Autogenous bone grafting

Periodontitits is a multifactorial disease which leads to progressive loss of periodontal tissues including the alveolar bone. Since autogenous bone grafting has been considered as the gold standard referring to the lowest incidence of graft rejection, this ppt gives an insight about the autogenous bone grafts that can be used in periodontal defects.

1. LET’S FIX BONES TODAY 1 Dr. Kritika Jangid

2. Dr. Kritika Jangid ( MDS- Periodontics and Implantology ) AUTOGENOUS BONE GRAFTS 2 Dr. Kritika Jangid

3. CONTENTS BONE BONE LOSS IN PERIODONTAL DISEASE AUTOGENOUS BONE GRAFTS 3 Dr. Kritika Jangid

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5. Circumferential lamellae 5 Dr. Kritika Jangid

6. Concentric lamellae 6 Dr. Kritika Jangid

7. OSTEON 7 Dr. Kritika Jangid

8. Interstitial lamellae 8 Dr. Kritika Jangid

9. outer "fibrous layer" and inner "cambium layer" (or " osteogenic layer"). P E R I O S T E U M 9 Dr. Kritika Jangid

10. Are responsible for formation, resorption and maintenance of osteoarchitecture Osteogenic cells Osteoprogenitors Preosteoblasts Osteoblasts Osteocytes Bone lining cells Osteoclast B O N E C E L L S 10 Dr. Kritika Jangid

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12. WHAT HAPPENS IN PERIODONTAL DISEASE??? 12 Dr. Kritika Jangid

13. Extension of inflammation from the marginal gingiva into the supporting periodontal tissues Invasion of the bone surface and the initial bone loss Gingivitis Periodontitis Bone loss in periodontal disease 13 Dr. Kritika Jangid

14. Pathways of inflammation 14 Dr. Kritika Jangid

15. Page & Schroeder- range of effectiveness of dental plaque to induce loss of bone is within about 1.5 to 2.5 mm. Acc to Loe & co-workers 8% severe periodontal diseases, yearly loss of attachment 0.1-1mm 81%moderate periodontitis, CAL 0.05-0.5mm 11%mild Periodontitis, 0.05-0.09mm Radius of Action 15 Dr. Kritika Jangid

16. PLAQUE PRODUCTS BONE PROGENITOR CELLS OSTEOCLASTS BONE DESTRUCTION GINGIVAL CELLS AGENTS 1. 2. 3. 5. 4. ACT AS COFACTOR DIRECT CHEMICAL ACTION Hausmann,1974 Mechanism of Action 16 Dr. Kritika Jangid

17. BONE DESTRUCTION PATTERNS IN P.DISEASES Horizontal bone loss Osseous defects Vertical/Angular defects 17 Dr. Kritika Jangid

18. VERTICAL/ANGULAR DEFECTS 18 Dr. Kritika Jangid

19. Osseous Craters Bulbous Bone Contours Reverse Architecture 19 Dr. Kritika Jangid

20. Ledges Furcation Involvements 20 Dr. Kritika Jangid

21. BONE GRAFTS 21 Dr. Kritika Jangid

22. GRAFT is defined as the portion of tissue removed from one site and placed at another, either in same or in another individual in order to repair a defect caused by operation , accident or disease. 22 Dr. Kritika Jangid

23. History Job Van Meekeren 1668 Performed the first heterologous graft by inserting a segment of dog’s skull into the skull of an injured soldier Duhamel in 1743 Periosteum has a pivotal role in osteogenesis Leopold Ollier in 1861 Osteogenetic capability of periosteum to autologous and homologous grafts 23 Dr. Kritika Jangid

