XENOGRAFTS

Dr. Dandu Sivasai Prasad ReddyII yr Post graduateDepartment of PeriodonticsMamata Dental College

Dr. Dandu Sivasai Prasad ReddyII yr Post graduateDepartment of PeriodonticsMamata Dental College

Introduction

Terminologies

Bone graft

History

Mechanism of bone grafting

Clinical objectives of bone grafting for periodontal

regeneration

Ideal properties of grafts

Indications of periodontal bone graft

CONTENTS

Classification of bone grafts

Xenografts

Calf bone

kiel bone

Anorganic bovine bone

Bio oss

Pepgen 15

Porcine derived bone graft

Osteobiol

Corrolline calcium carbonate

Combination procedures

Risk of disease transmission

Conclusion

References

INTRODUCTION

Periodontal diseases

Graft ????

TERMINOLOGY

Reattachment

New attachment

Periodontal repair

Periodontal regeneration

Regenerative therapy

Historically, bone grafting has consisted of:

A surgical procedure to harvest the patients own bone from a secondary site

Utilization of an organic or artificial material to replace missing bone

Structural scaffolds &

matrices for attachment &

proliferation of anchorage

dependent osteoblasts

Evolution

Bone grafting accomplished through

Formation and development of new bone by viable cells contained in the graft

Eg: Autogenous graft

Provide a biologic stimulus (proteins and growth factors) that

induces the progression of mesenchymal stem cells and other

osteoprogenitor cells toward the osteoblast lineage

Eg: DFDBA

Is the process by which the graft material acts as a nonviable

scaffold onto and within which the patients own natural bone

grows

They allow apposition from existing bone, but do not produce

or trigger bone formation.

Eg Alloplastic material

OsteopromotionOsteopromotion

Osteopromotion involves the enhancement of

osteoinduction without the possession of osteoinductive

properties. 

Clinical objectives of bone grafting for periodontal regeneration

    Probing depth reduction

    Clinical attachment gain

   Bone fill of the osseous defect and

  Regeneration of new bone, cementum and periodontal

ligament as determined by histologic analysis.

 

In a review of animal histologic studies, Mellonig found that

75% of these studies indicated favorable regenerative

results when periodontal defects were treated with

grafting; none showed that non-graft control sites were

superior to grafted ones.

 

Non-toxic-Non-antigenic with patient

acceptance

Resistant to infection

Facilitate vascularization

No root resorption or ankylosis

Strong and resistant

Stimulates osteoinduction- & framework for

osteoconduction

Easily adaptable

Readily and sufficiently available

Minimal surgical procedure with minimal post-operative sequelae

Predictability

Completely replaced by host bone of the same quality – quantity

Induce & enhance cementogenesis.

CONTD..,CONTD..,

Indications of periodontal bone graft

1.Deep intraosseous defect

2.Tooth retention

3.Support for critical teeth

4.Defects associated with aggressive

periodontitis

5.Esthetics

6.Furcation

Classification

Conge et al, 1978 AAP 1986 Carranza FA 1990 Rosenberg& Rose 1998 Nasr et al, 1999

Resorption of the graft and replacement by new bone

depends upon

Particle size

Pore size

XenograftsSource

CALF BONE - treated by detergent, sterilized and freeze dried. Used for

treatment of osseous defects.

KIEL BONE - Calf or Ox bone denaturated with 20% H2O2, dried with acetone, and

sterilized with ethylene oxide.

ANORGANIC BONE - Ox bone from which the organic material has been extracted by

ethylene diamine. Then sterilized by autoclaving.

Recently a natural, anorganic, microporous, bovine-derived hydroxyapatite bone

matrix, in combination with a cell-binding polypeptide that is a synthetic clone of 15

amino acid sequence of type I collagen is been used.

ANORGANIC BOVINE BONE(ABB)

New processing and purification methods

have been utilized which make it possible to

remove all organic components from a

bovine bone source and leaving behind a

non-organic bone matrix in an unchanged

inorganic form.

Commercially availableBio – OssBio – Oss CollagenPepgen-P15

Osteoconductive

Chemical & physical characteristics similar to human mineral matrix

Porosity similar to human cancellous bone Large mesh interconnecting pore system facilitates angiogenesis and migration of osteoblasts.

