autografts (the patient's own bone), allografts (cadaver bone), and synthetic grafts. Autografts are considered ideal as they possess osteoconductivity, osteogenicity, and osteoinductivity allowing for new bone growth. However, autografts require an additional donor site surgery which can cause morbidity. Allografts avoid donor site issues but may carry disease transmission risk. The graft incorporation process involves inflammation, new bone formation, and remodeling of the graft into lamellar bone over time.
Advanced Bone grafting procedures in dental implant surgeryDr Omfs
This document summarizes an oral presentation on advanced surgical procedures in implant dentistry. It discusses various grafting techniques like alveolar socket preservation, onlay grafting, interpositional grafting, sandwich osteotomy, alveolar ridge split osteotomy, distraction osteogenesis, and sinus lift surgery. It also covers principles of grafting, types of grafts including autogenous, allogenic and xenogenic grafts. Soft tissue management techniques like palatal connective tissue grafting are presented. Complications of grafting procedures and post-operative care are also summarized.
This document discusses bone grafting and grafting techniques. It defines what a graft is, describes different types of bone grafts including autografts, allografts, and bone graft substitutes. It covers the biological process of bone graft incorporation and lists various techniques for harvesting and placing bone grafts, such as onlay grafts, dual onlay grafts, and fibula grafts. Risks, advantages, and disadvantages of different graft options are also summarized.
Bone grafts are materials used to replace or augment bone. They work through osteoconduction, osteoinduction, and osteogenesis. Common graft materials used for periodontal defects include autografts obtained from the patient, allografts from other humans, xenografts from other species, and alloplasts which are synthetic grafts. Demineralized freeze-dried bone allograft is often used as it promotes bone formation through osteoinduction without the morbidity of harvesting autografts. The procedure involves graft placement in the defect followed by flap closure and post-operative care including plaque control to support healing.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Bone grafting is a surgical procedure used to fill bone defects caused by trauma, tumors, or infections. There are three main types of grafts: autografts which use the patient's own bone, allografts which use cadaver bone, and synthetic grafts. Autografts are considered ideal as they possess osteoconductivity, osteogenicity, and osteoinductivity, but they require a separate donor site surgery. Allografts do not require donor site surgery but risk immune rejection. The graft incorporation process involves inflammation, new bone formation, and remodeling of the graft to become living bone. Cancellous grafts incorporate more quickly than cortical grafts.
Harvesting of bone from the iliac cres /certified fixed orthodontic courses b...Indian dental academy
Welcome to Indian Dental Academy
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 has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
application of bone graft in dentistryOmar Mabrouk
Bone grafting involves transplanting bone material from one site to another to aid bone regeneration. There are several types of grafts including autografts, allografts, xenografts, and alloplasts. Autografts are considered the gold standard as they are osteoinductive, osteoconductive, and osteogenic, but require a second surgical site. Allografts risk disease transmission. Bone graft healing relies on revascularization, with cancellous grafts replacing with new host bone within a year, while cortical grafts take longer. Grafting has various applications including alveolar ridge preservation and augmentation, maxillary sinus lifts, and distraction osteogenesis. Complications can include membrane perforation
Bone Grafts /certified fixed orthodontic courses by Indian dental academy Indian dental academy
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
00919248678078
The document summarizes bone grafting procedures. It discusses the properties of bone grafts including osteoinduction, osteoconduction and osteogenesis. It describes different types of grafts such as autografts, allografts, xenografts and alternatives like calcium phosphate ceramics. Autografts are ideal but have morbidity risks. Allografts have limitations due to processing but are commonly used. Demineralized bone matrix and mesenchymal stem cells are discussed as promising alternatives.
Bone replacement grafts are widely used to promote
bone formation and periodontal regeneration.
Xenografts are grafts shared between different species.
Currently, there are two available sources of xenografts
used as bone replacement grafts in periodontics: bovine
bone and natural coral.
This document discusses the anatomy and types of bone grafts. It begins by describing the two types of bone tissue: cortical/compact bone, which forms the dense outer layer, and cancellous/spongy bone, which fills the interior. Bone grafting is then introduced as a surgical procedure to repair broken or defective bone using donor bone material. The document proceeds to explain the three key processes in bone graft incorporation: osteoinduction, osteoconduction and osteogenesis. It provides details on the types of bone grafts, including those based on donor origin (autograft, allograft, xenograft) and composition (cortical, cancellous). Risks, techniques and applications of different bone graft procedures are
SmartBone: the innovative bone substitute for oral surgery and maxillofacial ...SmartBone
SmartBone is a new hybrid bioactive bone substitute specifically developed for bone regeneration in reconstructive surgery.
SmartBone is produced by combining a bovine mineral bone matrix with bioactive resorbable polymers and cell nutrients. This new concept of composite biomaterial promotes a quick growth of the patient’s cells into SmartBone while its biopolymers degrade, providing perfect integration and osteogenesis.
Bone grafts and bone grafts substitutessiddharth438
This document summarizes different types of bone grafts and bone graft substitutes. It discusses autogenous bone grafts which are considered the gold standard but have limitations related to donor site morbidity. Allografts from cadaveric donors are also discussed. Bone graft substitutes described include ceramics like calcium sulfate and calcium phosphate, demineralized bone matrix, and growth factors like bone morphogenetic proteins which provide osteoinduction. The properties, advantages, and limitations of each type of graft and substitute are summarized.
This document discusses non-vascularized bone grafts. It notes that autogenous bone grafts are the gold standard for bony reconstruction of the jaws. Costochondral rib harvesting is described as a technique for obtaining bone grafts. The document outlines the advantages of autogenous bone grafts and principles of non-vital grafts, such as needing a blood supply from the recipient site. It provides details on harvesting and using costochondral rib grafts, including preoperative preparation, incision and procedure steps.
1) Autogenous cancellous bone graft is the gold standard but has drawbacks like donor site morbidity.
2) Allografts have risks of immune response and disease transmission but are more available. Demineralized bone matrix and ceramics are also options.
3) Composites of osteoconductive scaffolds with osteogenic cells or growth factors can enhance new bone formation compared to scaffolds alone. Bone marrow aspirate and synthetic carriers of BMPs show promise in composite grafts.
