Bone Grafts & Implantology

Question 1

What are the four causes of bone loss?

Answer 1

1. Congenital = born with deficiency in bone
2. Traumatic
3. Pathology
4. Natural

Question 2

Name some different types of bone grafts:

Answer 2

• autogenous
• xenograft
• allograft
• alloplastic
• bone bioengineering

Question 3

What is an autogenous bone graft?

Answer 3

bone tissue is harvested from one areas of the pts own body & transplanted to another site

Question 4

What are some common intra-oral/local areas of autogenous bone harvesting?

Answer 4

• chin
• ramus
• tuberosity
• coronoid process
• buccal cortex

Question 5

What are some common extra-oral areas of autogenous bone harvesting?

Answer 5

• hip
• calvarium
• iliac crest [hip]

Question 6

What is a xenograft?

Answer 6

type of bone graft material derived from a non-human source

Question 7

What is commonly used for dental xenograft procedures?

Answer 7

Bio-Oss
- deproteinised bone
- used alongside allograft procedures to minimise bone resorption

Question 8

What is an allograft?

Answer 8

bone graft material derives from human donors [cadaveric bone]
- donated bone is processed and sterilised to remove organic components

Question 9

What can be used to perform an allograft?

Answer 9

irradiated sterilised free dried bone blocks

Question 10

What is an alloplastic graft?

Answer 10

a bone graft using synthetic or manufactured grafting material
- proplast
- HA
- TCP
- TCS

Question 11

What is used when performing bone bioengineering procedures?

Answer 11

bone morphogenic protein

Question 12

What are the 2 principles of bone grafting?

Answer 12

• osteoconduction
• osteoinducation

Question 13

What is osteoconduction?

Answer 13

the ability of bone graft material to provide a scaffold or framework for new bone formation [bone forming cells]

Question 14

What is osteogenesis?

Answer 14

formation of new bone tissue, induced through the recruitment of immature cells (UMC) for bone formation

Question 15

What are the basic principles of distraction osteogenesis?

Answer 15

• latency
• distraction
• consolidation
• remodelling

Question 16

When are zygomatic implants indicated?

Answer 16

• severe maxillary atrophy
• sinus pneumotisation
• avoid harvesting of bone graft
• hemimaxillectomy

Question 17

What are bone morphogenic proteins?

Answer 17

Group of growth factors that play a role in bone formation & regeneration
- active osteoinductive factors
- convert UMCs [undifferentiated mesenchymal cells] into osteoblasts

Question 18

What is an example of congenital bone loss?

Answer 18

Cleft palate

Question 19

What is an example of traumatic bone loss?

Answer 19

car crashes

Question 20

What is an example of natural bone loss?

Answer 20

• Alveolar ridge resorption over the years

Question 21

What type of bone grafts can be performed?

Answer 21

• onlay
• interpositional
• sinus lift

Question 22

A low maxillary sinus poses a problem for implant placement, what can be done?

Answer 22

Implant lift

Question 23

What is the most common distant donor site for bone?

Answer 23

iliac crest [hip]

Question 24

Why is bone grafting from calvarium good?

Answer 24

membranous ossification [leads to less resorption when grafted into mouth]

Question 25

What anatomical feature is at risk during buccal cortex grafting procedures?

Answer 25

Inferior alveolar nerve

Question 26

Bone mill

Answer 26

take piece of bone & crush it into small places, then apply it as a “putty” to area needed

Question 27

What are the steps of a maxillary sinus lift?

Answer 27

• cut a window in outer cortext
• lift membrane
• apply bone graft
• apply Bio-Oss
• apply guided tissue repositioning and suture closed

Question 28

What is an interpositional bone graft?

Answer 28

graft is applioes between the inner and outer cortex to increase bone width

Question 29

Guided tissue regeneration

Question 30

What do you want the implants to do when placed?

Answer 30

osseo-integration

Question 31

What is the gold-standard type of bone grafting?

Answer 31

Allograft procedures with local bone harvesting

Question 32

How do you decide where to harvest bone from in Allograft procedures?

Answer 32

• pt preference
• availability of bone based on CBCT
• proximity of anatomical structures [eg mental foramen too close]

Question 33

When might alveolar distraction osteogenesis be required?

Answer 33

for elderly pt who cant withstand harvesting procedure

Question 34

What is latency?

Answer 34

inflammatory cells infiltrate into the area and soft tissue healing

Question 35

How does distraction osteogenesis occur?

Answer 35

• cut bone & separate piece
• separate 1mm per day [half a mm in morning, half a mm in evening]
• any faster will leads to breaking of the soft tissue
• allow natural biologic depositon of bone in these areas

Question 36

What is “vector” in reference to alveolar distration?

Answer 36

direction you want the bone to grow in

Question 37

What is inferior dental nerve lateralisation?

Answer 37

put a stitch around the [IAN] nerve to pull it laterally so you can you place implants into remaining bone to lower risk to nerve

Question 38

What are indications for zygomatic implants?

Answer 38

• severe maxillary atrophy
• sinus pneumotisation
• avoids harvesting of bone graft
• hemimaxillectomy [ one half of maxilla removed ]

Question 39

Bone-bioengineering **