BONE GRAFTS

Oral surgery seminar

University of Anbar College of dentistryDepartment of oral and maxillofacial surgery

Presented by:Ayman Ahmed Khaldoon HassanZaid Abdul-Saheb

Supervised by:Dr.Amera K. Alqaisy

What is bone graft

• Bone grafts are the material used for replacement and agumentation of the missing and defected bone

Grafting is the procedure used to repalce and agument the missing bone

Historical view

The first person who attempted the bone graft procedure is doctor Hedegus back in 1923to treat bone defects caused by necrotizing periodontal disease

Historical view

In 1965, doctor Nabers O`Leary revived the concept of bone grafts and was able to treat 6 patients by means of osteoinduction

Objectives of bone graft

• -To increase he fill of defected bone

-To preserve and agument the bone for future implants or any other prosthesis

-To aid in formation of healthy P.D.L.

- To provide esthetic foundation of gingiva

Biologic concepts of bone graft

• 1-Osteogensiscontain bone forming cells

2-Osteoconductionserve as scaffold for bone formation

3-osteoinductionmatrix of bone grafting material containsbone inductive substance.

Osteoconduction

• Osteoconductive materials facilitate bone formation by bridging the gap between existing bone and a distant location that otherwise would not be occupied by bone

Osteoinduction

•The cell mediators at the defect will stimulate the osteoprogentor cells to form osteoblasts that will form new bone.

Osteogensis

• The osteoblasts in the transplanted bone that have adequate blood supply and cellular viability will form new ossification centers within the graft.

Types of bone graft

• 1-autografts

2-allografts(homografts)

3-xenografts(hetrografts)

4-alloplasts

Autografts• A tissue transferred from one position to

other position within the same individual

they`re obtained either from intraoral source( ex: body of mandible, maxillary tuberosity)Or from extraoral source( ex: hip marrow)

Allografts(homografts)• Obtained from genetically dissimilar

individual from the same species

types1-frozen cancellous iliac bone and marrow2-cryopreserved bone from head of femur3-freeze-dried bone allografts(FDBA)4-Demineralized freeze-dried bone allografts(DFDBA)

Xenografts(hetrografts)

• Tissue transferred from one species to another species.Ex: anorganic bovine bone(ABB), Boplant, keil bone, Ospurance , and boiled bone.

Alloplast• Synthetic graft or inert material planted

into the tissue.

Classified into:

1- absorbable ex: Calcium sulphate

2- non-absorbable ex: Bioglass

Grafts from intraoral site• Osseous coagulum: mixture of bone dust

and blood.Bone blend: bone removed from surgical site, triturated to plastic like mass, and packed into bony defectsCancellous bone transplants: obtained from maxillary tuberosity, extraction sites and edentulous areaBone swaging: bone is bushed into contact with the root surface without fracturing the bone.

CLINICAL TECHNIQUEStep by step

Patient selection• Criteria of the patient

1-should have good physical health

2-demonstarte an acceptable level of oral hygiene

3- should be able to commit to a long-term maintenance program

4- Ideally should be non-smoker

Pre-operative care• -perform a plaque control

-Occlusal therapy consisting of adjustmentor splinting the teeth

- Preoperative 0.12% chlorohixidine mouth rinse to reduce intraoral bacteria

CASE EXAMPLEThe radiographic image of this patient shows a bone loss near the distal root of lower 1st molar.

The bone loss is due to pathological periodontal pocket

Anesthesia • The procedure is performed under local

anesthesia

local infilteration with epinephrine to facilitate hemostasis

Flap DesignA semi-lunar incison with full thickness flap is raised to expose the bony defect.Flap design can be adjusted according to the location of the defect

DepridementMulti-fluted surgical length bur is placed on high-speed hand-piece to gain access to the depth of defect and clean the site and plane the root surface.to produce clean vital margins

Placement of grafting materialChoice of graft material should based on clinical considerationincluding treatment objectives and potential patient morbidity.

If patient morbidity is a concern, allograft of (DFDBA) can be used

Flab closure

A mono-filament suture is used to close the wound by primary closure

Postoperative care• -postoperative Antibiotics

- Topical anti-microbial rinse

-regular follow-up visit including plaque removal

-periodontal probing shouldn`t be done in the first 6-12 months, because it may damage the healing wound.

Radiographic follow-up

CLINICAL APPLICATIONSBone graft

Sinus lift• surgical procedure which aims to increase

the amount of bone in the posterior maxilla (upper jaw bone), in the area of the premolar and molar teeth, by lifting the lower sinus membrane and placing a bone graft

Sinus lift

alveolar ridge augmentation• surgical procedure done to improve the

shape and size of the alveolar ridge(s)

alveolar ridge augmentation

Socket preservation• Socket preservation or alveolar ridge

preservation (ARP) is a procedure to reduce bone loss after tooth extraction to preserve the dental alveolus (tooth socket) in the alveolar bone.

Socket preservation

Advancement in bone graft• After placing the grafting material a bio-

absorbable membrane is placed to cover the grafting material, in order to prevent gingival tissue from growing inside the graft.

Advancement in bone graft• Certain research shows that a few drops

of platelet rich plasma taken from the same patient improves the success rate and speeds up wound healing

Thank You