Bone grafts are used to repair bone fractures that fail to heal properly or require structural support. The document discusses various types of bone grafts including autografts, allografts, and bone graft substitutes. Autografts are considered the gold standard but have limitations of limited supply and donor site morbidity. Allografts and bone graft substitutes provide alternatives while avoiding complications of autograft harvesting.
1. The document discusses the history, principles, types, and mechanisms of bone grafts. It provides definitions of key terms like graft, flap, osteogenesis, osteoinduction, and osteoconduction.
2. The main types of bone grafts discussed are autogenous grafts, allografts, xenografts, alloplasts, and composite grafts. Autogenous grafts are considered the gold standard due to their osteogenic, osteoinductive and osteoconductive properties but require a second surgical site.
3. Allografts avoid a second surgical site but have reduced osteoinductive potential and risks of disease transmission or immune rejection. Growth factor based grafts and
Bone graft materials | Bone grafting in Implantation | Periodontal surgeries ...Dr. Rajat Sachdeva
Bone grafting is a surgical procedure that replaces missing bone in order to repair bone fractures that are extremely complex, pose a significant health risk to the patient or fail to heal properly.
It is beneficial in fixing bone that are damaged from trauma.Its also useful for growing bone around an implanted device.
Call us regarding Dental Treatment and Implants Placement:-
Dr. Rajat Sachdeva
+919818894041,01142464041
drrajatsachdeva@gmail.com
Follow us here:-
• Google+ link: https://goo.gl/vqAmvr
• Facebook link: https://goo.gl/tui98A
• Youtube link: https://goo.gl/mk7jfm
• Linkedin link: https://goo.gl/PrPgpB
• Slideshare link : http://goo.gl/0HY6ep
• Twitter Page : https://goo.gl/tohkcI
• Instagram page : https://goo.gl/OOGVig
Learn more:-
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
Bone grafting is a surgical procedure used to fill bone defects caused by trauma, tumors, infections, or other conditions. There are several types of grafts including autografts (the patient's own bone), allografts (cadaver bone), and synthetic grafts. Autografts are considered ideal as they possess osteoconductivity, osteogenicity, and osteoinductivity allowing for new bone growth. However, autografts require an additional donor site surgery which can cause morbidity. Allografts avoid donor site issues but may carry disease transmission risk. The graft incorporation process involves inflammation, new bone formation, and remodeling of the graft into lamellar bone over time.
Advanced Bone grafting procedures in dental implant surgeryDr Omfs
This document summarizes an oral presentation on advanced surgical procedures in implant dentistry. It discusses various grafting techniques like alveolar socket preservation, onlay grafting, interpositional grafting, sandwich osteotomy, alveolar ridge split osteotomy, distraction osteogenesis, and sinus lift surgery. It also covers principles of grafting, types of grafts including autogenous, allogenic and xenogenic grafts. Soft tissue management techniques like palatal connective tissue grafting are presented. Complications of grafting procedures and post-operative care are also summarized.
This document discusses bone grafting and grafting techniques. It defines what a graft is, describes different types of bone grafts including autografts, allografts, and bone graft substitutes. It covers the biological process of bone graft incorporation and lists various techniques for harvesting and placing bone grafts, such as onlay grafts, dual onlay grafts, and fibula grafts. Risks, advantages, and disadvantages of different graft options are also summarized.
Bone grafts are materials used to replace or augment bone. They work through osteoconduction, osteoinduction, and osteogenesis. Common graft materials used for periodontal defects include autografts obtained from the patient, allografts from other humans, xenografts from other species, and alloplasts which are synthetic grafts. Demineralized freeze-dried bone allograft is often used as it promotes bone formation through osteoinduction without the morbidity of harvesting autografts. The procedure involves graft placement in the defect followed by flap closure and post-operative care including plaque control to support healing.
This document summarizes the dental treatment of a 64-year-old Vietnamese male patient. It details that the patient underwent ridge augmentation through block grafting due to insufficient bone for implant placement. After good bone growth was observed, the patient received implant surgery with no reported complications.
This document provides information on Pro Osteon, a bone graft substitute product offered by Biomet. It describes the various forms of Pro Osteon, including blocks and granules in resorbable and non-resorbable varieties. Pro Osteon is a porous, hydroxyapatite matrix that is osteoconductive and has a structure and chemistry similar to human bone. It has been used in over 1 million procedures since 1982 to fill bony defects and aid fusion. Pro Osteon is available in different sizes to suit small and large defects and can be combined with autograft or allograft.
1) The document discusses two techniques for vascularized bone grafts to treat scaphoid nonunion: the palmar pedicled vascularized bone flap of the radius and the dorso-radial pedicled vascularized bone flap of the radius.
2) The palmar pedicled flap utilizes the palmar carpal artery and harvests a bone graft from the palmar aspect of the distal radius.
3) The dorso-radial pedicled flap utilizes the intercompartmental supraretinacular artery and harvests a bone graft from the dorsal aspect of the distal radius.
Analysis of Cost of Autologous Bone Graft; Podium Presentation; AOFAS Annual ...Erik Harris
This Podium Presentation summarized the initial findings of a study that applied an interactive budget impact model (BIM) to assist surgeons and hospitals with cost/benefit analyses of: 1) incremental costs associated with iliac crest bone graft harvest and local bone graft harvest; 2) additional costs associated with graft site enhancers; and 3) utilization of an orthobiologic bone graft substitute (Β-TCP with rhPDGF-BB) as a replacement of autograft. The objective of the study was to facilitate informed decision-making through the application of comparative clinical and economic value assessments of competing interventions in foot and ankle fusion.
Fascia and fat graft short topic 24th june 2010Tauseef Hassan
Free fascial grafts can be harvested from various areas of the body including the tensor fascia lata, temporoparietal fascia, and radial forearm. They are used to repair defects, treat facial nerve palsy, and for augmentation. Harvesting involves an open or closed approach depending on the size and shape of the graft needed. Facial grafts can achieve vascularization and structural integrity when conditions are favorable or less than ideal.
Fat grafting involves harvesting fat via liposuction from areas like the abdomen, then purifying and transferring the fat cells to the treatment site to correct defects, atrophy or enhance areas of the body. Some absorption occurs so overcorrection by 30% is recommended.
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.