24. Zoltan Hegedus in 1923 Portion of tibia grafted to the labial surface of the mandibular anteriors [1 st recorded human autogenous bone graft in periodontics ] Buebe and Silvers 1936 Used boiled cow bone powder to successfully repair intrabony defects Forsberg in 1956 Ospurum [ox bone ] Melcher in 1962 Anorganic bone [ bovine bone ] Allogenic freeze-dried bone – introduced in early 1970 Schallhorn in 1980 Grafting successful for 20 years with daily plaque control by patients & supervised periodontal maintenance program. Bower’s in 1989 Bone grafting enhances regeneration of new attachment aparartus 24 Dr. Kritika Jangid

25. Vittorio Putti [1912] Principles considered as the basis of modern science of grafting 1. Ability to be critical 2. Uniformity in graft integration 3. Osteogenic potential of periosteum 4. Biological capacity of treated grafts 5. Quality of tissue in which graft is placed 6. Mechanical characteristics of grafts and it’s fixation 7. Importance of asepsis 8. Importance of functional exercise 25 Dr. Kritika Jangid

26. Ideal bone graft should ……. Gross [1997] Be biocompatible Serve as scaffold [framework for new bone formation] Be resorbable in the long term & have the potential for replacement by host bone 4. Be osteogenic 5. Be radiopaque 6. Be easy to manipulate 7. Non Allergenic 8. Not support the growth of pathogen 26 Dr. Kritika Jangid

27. 9. Hydrophilic [to attract & hold the clot in a particular area] Availability in particulate & molder forms Microporous Have high compressive strength Have a surface amenable to grafting Act as a matrix or vehicle for other materials 27 Dr. Kritika Jangid

28. Reattachment Reunion of root and connective tissue separated by incision or injury New attachment Formation of new cementum with the insertion of new connective tissue fibers about a tooth surface previously exposed to bacterial plaque. Epithelial attachment – by long junctional epithelium Regeneration The formation of new bone, new cementum and PDL about a tooth surface previously exposed to bacterial plaque. Repair The healing of a wound by tissue that does not fully restore the architecture or the function of the part i.e.; scar tissue . -Melcher (1976) 28 Dr. Kritika Jangid

29. TYPES OF BONE GRAFTS Autograft : A tissue graft transferred from one position to a new position in the body of the same individual. Isograft : A tissue graft taken from one individual and transferred to another individual of the same genetic make. Eg : Identical twins Allograft: A tissue graft between individual of the same species but of non –identical genetic. Xenograft : A tissue graft between members of differing species i.e animal to man. Alloplast : A synthetic bone graft material, a bone graft substitute. 29 Dr. Kritika Jangid

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31. Osteogenesis Formation or development of new bone by cells contained in the graft : eg – autogenous graft. Osteoconduction Physical effect by which the matrix of the graft forms a scaffold that favors outside cells to penetrate the graft and form new bone. Eg ; Alloplasts Osteoinduction Chemical process by which molecules contained in the graft (BMP’s) convert the neighboring cells into osteoblasts , which in turn form bone Osteopromotion When the grafted material does not possess the property of osteoinduction but enhances osteoinduction by promoting new bone formation. For eg : Enamelmatrix derivatives do not stimulate de novo bone growth alone, but when used with DFDBA, enhances the osteoinductive effect of DFDBA. 31 Dr. Kritika Jangid

32. INDICATIONS Two walled intra bony defect Three walled intra bony defect Grade II, III Furcation involvement Ridge augmentation Sinus lifting procedure Regeneration around implants Socket conservation Filling donor side bone defects 32 Dr. Kritika Jangid

33. AUTOGENOUS BONE GRAFTS 33 Dr. Kritika Jangid

34. Considered the GOLD STANDARD among all the graft materials Gives more predictable results Contains live osteoblasts and osteoprogenitor stem cells and heal by osteogenesis 34 Dr. Kritika Jangid

35. Graft Procurement Bone Trap Trephine Bur Bone Shaving Device Suction Trap 35 Dr. Kritika Jangid

36. INTRA-ORAL SITES Healing extraction wounds Bone from edentulous ridges Bone trephined from the jaw without damaging the roots Bone removed during osteoplasty or ostectomy Mental and mandibular retromolar areas Maxillary tuberosity Exostoses 36 Dr. Kritika Jangid