Bio - Oss®

PACKAGING: 1. SPONGIOSA GRANULAT Particle Size: 0.25 – 1mm Quantity: 0.5, 2gms. 2. SPONGIOSA GRANULAT Particle Size: 1 – 2mm Quantity: 0.5, 2gms   3. SPONGIOSA BLOCK Block 1x1x2 cm   4. BIO-OSS COLLAGEN 100mg Spongiosa Granulat + 10% Collagen b

BIO-OSS CONTD..,

USES:

1. Treatment of defect sizes up to 2 alveoli, but can

be used for defect size larger than 2 alveoli.

2. Sinus floor elevations.

3. When combined with autogenous bone, it can be

used for large ridge augmentation.

BIO-OSS CONTD..,

Bio – Oss Collagen® (Osteohealth Co., Shirley, NY)

Bio Oss spongiosa granules + 10% highly purified porcine collagen

Collagen component enables convenient handling to be easily adapted in the defect but does not function as a barrier

Collagen component is resorbed within 4 – 6 weeks.

Studies

Stefano Sartori et al., analyse the amount of Bio-Oss

ossification in a case of maxillary sinus augmentation,

recording and comparing histomorphometric data 8 months, 2

and 10 years after surgery.

Eight months after surgery they observed a mean amount of

bone tissue (including medullar spaces) of 29.8% (and 70.2%

of Bio-Oss) . At 2years the bone tissue increased to 69.7%

and 10years after surgery it was 86.7% .

Effect of low-level laser therapy irradiation and Bio-Oss graft

material on the osteogenesis process in rabbit calvarium defects:

a double blind experimental study- Alireza Rasouli et al., 2014

The mean amount of new bone was 15.83 and 18.5 % in the

controls on the 4th and 8th week; 27.66 and 25.16 % in the

laser-irradiated group; 35.0 and 41.83 % in Bio-Oss and 41.83

and 47.0 % in the laser + Bio-Oss treated specimens with

significant statistical differences. Application of LLLT in

combination with Bio-Oss can promote bone healing.

ABB plus P-15 cell

binding peptide

(pentadecapeptide)

Mimics the cell

binding domain of

type I collagen

PepGen P-15

Hanadi Baeissa

Available forms

Clinical and radiographic evaluation of

human periodontal osseous defect

(mandibular grade II furcation) treated with

PepGen P-15 and a bioresorbable membrane

(Atrisorb)- 2012 KL Vandana et.,al .

It can be concluded from this study that the reduction in

furcation defect using PepGen P-15 alone and a

combination of PepGen P-15 and Atrisorb were equivocal.

It can be suggested that the combined use of GTR barrier

and bone graft did not prove beneficial for the clinical

outcome of the mandibular grade II furcation defect

treatment. Hence, the cost effective and economical

treatment of choice for grade II furcation defects may be

bone graft alone.

A Novel Combination Of Platelet Rich Fibrin

And Pepgen P-15 Xenograft, In The Treatment

Of Intrabony Defects: A Volumetric CT Scan

Analysis. 2013

At 6 and 9 month follow-up examination, it was observed that

PD reduced in range of 3 to 5 mm with 1 to 2 mm coronal shift

in PGM and again in CAL of 2 to 5 mm . A three-dimensional

(3D) reconstructed Dentascanimages acquired at 9 month

interval, confirmed positive changes in the defect morphology,

with a linear bone growth of 1.5-3mm( 33 to 37 %).The

volumetric analysis showed a bone fill of 55 to 81% at the

defect sites

Interdisciplinary Management of an Isolated Intrabony Defect- 2014

A 24 year male patient reported with the complaint of food lodgment and occasional pain in relation to right lower first molar. Clinical examination revealed deep periodontal pocket measuring 9 mm on distal aspect of 46 and no mobility 

1yr follow up

Treatment of Intrabony Defects with

Anorganic Bone Matrix/P-15 or Guided Tissue

Regeneration in Patients with Aggressive

Periodontitis -2013

Treatment of intrabony periodontal defects in

patients with G-AgP with ABM/P-15 and GTR

improved significantly the clinical outcomes. The

use of ABM/P-15 promoted a better radiographic

bone fill.

Porcine derived bone graft:

Xenografts derived from porcine cortical and cancellous bone

have also been developed to be used as bone substitutes

OsteoBiol® It is a commercially available xenograft of porcine origin.

It is heterologous cortico cancellous collagenated bone mix. It always

be hydrated before use

Advantages:

It can act as a carrier for various therapeutic agents.

The collagen present in this bio material facilitates blood clotting

and the subsequent invasion of repairing and regenerative cells thus

favouring bone formation.

It also provides cohesive environment for graft particle.