Implant surgeries to overcome anatomic difficulties ii / dental implant cour...Indian dental academy
This document discusses various surgical techniques used to overcome anatomical difficulties for dental implants. It covers guided tissue regeneration, ridge augmentation, maxillary sinus lift, inferior alveolar canal lateralization, and mental nerve distalization. The maxillary sinus lift technique is described in detail, including indications, contraindications, the original method, benefits and potential complications like membrane perforation. Lateralization of the inferior alveolar nerve and distalization of the mental nerve are also summarized. The document provides an overview of these procedures to help restore function and aesthetics for patients with atrophy or injury.
Implant surgeries to overcome anatomic difficulties/ oral surgery courses Indian dental academy
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.for more details please visit
www.indiandentalacademy.com
Mandibular angle fractures account for 23-42% of facial fractures and are commonly caused by motor vehicle accidents and assaults. The angle is prone to fractures due to its thin cross-section and presence of impacted third molars. Fractures are classified as vertically or horizontally favorable/unfavorable based on the direction of the fracture line and effect of muscle forces. Traditionally, rigid plate fixation and intermaxillary fixation were used but caused complications. Currently, semi-rigid fixation using a single miniplate placed along the superior border based on Champy's lines of osteosynthesis is the standard approach, allowing early function with low complications.
The document discusses the evolution of the concept of osseointegration in dental implants over the past few decades. It defines osseointegration as the direct structural and functional connection between living bone and the surface of a load-bearing dental implant. This is in contrast to earlier theories of fibro-osseous integration which proposed integration through fibrous tissue rather than direct bone contact. The document also examines the cellular processes of bone healing and remodeling around implants, as well as theories on the mechanism of osseointegration including distance osteogenesis, contact osteogenesis, and osteoconduction.
Tissue reaction to dentofacial orthopedic appliances /certified fixed orthodo...Indian dental academy
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
Physiology of tooth movement ii /certified fixed orthodontic courses by India...Indian dental academy
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
Proposal to National Science Foundation co-authored by Ian Nieves and James Earthman. It describes using FEA simulation and advanced computer-assisted fabrication techniques to develop materials for bone regeneration.
This document summarizes a randomized clinical trial comparing the bone quality of free autogenous bone grafts harvested from two mandibular donor sites (chin and retromolar region) for maxillary alveolar ridge augmentation. 14 patients received either chin (n=7) or retromolar (n=7) shell grafts fixed with screws. 6 months post-op, 42 core biopsies were analyzed and found the chin shells had a higher bone area percent (52.53% vs 47.97%) indicating better bone quality and stability compared to retromolar grafts.
This document discusses the evolution of dental implant loading protocols from the original Branemark protocol of a stress-free healing period of 3-6 months before loading to immediate and early loading protocols. It provides details on different loading protocols including Brånemark's protocol, progressive loading, non-submerged single stage protocol, immediate functional loading, immediate non-functional loading, early loading, delayed loading, and anticipated loading, focusing on factors like time interval, diet, occlusal material, occlusal contacts, and prosthesis design. The key factors identified for successful loading are minimizing micromotion at the bone-implant interface and ensuring adequate stability and occlusion.
Dr. Ahmed M. Adawy
Professor Emeritus, Dep. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar University. Numerous etiologies lie behind mandibular defects including pathologic lesions, trauma related, infectious diseases and congenital defects. At present, the methods to restore mandibular defects can be classified into four basic categories:
1.Autogenous bone grafts in the form of nonvascularized free bone transfer, or vascularized tissue transfer, either pedicled or based on microvascular anastomosis
2. Distraction osteogenesis
3. Alloplastic materials (with or without bone)
4. Tissue engineered grafts
Advancement in Scaffolds for Bone Tissue Engineering: A Reviewiosrjce
In last decade, Tissue Engineering has moved a way ahead and has proposed solutions by replacing
the permanently or severely damaged tissues of our body. The field has expanded to tissue regeneration of
cartilage, bone, blood vessels, skin, etc. The domain of tissue engineering is very wide and is the combination of
bioengineering, biology & biochemistry. This review is focus on recent research advancement in bone tissue
engineering. Bone grafting techniques are used to replace the severely damaged due to any accident, trauma or
any disease. These are either allograft, autologous or synthetic bone properties similar to bone. Bone Tissue
Engineering is part of a synthetic technique and overcome the limitations faced in other two mentioned
techniques. Bone Tissue engineering is rapidly developing field and has become important due to its remarkable
therapeutic properties. Mesenchymal stem cells are used as starting cells in tissue regeneration. These cells get
differentiated into bone cells and start multiplying to form bone. One inevitable requirement of these growing
human cells is a strong support which helps in the proper growth. This support is known as scaffold, in tissue
engineering. For proper regeneration of cells scaffold materials plays vital importance in the field of bone tissue engineering. This review attempts is illustrate the biology of natural bone, various desirable properties of scaffold, biomaterials used for fabrication of scaffold and various fabrication techniques with examples of bone regenerate.
loading of dental implants/certified fixed orthodontic courses by Indian dent...Indian dental academy
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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Description :
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.for more details please visit
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The document discusses osteointegration of dental implants. It defines osteointegration as the direct structural and functional connection between living bone and the surface of a load-bearing implant. The document outlines the history of implants and describes the mechanisms of osteointegration, including primary and secondary bone healing. It also discusses the factors that affect osteointegration and the bone-implant interface.
This document discusses the use of bone grafts in periodontal reconstruction. It begins with an introduction and definitions of key terms like regeneration, repair, new attachment, and reattachment. It then covers the classification of bone grafts into autografts, allografts, and xenografts. Specific types of grafts are explained like DFDBA, FDBA, Bio-Oss, and various xenograft materials. The roles of osteogenesis, osteoinduction and osteoconduction in graft incorporation are defined. Factors for successful graft outcomes are noted.
Bone grafting is a surgical procedure that uses bone material to repair and fuse bones. The bone material can come from the patient's own body (autograft), donated bone tissue (allograft), or synthetic substitutes. Bone grafting helps repair complex fractures, spinal fusions, and defects from injuries or surgery through osteoconduction, osteoinduction and osteogenesis. While autografts have the best incorporation rates, all grafts carry risks of infection, rejection, and limited healing.
Bone grafting is a surgical procedure that uses bone material to repair and fuse bones. The bone material can come from the patient's own body (autograft), donated bone tissue (allograft), or synthetic substitutes. Bone grafting helps repair complex fractures, spinal fusions, and defects from injuries or surgery through osteoconduction, osteoinduction and osteogenesis. While autografts have the best incorporation rates, all grafts carry risks of infection, rejection, and failure to heal.
