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
Corrolline calcium carbonate
Combination procedures
Risk of disease transmission
Conclusion
INTRODUCTION
Periodontal diseases
TERMINOLOGY
Reattachment
New attachment
Periodontal repair
Periodontal regeneration
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
Formation and development of
new bone
by viable cells
contained in the 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
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.
Osteopromotion
Osteopromotion
Osteopromotion
involves
the
enhancement
of
osteoinduction without the possession of osteoinductive
Clinical objectives of bone grafting for periodontal regeneration
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
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..,
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
Classification
Conge et al, 1978
AAP 1986
Carranza FA 1990
Rosenberg& Rose 1998
Resorption of the graft and replacement by new bone
depends upon
Particle size
Xenografts
CALF BONE - treated by detergent, sterilized and freeze dried. Used for treatment
of osseous defects.
KIEL BONE - Calf or Ox bone denaturated with 20% H
2O2, 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
ANORGANIC BOVINE
BONE(ABB
(
New processing and purification methods have been
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.
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 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
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
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
ABB plus P-15 cell binding
peptide
(pentadecapeptide)
Mimics the cell binding
domain of
type I collagen
Hanadi Baeissa
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
A Novel Combination Of Platelet Rich Fibrin And Pepgen P-15
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
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
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
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
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.
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
CORROLLINE CALCIUM CARBONATE
Biocoral is a calcium carbonate
Natural coral,
Primarily of aragonite.
It is biocompatible and resorbable
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.
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
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
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
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
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
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.
•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