Experimental Model of Bone Response to

Collagenized Xenografts of Porcine Origin

(OsteoBiol® mp3): A Radiological and

Histomorphometric Study

After 4 months, radiological images revealed bone

defects with a decrease in graft volume and the

complete repair of the osseous defect.

The biomaterial used proved to be biocompatible,

bioabsorbable, and osteoconductive and as such, a

possible bone substitute that did not interfere with

the bone’s normal reparative processes.-Jose Luis

Calvo Guirado et al., 2013

CORROLLINE CALCIUM CARBONATE

Biocoral is a calcium carbonate

Natural coral,

Primarily of aragonite.

It is biocompatible and resorbable

Porous size of 100-200um

Combination procedures

A combination of autogenous bone and bone substitute is widely used in

oral surgery procedures

Systematic review recommended a proportion of 1:2 (Merkx et al. 2003).

Pripatnanont et al. (2009) assessed new bone formation generated using

three different proportions of autogenous bone (AB) and deproteinized

bovine bone (BDX) in cortical skull defects in rabbits.

1:1 1:2 1:4

In deep intrabony defects treatment, at 12 months evaluation,

the combined use of autogenous spongiosa with bovine-derived

xenograft led to significantly greater gain of clinical attachment and

hard tissue formation compared to the use of autogenous

spongiosa alone

- (Zafiropoulos et al. 2007)

Efficacy of Using PDGF and Xenograft With or Without Collagen

Membrane for Bone Regeneration Around Immediate Implants

With Induced Dehiscence-Type Defects: A Microcomputed

Tomographic Study in Dogs- 2013

GBR around immediate implants with dehiscence defects using PDGF

and xenograft alone resulted in higher BBT, BBV, VBH, and BIC than

when performed in combination with CM.

A clinical and radiological evaluation of the relative efficacy of

demineralized freeze-dried bone allograft versus anorganic bovine bone

xenograft in the treatment of human infrabony periodontal defects: A 6

months follow-up study- 2014

The use of anorganic bovine bone mineral matrix combined with TGFβ-1

seemed to be effective in the treatment of intrabony defects. This showed an

improvement in the clinical outcome of periodontal therapy superior to the use

of anorganic bovine bone on its own.

Risk of transmission of prion mediated diseases –

bovine spongiform encephalopahty

In humans – Creutzfeldt – Jakob disease

WHO – bone as type IV (no transmission)for prion

diseases

Segal and Tofe (1999) conducted an extensive

review of current literature on the status of risk

assessment of BSE transmission the risk of disease

(BSE) transmission was negligible

Risk of disease transmission

CONCLUSION

Although complete periodontal regeneration is unpredictable with any

regenerative therapy currently used, periodontal bone grafts show strong

potential. Requirements for a successful graft includes Patient Selection,

material Selection, Proper Flap Reflection and Wound Stability,

Revascularization, Root Debridement, Postsurgical care .A large body of

clinical evidence clearly indicates that grafts consistently lead to better bone

fill than nongrafted controls. As more is learned about the biologic process of

periodontal regeneration, new graft materials are expected to make the task

of periodontal regeneration even more predictable.

REFERENCES

•Nasr HF, Reidy AME, Yukna RA. Bone and bone substitutes. Periodontology

2000, 1999; 19: 74-86.

•Carranza FA, Takei HH, Cochran DL. Chapter-67, Reconstructive Periodontal

Surgery. Carranza's Clinical Periodontology, 10th edition: 968-969.

•Reynolds MA, Reidy AME, Branch-May GL, Gunsolley JC. The efficacy of bone

replacement grafts in the treatment of periodontal osseous defects. Ann

Periodontol 2003; 8(1): 227-265.

•Dental & Medical Device. Product information on Osteo-Biol ®, 2008.

•Dentsply-Friadent. Product information on PepGen P-15®, 2008.

•Rita Singh, Lanka Mahesh. Infections Resulting from Bone Grafting Biomaterials.

International Journal of Oral Implantology and Clinical Research, May-August

2013;4(2):68-71

•A.L. Dumitrescu, Chemicals in Surgical Periodontal Therapy, Bone Grafts and

Bone Graft Substitutes in Periodontal Therapy.

•Emmings et al. Chemically modified osseous material for restoration of bone

defects. J Periodontol 1974; 45:385.

•Boyne et al. Transplantation, implantation and grafts. Dent Clin N Am 1971; 15:

434.

•Krejci et al. Osseous grafting in periodontal therapy. Part I - Osseous graft

material. Comp. Cont. Edu. Dent. VIII 1987, No.10.

Thank you.,