Bone grafting is a surgical procedure that uses bone material to repair and fuse bones. The bone material can come from the patient's own body (autograft), donated bone tissue (allograft), or synthetic substitutes. Bone grafts help repair bones by osteoconduction, osteoinduction, and osteogenesis. Autografts are preferred but come with risks like donor site pain. Allografts and synthetic grafts have risks of disease transmission, immune rejection, and slower incorporation into the body. Bone grafting is used to treat complex fractures, spinal fusions, and bone defects from injuries or cancer.
Vertical bone defects occur after tooth extraction as bone remodeling leads to resorption. There are several classifications of alveolar ridge defects based on the amount and location of bone loss. Key factors for implant success include respecting the per-implant soft tissue and optimal implant positioning and angulation. Common techniques for treating vertical bone defects include guided bone regeneration, osteoperiosteal flap ridge-split, distraction osteogenesis, and block grafting. These use bone grafting materials and biomaterials as scaffolds to regenerate bone. Future advances like growth factors, stem cells, and 3D printing may improve outcomes. Sinus lifts can augment the posterior maxilla where resorption has left insufficient bone for dental implants.
Regenerative techniques for periodontal therapyEnas Elgendy
This document discusses graft materials and procedures for restoring periodontal osseous defects, as well as the principles of guided tissue regeneration (GTR). It describes the potential of autografts, allografts, and xenografts to promote osteogenesis, osteoinduction, and osteoconduction. The challenges of transplanting materials into periodontal defects are outlined. Techniques for GTR involve placing barriers to exclude epithelium and favor regeneration. Membranes can be non-resorbable like ePTFE or resorbable like collagen, polyglycolic acid, or polylactic acid polymers. Proper technique and postoperative care are important for successful regeneration.
The biological fixation determines the longevity of dental implant treatment. It ensures the long term survival of dental implant. Better the osseointegration,higher will be the survival rate
This study evaluated the healing of mandibular ramus bone block grafts used for alveolar ridge augmentation before implant placement through clinical, histological, and histomorphometric analysis. Bone blocks were harvested from the mandibular ramus in 15 patients and grafted to maxillary defects. After 3-9 months of healing, implants were placed and bone samples were taken. Histological analysis found signs of active remodeling but also substantial amounts of non-vital bone and generally weak neo-vascularization, suggesting that most osteocytes in the grafted bone do not survive and neo-vascularization of non-vital grafted bone is difficult. The outcomes suggest grafted bone undergoes slow remodeling into new vital bone.
Similar to Craniomaxillofac trauma reconstruction bone graft in cranifacial surgery/oral surgery courses by indian dental academy (20)
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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This document discusses dental occlusion concepts and philosophies for complete dentures. It introduces key terms like physiologic occlusion and defines different occlusion schemes like balanced articulation and monoplane articulation. The document discusses advantages and disadvantages of using anatomic versus non-anatomic teeth for complete dentures. It also outlines requirements for maintaining denture stability, such as balanced occlusal contacts and control of horizontal forces. The goal of occlusion for complete dentures is to re-establish the homeostasis of the masticatory system disrupted by edentulism.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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This document discusses dental casting investment materials. It describes the three main types of investments - gypsum bonded, phosphate bonded, and ethyl silicate bonded investments. For gypsum bonded investments specifically, it details their classification, composition including the roles of gypsum, silica, and modifiers, setting time, normal and hygroscopic setting expansion, and thermal expansion. It provides information on how the properties of gypsum bonded investments are affected by their composition. The document serves as a comprehensive overview of dental casting investment materials.
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The chapter Lifelines of National Economy in Class 10 Geography focuses on the various modes of transportation and communication that play a vital role in the economic development of a country. These lifelines are crucial for the movement of goods, services, and people, thereby connecting different regions and promoting economic activities.
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A Visual Guide to 1 Samuel | A Tale of Two HeartsSteve Thomason
These slides walk through the story of 1 Samuel. Samuel is the last judge of Israel. The people reject God and want a king. Saul is anointed as the first king, but he is not a good king. David, the shepherd boy is anointed and Saul is envious of him. David shows honor while Saul continues to self destruct.
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Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
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RHEOLOGY Physical pharmaceutics-II notes for B.pharm 4th sem students
Craniomaxillofac trauma reconstruction bone graft in cranifacial surgery/oral surgery courses by indian dental academy
1. Craniomaxillofac Trauma Reconstr. 2009 October; 2(3): 125–134.
Prepublished online 2009 April 14. doi: 10.1055/s-0029-1215875
PMCID: PMC3052656
Bone Grafts in Craniofacial Surgery
Mohammed E. Elsalanty, M.D., Ph.D.1
and David G. Genecov, M.D.2
Author information ► Copyright and License information ►
Abstract
Reconstruction of cranial and maxillofacial defects is a challenging task.
The standard reconstruction method has been bone grafting. In this
review, we shall describe the biological principles of bone graft healing,
as pertinent to craniofacial reconstruction. Different types and sources of
bone grafts will be discussed, as well as new methods of bone defect
reconstruction.
Keywords: Bone grafts, craniofacial, maxillofacial, reconstruction,
bone, vascularized, bone substitutes, bone augmentation, regeneration
Bone defects in the craniomaxillofacial skeleton vary from the small (few
millimeters) periodontal defects to the large segmental defects resulting
from trauma, surgical excision, or cranioplasty. Such defects typically
have complex three-dimensional structural needs, which are difficult to
restore. In cranial vault defects, the underlying brain needs permanent
protection. Segmental jaw defects require restoration of mechanical
integrity, temporomandibular joint function, and intermaxillary dental
occlusion. Maintaining acceptable facial esthetics is another unique
2. consideration in the treatment of facial defects, which cannot be
underestimated. Bone grafts remain the gold standard for reconstructing
segmental bone defects. We will overview the status of bone grafting
techniques for craniofacial reconstruction, their biological foundation, as
well as future directions.
The earliest report of a bone grafting procedure came in an 1682 book by
Job Janszoo van Meekeren, a surgeon in Amsterdam. In this account,
the author reported a case in Russia, where the surgeon restored a
cranial defect using a cranial bone graft from a dead dog.
