31 - Bone Grafts 1 - Hunter - DONE Flashcards
Should I do intramarrow penetration when I am doing grafting?
Yes you should.
Crea found OFD alone vs OFD + intramarrow penetration had 2x the radiographic bone fill in the mandible compared to OFD alone.
According to faculty as long the defect is bleeding on its own thats adequate. Faculty said it is difficult to do the amount and extent of intramarrow penetrations that they did here
What is osseous coagulum? What was the idea of using coagulum?
Robinson. Intraoral cortical bone dust that collects in the oral site while you are working. It mixes with the patients blood. Idea that autogenous bone is a readily available source if doing osseous surgery.
What is bone blending?
Diem.
When you put collected autogenous bone in an amalgam capsule and triturate it to decrease the particle size. Reported particle size is 0.2 mm.
Froum showed that this is better than OFD alone
What is the difference between defect resolution and % bone fill?
Defect resolution - takes into account crestal resorption as well as regeneration of bone
% bone fill - does not take crestal resorption into acount
Can you use intraoral cancellous bone as a graft for intrabony defects?
Hiatt showed the the maxillary tuberosity, healing extraction sites, and edentulous areas are viable sites of cancellous bone to use as graft material.
This bone did not do as well as iliac grafts in furcation defects only. Same result in vertical defects.
Talk about using a healed extraction site for a source of bone grafting in vertical defects.
Soehren gave recommendations in a review paper. Stated that the optimal time to enter the donor site is 6 to14 weeks post-extraction (depending upon any healing complications, where later is better). Gingiva over the site needs to be free of inflammation
First 6 weeks allow for clot retraction, clot reorganization and primary ossification. Based on clinical experience, the authors recommend 8 weeks for the maxilla and 12 weeks for the mandible due to the difference in blood supply. Harvest of the graft is accomplished by curettage of the socket contents with a Kirkland 13 and 14.
Evian (THIS WAS ASKED IN CASE PRES) looked at the histology of healing extraction sites to determine the optimal times to use it in autogenous grafting.
BL: 2 distinct phases of bone healing.
From 4-8 weeks, a very active osteogenic phase with many osteogenic cells and immature bone formation. After 8 weeks, osteogenesis slows down as the bone volume has increased and the bone starts maturing. By 12-16 weeks, the trabeculae are mature with little osteiod and few bone cells.
It is not known if it’s the osteogenic property or the “scaffolding” property is more advantageous for new bone formation. However, bone from the 8-12 week period contains elements of both.
Talk about using autogenous iliac bone grafts in vertical bone defects
Dragoo studied iliac bone grafts. He found that they do achieve regeneration. They are an osteogenic material because they have live cells in them. However, Dragoo detect root resorption at a 2.8% incidence. He said that it was associated with gingival inflammation and patients with meticulous home care would not have root resorption.
What diseases are human cellular and tissue donors screened for?
Tissues are screened for various bacteria and fungi, antibodies to HIV-1, HIV-2, HTLV-1, HTLV-2, HBcAb, HCVAb, and syphilis antibody.
In addition, testing is conducted for the HIV and hepatitis C virus as well as HBsAg (hepatitis B surface antigen.)
What type of processing does bone donor material go through? Does it take care of certain diseases?
DFDBA generally includes: soft tissue stripping, initial size reduction, initial cleansing and decontamination, microbiological treatment, freezing, dehydration, secondary size reduction, demineralization, buffering, final rinse, packaging, and terminal sterilization.
The process for FDBA is a little shorter as it does not include demineralization, buffering, or a final rinse.
These processing steps for DFDBA have been demonstrated to inactivate HIV, HBV, HCV, CMV and poliovirus.
What citation would you use to defend antibiotic use after bone grafting?
Sanders was looking at the results of FDBA in periodontal defects. T
Complete or >50% osseous regeneration was seen in 85% of grafted sites following the use of post-operative antibiotics (vs. only 38% of sites when antibiotics were not prescribed). For both groups, a significant difference in osseous regeneration was noted with antibiotics, intramarrow penetration and endodontically untreated teeth.
There was an apparent enhancement of the FDBA’s clinical success through the addition of autogenous bone for the treatment of 1,2 or wide 3 wall defects and furcation defects.
Can you use FDBA instead of DFDBA to treat periodontal defects?
Tsao says yes
Partial bone fill was obtained using mineralized bone allograft with and without GTR. Vertical bone fill was improved to a greater extent than horizontal bone fill.
Can you use mineralized cancellous bone allograft for periodontal regeneration?
Yes, Koylass found that that periodontal regeneration is possible using MCBA (mineralized cancellous bone allograft, PUROS) is possible.
Can I use cortical DFDBA to treat an osseous defect?
Mellonig
Cortical DFDBA shows bone fill in periodontal defects
Rosenberg came up with the threshold for success if greater than 50% bone fill
Do patients that have donor bone in them create HLA antibodies against the HLA-incompatible donor bone?
Quattlebaum
No, FDBA lacks clinically significant antigenicity
Can we achieve periodontal regeneration without using grafting material?
MEALEY said that the Bowers studies are very important
Yes, BOWERS found significantly greater regeneration of new attachment apparatus and individual tissues in a submerged environment compared to a nonsubmerged environment after scaling and root planing. WITH NO GRAFT MATERIAL
THIS IS A HENNAH STUDY
Will DFDBA enhance the amount of formation of a new attachment apparatus and component tissues?
IMPT - BOWERS HENNAH STUDY
There was a significant difference in the amount of new bone formed in DFDBA grafted defects vs no graft at all in submerged environment. In addition, more cementum formation occurred in grafted sites than in nongrafted, but the difference was not significant. Fibers of the PDL were more often oriented parallel to the root surface in grafted sites vs. both perpendicular and parallel in nongrafted sites.
