application of bone graft in different dental fields

2. defined as : a bone fragmenttransplanted, whole or in pieces, fromone
site to another
Bone is : the secondmost commonlyimplantedmaterial in the human
body, after blood transfusion
Bone graft

3. Principles of grafting
1.Host bone regeneration capacity
2. Surgical asepsis
3. Host site preparation
4. Optimization of growth factor
5. Graft immobilization
6. Soft tissue coverage

4. Bone graft
Note ridge
resorption
After ridge augmentaion

5. Types of bone grafts
•Autograft
•Allograft
•Xenograft
•alloplast

6. Biological mechanism
Osteoconduction
graft material serves as a scaffold for new bone growth
Osteoinduction
Chemical processwich stimulationof osteoprogenitor cells to differentiate into
osteoblasts that then begin new bone formation . The
most widely studiedtype of osteoinductive cell mediators are (BMP)
Osteogenesis
bone formation, fromcells that survive in the graftand are capable of produce
new bone

7. Structure of grafts
Cortical bone
cancellous bone
used primarily for structural support
cancellous bone grafts for osteogenesis

8. Mechanism of bone formation
Mechanism
Mechanism of bone formation in a cancellous cellular bone emanate from survival of theosteoprogenitor
cells (osteoblst & marrow cells)
Transplanted osteoprogenitor cells survive within the recipient tissue for first 3-4 days by a nutritional
diffusion from the surrounding vascular tissue envelop
From 3rd day – capillary buds start proliferation from surrounding tissue. This establish oxygen gradient
Between 3rd and 14th day – complete revascularization occur

9. Healing principles
Mechanism
revascularization of a cancellous graft may be completed within 2 weeks.
In contrast, revascularization of cortical grafts is much slower , due to lack of anastomoses
Grafted cortical bone particles may not entirely be replaced with host bone at the recipient bed
but grafted cancellous bone will be completely replaced by new host bone within the first year after
transplantation

10. Sources of grafts
Inraoral extraoral
Max. tuberosity
Ramus
Symphysis
rib
tibia
Iliac crest
Calvarial bone
Autogenous grafts

11. Autogenous
Disadvantages
Low availability of bone volume
Require a second operative site
Significant patient morbidity
Considered the “ goldstandard ” by which other materials are judged
Osteoinductive, osteoconductive, and osteogenic properties
No risk of infection
Sources of grafts

12. 1.FRESHFROZEN
- Highly antigenic
1.Mineralizedfreezedriedallograft
- Osteoconductive
-Low bioavailabilty and activity of (BMP)
1.Demineralizedfreezedriedbone
-Osteoinductive
-The process exposes BMP
BMP cause differentiation of mesenchymal cells into osteoblasts
Human cadavers source
Method to supress antigenicity
Disadvantages
Risk of disease transmission and unpredictability
Possible infections, and antigenicity risks
MinerOss®
allograft

13. Demineralized freeze dried bone
Mechanism
BMP are associated with the organic matrix of bone and embedded within mineral content, so demineralised
process increases its bioavailability
BMP attract mesenchymal stem cells and induce them to differentiate into chondrocytes leading into endochondral
bone formation.
Endochondral bone formation is attributed to a osteoinductivity response,
while intra-membranous bone formation is indicative of an osteoconductive response

14. Xenograft
Naturally derived hydroxylapatite from bovine, coral
Osteoconductive
Similar structure, chemistry, and porosity of human bone
Disadvantages
Risk of disease transmission
Remains in the defect for years
Continuous macrophage activity
MinerOss®
Sources of grafts

15. •Hydroxyapetite
•Polymers
•bioactive glass
•Tricalcium phosphate
•Calcium sulphate
alloplast
Cancellous Bone
Coralline hydroxyapatite
Sources of grafts

16. Techniques for using autogenous bone gra
Osseous coagulum : blood misture with bone dust
Bone blend : placing bone fragment placed in capsule & tituration

17. Techniques for using autogenous bone gra
Intraoralcancellous bone marrow transplant : from
-max. tuberosity
-healing socket
-edentulous area
Bone swaging :
pushing the bone (of edentulous area adjacent to the defect ) into contact with the
root surface without fractureing its base
Technically diffcult
No longer use
Extraction socket allowed to heal for 2-3 months before reintering

18. Grafting application

19. Alveolar socket preservation

20. Onlay grafting Procedure
Disadvantage : increase vertical load ridge resorption

21. interpositional Procedure
Le Fort I osteotomy

22. Alveolar bone split osteotomy
Used to increase ridge thickness

23. Sinus lift procedure
Maxillary sinus lift
lateral window

24. Distraction osteogenesis
By llizarov
Biologic process of new bone formation between
surfaces of separated bone segment by traction forces
Gradual lenthening of the bone by application of a
specific device (distractor)

25. Complication of grafting
1. Perforation of the Schneiderian membrane
2. Soft tissue dehiscence
3. Infection
4. Exposure of GBR membrane
5. Mobilisation of the graft
6. Graft resorption
7. Cyst formation
8. Transmission of diseases

26. Thank you

27. Any
question
thank you