In 1881, Sir William MacEwen of Rothesay, Scotland, published the first
case report of successful inter human transfer of bone grafts. He used
tibial bone wedges excised from three donors, during surgical correction
of skeletal deformity, to reconstruct a humeral defect in a 3-year-old
child. Subsequent clinical reports helped to establish the efficacy of
autogenous bone grafts in defect reconstruction.
MECHANISM OF ACTION OF BONE GRAFTS
A bone graft is defined as any implanted material that promotes bone
healing, whether alone or in combination with other material.
Augmentation of bone healing at the recipient site occurs through one or
more of the following mechanisms: osteoconduction, osteoinduction,
and osteogenesis.
An osteoconductive material simply allows, or directs, new
bone formation along its surfaces. Examples include bone graft matrix
and synthetic osteoconductive polymers.
3. An osteoinductive graft supplies recruitment and/or differentiation
factors for bone-forming cells at the recipient site.
An osteogenic graft supplies induced or inducible, bone-forming cells to
the recipient site. Accordingly, an ideal bo ne graft is the one that
functions through all three mechanisms by providing a template that
directs three-dimensional bone growth (osteoconduction), recruits and
induces differentiation of resident bone-forming cells, and supplies more
bone-forming cells to the recipient site. Such grafts include cancellous
and vascularized bone grafts.
Bone grafts can be employed for functions other than to stimulate bone
formation within a defect. An onlay graft laid over facial bone surfaces
could augment the cheek prominence or restore facial contour. In this
case, more emphasis is directed toward the rate of graft resorption.
Those grafts that are known for their slow resorption, such as calvarial
and cortical bone, or nonresorption, such as synthetic materials, are
preferred. Such grafts might also be used for their mechanical properties
wherever mechanical support or immediate protection of vital structures
is required, as in reconstructing orbital floor or calvarial defects.
Slow resorption is a disadvantage if the graft is used to augment bone
formation at the recipient site. Graft incorporation is inversely
proportional to how solid the graft is and how slow it resorbs. Therefore,
osteoconductive graft materials with interconnected internal spaces that
reach the outer surface are better scaffolds for directing three-
dimensional bone invasion of the graft. This architecture provides more
surface area along which native osteoclasts can attach themselves and
start dissolving the graft, which is the first stage in graft incorporation.
4. TYPES OF BONE GRAFTS
Bone grafts can be divided into the following subtypes: autografts,
allografts, xenografts, synthetic materials, and any combination thereof.
Autografting is the transfer of graft material obtained from one anatomic
site to another within the same subject. It includes transferring
cancellous, cortical, corticocancellous, or vascularized bone or aspirated
bone marrow. Autografts have the advantage of retaining at least some
osteogenic cells and do not trigger an immune response. However, the
total amount of bone that can be transferred is limited, and there can be
high morbidity at the donor site.
Grafts that are transferred between two genetically matched subjects,
identical twins in humans, are called isografts. They would be expected
to have the same advantages and disadvantages as autografts.
Grafts that are transferred between two genetically unmatched subjects
are called allografts. Bone allografts are unique in that the cellular
component is typically removed to minimize their rejection. In addition,
they are thoroughly treated to eliminate any possibility of disease
transmission. Therefore, allografts can be subdivided according to their
source, processing method, or available form.
With advancement in biomaterials technology, the use of animal-derived
tissues for human tissue reconstruction is on the rise. These types of
grafts are called xenografts. Several bone xenografts have been
developed and are commercially available. They are typically in the form
of bovine or porcine collagen and can be used either alone or in
combination with a synthetic carrier.
Synthetic bone substitutes and bone-augmenting preparations have been
the focus of extensive research and have recently spawned a huge
industry. Synthetic skeletal materials include osteoconductive polymers
in the form of blocks, granules, or cements and osteoinductive
5. proteins.8 Synthetic osteoinductive proteins that have been extensively
studied in bone reconstruction include differentiation factors, such as
bone morphogenic protein (BMP)-2 and -7,11,12,13,14,15 and angiogenic
factors, such as vascular endothelial growth factor (VEGF).16,17,18
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INCORPORATION OF BONE GRAFTS INTO THE RECIPIENT SITE
It is true a bone graft may be used for its bulk or mechanical properties
or to stimulate bone formation at the recipient site without necessarily
being integrated into the newly formed bone. However, when bone grafts
are used to bridge a critical-size bone defect, they are expected to become
incorporated into the bed. Incorporation of the bone graft in the
recipient site involves two essential steps: first is the bony union between
the edges of the graft to the edges of native bone segments, and second is
graft remodeling, or gradual resorption of the graft material itself,
concomitant with its replacement by new bone.19,20,21 Graft remodeling
can be of secondary importance in case of vascularized grafts, where the
bone should be viable from the time of implantation. In this case, the
remodeling process is expected be similar to that of normal bone.
Ideally, the whole bone graft should be incorporated into the recipient
site. In other words, the space that the graft originally occupies should
ultimately become viable bone permanently accessible to the
physiological remodeling mechanisms. That process is typically very
slow, and perfect outcome cannot always be achieved. Many factors
determine how far the incorporation process will proceed. These factors
may be pertinent to the graft itself, graft bed (recipient site), or the
interface in between.
6. Factors related to the graft include the graft type, porosity, and
mechanism of action. Autogenous cancellous and corticocancellous
grafts are better incorporated due to their porous architecture, allowing
easy cellular and vascular invasion. The graft trabeculae have a large
surface area that is covered by osteoblasts, making it osteogenic as well
as osteoconductive for three-dimensional bone growth. Additionally, due
to the extensive vascular invasion, the bone matrix can readily be
demineralized and its proteins exposed through the actions of
osteoclasts. This leads to the release of osteoinductive matrix proteins.
By contrast, autogenous cortical bone grafts are more solid. The only
available access for cellular and vascular invasion of such grafts is the
junction with the adjacent bone segments, making the integration
process slow and rarely complete.19 This deficiency can be eliminated by
using vascularized bone, which provides excellent long-term viability at
the recipient site, even in large defects.8,19 In fact, the only factor to
worry about regarding integration of a viable vascularized graft is its
mechanical stability.8
As in fracture repair, rigid fixation of the graft to its bed is essential.
Bone formation requires very low tissue strain levels. In addition, the
ratio between the graft size and the contact area with circulation is a
major determinant of how fast the graft can be incorporated, if at all.