37. EXTRA- ORAL SITES Hip marrow grafts – from iliac crest Gerdi’s tubercle – from tibia 37 Dr. Kritika Jangid

38. BONE GRAFTS HARVESTED FROM INTRA-ORAL SITES Cortical Bone Chips Osseous coagulum Bone Blend Intra oral Cancellous Bone Marrow Transplants Bone swaging 38 Dr. Kritika Jangid

39. Cortical Bone Chips Nabers & O’Leary [1965 ] – shavings of cortical bone removed during osteoplasty & ostectomy Large particle size Potential for sequestration 39 Dr. Kritika Jangid

40. OSSEOUS COAGULUM R. Earl Robinson Technique uses mixture of bone dust & blood Small particles ground from cortical bone used Sources: Lingual ridge on the mandible, exostosis , edentulous ridges, bone distal to the terminal tooth, bone removed from osteoplasty or ostectomy . 40 Dr. Kritika Jangid

41. ADVANTAGES: Additional surface area for interaction of cellular & vascular elements. Ease of obtaining bone from already exposed surgical site. DISADVANTAGES: Inadequate materials for large defects. 41 Dr. Kritika Jangid

42. BONE BLEND Uses an autoclaved capsule & pestle. Bone removed from pre-determined site , triturated in capsule to a workable , plastic like mass, & packed into bony defects 42 Dr. Kritika Jangid

43. INTRA ORAL CANCELLOUS BONE MARROW TRANSPLANTS From maxillary tuberosity Procedure: Bone removed from curved or cutting rongeur . Ridge incision distally from the last molar 43 Dr. Kritika Jangid

44. Edentulous area Procedure: Raising a flap Bone and its marrow are removed from curettes and back action chisels 44 Dr. Kritika Jangid

45. Healing sockets. Procedure: After 8-12 weeks of healing Apical portion used as donor material Particals are reduced to small pieces 45 Dr. Kritika Jangid

46. BONE SWAGING Edentulous area near the defect required Bone is pushed into the root surface without fracturing the bone at the base Technically difficult 46 Dr. Kritika Jangid

47. SOURCE OF INTRAORTAL BONE- Imp. Predominantly , cortical in nature which is less osteogenic Cancellous bone provides better osteogenic potential Dr. Kritika Jangid 47

48. Extra Oral Illiac Autografts The use of fresh or preserved illiac cancellous marrow has been extensively investigated Studies show that there was a mature PDL and about 2mm supracrestal new attachment formation No longer in use owing to some problems such as 48 Dr. Kritika Jangid

49. Root resorption Post operative infections Tooth loss & sequestration Varying rates of healing Rapid recurrence of defects Difficulties in procuring the graft material 49 Dr. Kritika Jangid

50. Healing Of Autografts Four Stages : Granulation Stage : When hematoma develops , an inflammatory response occurs and the formation of granulation tissue takes place Callus Stage : Mesenchymal cell differentiates mainly into osteoblasts Remodelling Stage : Hard callus tissue is replaced by lamella bone Modelling Stage : Bone adapts to the structural demands due to functional stimuli 50 Dr. Kritika Jangid

51. 7 days: Initiation of new bone formation 21 days: Cementogenesis 3 months: New PDL 8 months: Graft fully incorporated into the host with functionally oriented fibers between the bone and the cementum Maturation may take as long as 2 years [ Dragoo 1972 ; Dragoo & sullivan 1973] 51 Dr. Kritika Jangid

52. Autografts …….. Advantages 1. Promotes osteogenesis 2. Risk of disease transfer avoided 3. Easily procured Disadvantages 1. Inadequate material 2. Not comfort with hospitilization 3. Inflicting surgical trauma in other parts of the body 52 Dr. Kritika Jangid

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54. Kritika Shyam Darshana Archana Asha Sheethalan Sudarshana Avinash 54 Dr. Kritika Jangid