Large bone grafts with only minimal contact to bleeding, viable bone
edges at the recipient site are expected to take a long time to become
incorporated. One way to expose more of the graft core to the circulation
is to mince the graft in a bone mill and pack it into the raw bed, given
that it can be shielded from undue tissue strains.
Another important factor in determining graft incorporation is
vascularity and viability of the graft bed. The bone graft typically needs
7. to be attached to viable, bleeding bone edges. Too much reaming or
excessive heat generation during saw cutting can cause necrosis of the
bone edges and delay union to the graft.9 Radiotherapy can jeopardize
tissue vascularity, eliminating the option of reconstruction using a
nonvascularized bone graft. In such cases, a vascularized bone graft
should be used, given that reasonably viable bone edges can be found to
connect to the graft, dependable vessels can be used for microvascular
anastomosis, and absence of infection. Some reports suggest the use of
hyperbaric oxygen therapy to promote tissue perfusion before
reconstruction.22,23,24 Finally, graft incorporation depends also on the
overall physiological healing capacity of the body.
The biological process leading to graft incorporation is very similar to
that of fracture repair. In brief, the cascade starts with the surgical
hematoma, which involves the recruitment of platelets and white blood
cells and the subsequent release of essential growth factors and
cytokines. The recruited monocytes differentiate into osteoclasts and
start removing the necrotic bone edges, with the demineralization of the
matrix and release of bone augmenting factors. This leads to
differentiation of osteoblasts and triggering the union between the graft
and native bone edges. In the meantime, new blood vessels form within
the granulation tissue and begin tunneling their way into the graft.
Since the early studies in bone transplantation immunity, it has been
widely believed that at least some autograft-carried osteoblasts survive
the transplantation process.25,26,27,28,29 Cell survival is also believed
to occur more often in vascularized autografts than in nonvascularized
autografts and in cancellous more than in cortical autografts.8,30 These
cells can play an essential role early during the incorporation
8. process.8,31 Graft incorporation has been summarized by Bauer and
Muschler into five major steps8:
1.Hematoma formation, release of bone inducing factors and
cellular recruitment
2. Inflammation and development of fibrovascular tissue,
connecting the graft to the adjacent bone
3. Vascular invasion of the graft
4. Focal resorption of the graft by recruited osteoclasts
5. New bone formation, union between the graft and the
surrounding bone, and graft remodeling
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SOURCES OF AUTOGENOUS BONE GRAFTS FOR CRANIOFACIAL
RECONSTRUCTION
Free Nonvascularized Bone Grafts
ILIAC CREST
The iliac crest is one of the most common donor site for bone grafts, both
vascularized and nonvascularized. Large segments of cortical,
corticocancellous, or cancellous bone can be quickly obtained for
different-sized defects. Furthermore, the location of the ilium allows
harvesting by a separate surgical team to save operation time. A full-
thickness iliac crest graft would have two thick cortices with ample
amount of trabecular bone in between and can very closely resemble the
thickness and height of mandibular bone. The graft shows reasonable
long-term survival, and rehabilitation with osseointegrated dental
implants is possible.32,33,34 Mandibular defects could be filled using
nonvascularized iliac bone with a 70% success rate.35 The graft could be
9. implanted as corticocancellous blocks or particulate cancellous bone
carried within either a titanium mesh tray or a crib of alloplastic rib
bone. However, the rate of successful union drops sharply when the
defect is longer than 6 cm.35,36
Posterior iliac crest graft can also be used for craniofacial reconstruction.
However, the patient has to be tilted to the prone position, which
eliminates the advantage of a simultaneous two-team approach. Donor
site morbidity rate for anterior iliac crest grafts is around 23%, and much
less for posterior iliac crest.37 Complications include postoperative pain,
iliac or acetabular fractures or instability, persistent hematoma,
herniation of abdominal contents, vascular injury, lateral femoral
cutaneous nerve injury, and unsightly contour defects along the iliac
crest.38,39,40,41
CALVARIAL GRAFT
This is one of the most popular cortical bone grafts in craniofacial
reconstruction, mainly for its mechanical properties and very slow
resorption rate.8 This makes it ideal for facial augmentation, orbital roof
and floor reconstruction, and covering cranial defects. Typically, only the
outer cortex is used, although a full-thickness graft could be taken and
split into two grafts (Fig. 1). Typically, the skull continues to grow until
the age of 8, continues to thicken until the age of 20, and is thickest at
the parietal region. This area can provide ∼8× 10 cm of bone and is
considered the safest to harvest.42
Figure 1
Technique of splitting cranial bone using a reciprocating saw.
10. However, there are several key anatomic facts to consider before
harvesting a calvarial bone graft:
1.Thickness of the calvarium is highly variable to the point of
being unpredictable, even within the parietal
region.43 Preoperative radiographic measurement of the
bone thickness should give an idea of the area of bone that
can safely be harvested.
2. The dura is tightly adherent to the inner cortex and can
easily be injured if the inner cortex is to be harvested with
the graft.
3. Various important vascular structures exist immediately
beneath the bone at various sites, including the superior
sagittal sinus in the midline.
4. The two cortices fuse together and the bone can become
quite thin laterally and inferiorly to the temporal line, the
attachment of the temporalis muscle, and at suture sites.
5. Other anatomic variables, including transcortical emissary
veins, subcortical vessels, and aberrant arachnoid plexuses
(within the cortical calvarium), should also be
considered.42
The temporoparietal region provides more curved bone, which would be
more suitable for orbital or malar reconstruction.44 However, straight
grafts can be harvested more posteriorly (i.e., from the occipitoparietal
region). In any case, the bone is typically harvested as narrow strips (5 to
6 cm long× 1.5 to 2 cm wide) to avoid graft fracture during harvest.
Then, several strips can be fixed together and used as one graft.
Calvarial bone can be harvested at three levels: partial-thickness outer
cortex, full-thickness outer cortex, and bicortical.42 Partial-thickness
outer cortex can be harvested using a very sharp osteotome to curl off a
11. sheet of cortical bone from the outer cortical plate. This technique can be
used in children between the age of 4 and 8 years and can yield enough
bone to fill a small defect.
In adults, full-thickness outer cortex can safely be harvested and is
therefore the most commonly used calvarial graft. If a craniotomy has
already been performed, the inner cortex can be harvested from the bone
flap and used in the reconstruction, leaving the outer cortex to be placed
back in its original position. This technique maintains the contour of the
calvarium. If large quantities of bone are needed, bicortical grafts may be
harvested, followed by splitting of the two cortices to double the surface
of the graft. It is obvious that harvesting a bicortical calvarial graft would
have the most complications hazard.
Complications of calvarial grafts include surface deformity at the donor
and/or recipient site and graft fracture during harvest. Less commonly,
dural exposure or tear can occur. If the dura is injured, the tear should
be totally exposed, by expanding the bone defect with a rongeur, and
patched with a temporalis fascia or, more recently, a synthetic graft.
Intracranial hemorrhage after calvarial bone harvesting has been
reported but is extremely rare.42
CHIN GRAFT
Up to 3 cm of cortical and corticocancellous bone can be shaved off the
chin bone through an intraoral approach. This can be sufficient for small
defects, such as cleft palate and orthognathic osteotomy defects. Because
of its slow resorption, it can be used as an onlay graft for facial
augmentation.
RETROMOLAR GRAFT
12. A small block of cortical or corticocancellous bone can be chiseled off the
area behind the third molar.45 This graft has the same indications as
chin grafts; however, the amount of available bone is much smaller.
TIBIAL GRAFT
The anterior surface of the tibial plateau can be a good source of cortical
or corticocancellous bone grafts. Mechanical stiffness of the tibial cortex
can be useful in augmentation of atrophic alveolar ridge for implant
placement, facial bone augmentation, or bridging an osteotomy defect.
RIB GRAFT
Nonvascularized rib was the first autogenous bone graft used for
reconstruction of mandibular segmental defects.45 Osseous or
osseochondral segments can be harvested from ribs 5 to 7 and can either
be used in full or split thickness (Fig. 2). Costochondral grafts remain
very popular in the treatment of ascending mandibular ramus and
condylar defects.46,47,48,49 Side effects and complications include
postoperative chest wall pain, pleural injury leading to pleuritis or
pneumothorax, and facial asymmetry due to overgrowth of the
graft.47,50,51
Figure 2
Mandibular reconstruction with an osseocartilaginous rib graft.
Although they were frequently used for facial bone augmentation,
bridging osteotomy defects, and orbital floor reconstruction, osseous rib
grafts are now rarely used in craniofacial reconstruction.45 In addition
to the problems mentioned previously, the amount and quality of bone
obtained are inadequate for most reconstruction procedures. The
13. availability of other sources of bone graft with better quality and
quantity, as well as with safer approaches and synthetic bone substitute
materials, has rendered rib grafting less popular.
REIMPLANTATION OF RESECTED BONE SEGMENTS
Limited studies have tested the possibility of ―recycling‖ native bone
segments that were removed as a part of tumor
excision.52,53,54,55 Intuitively, if tumor cells were successfully
eradicated from the excised segments, they would be ideal for
reconstructing the remaining defects. Resected mandibular segments
could be reimplanted intact or hollowed out to remove trabecular bone,
with use of the cortical bone shell as a tray for autogenous cancellous
grafts. Larger long-term studies are needed to validate the safety and
efficacy of this technique.
Regional Pedicled Bone Grafts
PEDICLED RIB
In 1980, Cuono and Ariyan reported their successful use of the pectoralis
major–attached rib as an osteomyocutaneous flap for oromandibular
reconstruction.56 However, subsequent reports showed flap necrosis
rates ranging from 21 to 75%.57,58 The rib graft can also be carried along
the latissimus dorsi or serratus anterior flaps.45 In all the above-
mentioned flaps, the pedicle only allows to rib graft to reach the lower
third of the face, limiting its use to mandibular defects. As mentioned
earlier, rib grafts are not suitable for such defects. Thus, these flaps are
used only for soft tissue, and not bone, reconstruction.45
PEDICLED CLAVICLE
Sternocleidomastoid muscle (SCM) flaps have been extensively studied
but not widely used. Several reports suggested the possibility of
transferring clavicular periosteum59 and bone segments of the clavicle
14. itself.60 The bone segment can either be partial or full thickness and can
be utilized in reconstruction of small mandibular bone defects.
The technique preserves the neurovascular supply of the SCM muscle,
thus allowing for its use in dynamic facial reconstruction.61 This is
particularly advantageous in cases where restoration of facial muscles,
lower lip competence, mastication, or tongue movements is attempted.
However, preserving the SCM muscle raises some concern in oncology
cases due to the possibility of cervical lymph node involvement. In
addition, the unsightly contour defect at the donor site and in the lower
neck is another disadvantage of this flap.61
PEDICLED TEMPORAL BONE
The temporalis flap is one of the earliest described muscle flaps.62 Over
the years, it became one of the main techniques for reconstructing
paralyzed facial muscles and midfacial full-thickness defects.63,64 More
relevant to our review, partial or full-thickness temporal bone can be
raised with the muscle flap. It can be used to reconstruct maxillary,
palatal, orbital rim, orbital floor, or ascending mandibular ramus
defects. It can also be used as an onlay graft for facial augmentation.62
However, significant donor site morbidity has been reported when
calvarial bone is carried with the flap. These include limitation of mouth
opening, which can be permanent, in addition to the mentioned
complications of calvarial grafts.45
Vascularized Bone Grafts
Although not widely used for midface, upper face, or cranial
reconstruction, vascularized bone grafting is considered the gold
standard for large mandibular defect reconstruction. Because the graft's
blood supply is coming through the anastomosis, it is independent of the
condition of the recipient site. That makes it the most resistant to
15. conditions like poor vascularity, extensive scarring, and previous
radiotherapy of the bed.45 Moreover, they show less resorption than
nonvascularized grafts and can immediately take endosteal implants for
permanent dental restoration.65 They are ideal for primary
reconstruction, unlike free grafts that have very high failure rate in
primary reconstruction. Another advantage is the possibility of
simultaneous soft tissue and bone reconstruction with the same
composite flap. Success rates of vascularized grafts is more than
90%.36,66,67
However, vascularized bone grafts are much more demanding and are
technique sensitive as compared with nonvascularized grafts. Harvesting
and an anastomosis require special surgical training and equipment.
They add significantly to the operation time in cases of primary
reconstruction, which can increase postoperative morbidity and
mortality.66,68 Microvascular reconstruction is mostly limited to
mandibular defects, with the most commonly used vascularized grafts
being the fibula, iliac crest, scapula, and radius. Detailed description of
these techniques is beyond the scope of this review.
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ALLOPLASTIC BONE GRAFTS IN CRANIOFACIAL
RECONSTRUCTION
Demineralized bone matrix (DBM) allografts have been frequently used
in craniofacial reconstruction.69,70,71,72,73 Various DBM preparations
are commercially available, varying from particles to blocks to sheets of
different sizes. Generally, the smaller particles incorporate into the
recipient bed faster than larger blocks or cortical sheets.8 A recent study
16. has shown that the bone augmenting properties of DBM vary from one
commercial preparation to another.74
In addition to its osteoconductive and osteoinductive properties, DBM
has some degree of mechanical stiffness, rendering it useful in
reconstructing large cranial vault defects after cranioplasty
procedures.73Sheets of cortical DBM could be molded into various
shapes to match the three-dimensional configuration of the defect,
providing a semirigid shield for the underlying brain during the
regeneration process.
Despite the overwhelming experimental evidence supporting the role of
DBM as a bone augmenting material, incorporation of such allografts
into recipient sites in human patients could be extremely slow.
Replacement of DBM with new calcified bone has been inconsistent,
typically takes several months, especially in large defects.75,76 During
that period, mechanical stiffness of the DBM implants is not high enough
to protect the underlying brain, necessitating the use of protective
helmets. The process of graft incorporation and new bone formation can
be markedly accelerated with the addition of bone augmenting factors,
such as BMP-2.75
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SYNTHETIC BONE SUBSTITUTES AND BONE AUGMENTING
FACTORS
Advances in tissue engineering have provided a myriad of new tools for
bone grafting. Growth factors, whether extracted or synthetic, adhesion
molecules, and osteoconductive materials are becoming more available
for bone reconstruction (Fig. 3). These factors and materials vary widely
17. in their osteoinductive, osteoconductive, and mechanical properties and
therefore in their applications.
Figure 3
Constructs for cranial defect reconstruction. (A) Acellular collagen
sponge and bone morphogenic protein-2 in defect. (B) The addition of
Mastergraft™ (Medtronic Sofamor Danek, Memphis, TN),
tricalcium (more ...)
The general aim of using growth factors in augmentation of bone
regeneration has been to stimulate the differentiation of bone-forming
cells, angiogenic cells, or both. The transforming growth factor β (TGF-
β) family is active in the periosteum in early stage of bone formation
after fractures.77,78 It stimulates the differentiation of cells of
mesenchymal origin into osteoblasts and chondrocytes79,80 and inhibits
cells of ectodermal origin.79 Specifically, bone morphogenetic proteins,
especially BMP-2, -3, -4, and -7, are potent inducers of
osteogenesis.81,82,83 Furthermore, hypoxia-inducing factor is expressed
in high levels in fractures and is therefore considered as one of the major
players in stimulation of angiogenic factors expression.84 In fracture
sites, hypoxia regulates osteoblast production of vascular modulators,
such as VEGF and members of the TGF-β, insulin-like growth factor, and
fibroblast growth factor families.85 Recruited osteoclasts have been
reported to produce heparinase, which releases VEGF from heparin in an
active form, stimulating local angiogenesis and further osteoclast
activity.86
On the other hand, the vascular response during bone regeneration is
extremely sensitive to the mechanical environment.87 Endothelial cells
18. subjected to mechanical forces, hypoxia, or VEGF stimulation could start
producing BMP-2.88,89 Other products of endothelial cells, including
endothelin-1 and endothelial-derived angiotensin II, can also stimulate
osteoblasts during bone healing.90 Of these factors, BMP-2, BMP-7, and
VEGF have shown the most potential for successful clinical
use.75,91,92 It has been reported that platelet-rich plasma (PRP)
promotes angiogenesis and osteogenesis via the presence of growth
factors, which include platelet-derived growth factor, platelet-derived
endothelial cell growth factor, and TGF-β.93,94,95
Kim and coworkers reported that demineralized bone and PRP produced
a significantly higher percentage of bone regeneration as compared with
the use of demineralized bone alone.96 However, Marden and coworkers
found that platelet-derived growth factor inhibited bone regeneration
induced by osteogenin, a bone morphogenetic protein, in rat craniotomy
defects.97 In our experience, we found no evidence that PRP either
promotes or interferes with osteogenesis occurring in the presence of
exogenous recombinant human bone morphogenetic protein-2
(rhBMP2).75
Two types of bone substitute materials have been used in craniofacial
reconstruction: calcium phosphate cements and calcium sulfate (plaster
of paris).98 Several preparations of calcium phosphates are
commercially available for bone defect reconstruction. They have been
successfully used to block cerebrospinal fluid leaks,99 obliterate the
frontal sinus,100 and reconstruct contour defects in the
cranium.101 Calcium sulfate hemihydrate, in combination with porous
ceramic hydroxyapatite granules, has also been successfully used for
cranial defect reconstruction.102
One major problem with cranial reconstruction has been how to
maintain mechanical stability and protection for the underlying brain
19. until sufficient bone regenerates to give permanent protection.
Temporary stability can be provided with either resorbable or
nonresorbable fixation materials. During growth, nonresorbable metal
fixation should be removed after reconstruction so as not to interfere
with subsequent cranial remodeling. Nonresorbable fixation materials
include titanium and cobalt chrome, the latter being easier to remove
due to lack of osseointegration.
Several forms of resorbable fixation materials are available, which are
mostly different forms of polylactate and polyglycolate
polymers.103,104 When using these materials, however, it should be
noted that the time needed to lose mechanical stiffness is much shorter
than the resorption time. Additionally, there might be some interaction
between certain bone graft materials, such as DBM or hydroxyapatite
cements and some resorbable materials, such as Lactosorb® (Walter
Lorenz Surgical, Inc., Jacksonville, FL).75,105
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FUTURE DIRECTIONS
Autogenous bone grafts remain the gold standard for surgical
reconstruction of bone defects. However, advances in tissue engineering
and biomaterials technology will provide more tools for these
procedures. Several problems remain that limit the wide utilization of
such options, including regulatory requirements, high costs, lack of
randomized controlled human studies, uncertain long-term results, as
well as method-specific limitations.
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