Bone Grafts in Perio Regeneration

Question 1

Define Regenertation

Answer 1

Restoration of functional attachment apparatus composed of cementum, PDL, and alveolar bone

Question 2

Define Reattachment

Answer 2

Reunion of epithelial and connective tissues with root surfaces and bone

Question 3

Define Repair

Answer 3

Healing of a wound by tissue that does not fully restore architecture and/or function

Question 4

Define New attachment

Answer 4

Union of connective tissue or epithelium with a root surface that has been deprived of its original attachment apparatus

Question 5

Define Bone Fill

Answer 5

Clinical restoration of bone tissue in a treated periodontal defect

Question 6

Define Osteogenesis

Answer 6

New bone formation derived from viable undifferentiated cells or osteoblasts residing within the graft

Question 7

Define Osteoinduction

Answer 7

Stimulation of host cells to differentiate and form new bone. Graft materials may release osteoinductive substances such as bone morphogenetic protein (BMP) resulting in new bone

Question 8

Define Osteoconduction

Answer 8

Formation of new bone by host cells where the graft merely provides a scaffold for growth

Question 9

Autograft

Answer 9

tissue transferred from 1 position to another from the same individual

Question 10

Allograft

Answer 10

(Homograft) graft between genetically dissimilar member of the same species (another human)

Question 11

Xenograft

Answer 11

Graft between genetically different species - COW, PIG

Question 12

Alloplast

Answer 12

synthetic graft or inert foreign body implanted into tissue

Question 13

Objectives of osseous grafting

Answer 13

1. pocket reduction/elimination
2. Restore lot alveolar process
   regenerate functional attachment

Question 14

Advantages of bone graft vs. other surgical procedures

Answer 14

reconstruct lost periodontium, reverse dz process, inc tooth support, enhanced esthetics/fxn

Question 15

limitations to osseous graft

Answer 15

inc time; finding autograft material (limited sources); add. PO care; unpredictable??; expensive; long time before re-eval; vulnerable to recurrence; safety concerns

Question 16

Success factors

Answer 16

non-smoker, good OH, vertical bone loss

Question 17

What type of defect has the best potential for osseous fill?

Answer 17

3 wall defect (bordered by 1 tooth surface and 3 walls

Question 18

What is a circumferential defect?

Answer 18

3 wall defect that is less successful bc it is 3 bony walls but more than one tooth surface, kind of circling around tooth.

Question 19

Describe a 2 wall defect?

Answer 19

bordered by 2 tooth surfaces and two osseous surfaces, reduced potential for fill.

Question 20

What is the most common example of a 2 wall defect?

Answer 20

osseous crater

Question 21

Most grafts are ____

Answer 21

osteoconductive??

Question 22

Surgical techniques

Answer 22

Intrasulcular incisions
Reflection of mucoperiosteal flap
Defect debridement
Root instrumentation/conditioning
Intra-marrow penetration
Graft placement
Flaps replaced and sutured

Question 23

Types of autografts?

Answer 23

cortical Chips, osseous coagulum, intraoral cancellous bone and marrow
Composite grafts

Question 24

Sources of intra-oral autogenous bone?

Answer 24

Max. tuberosity, edenulous areas, healing ext sockets, tori, exostoses

Question 25

types of allografts?

Answer 25

Freeze-dried bone, demineralized FDB

Question 26

Xenograft example?

Answer 26

bio-oss (cow?)

Question 27

Graft vs. No graft?

Answer 27

1. study: ~3 mm bone fill vs .66mm OFD
2. FDB
3. DFDB ~65% average
   More bone fill with the grafts

Question 28

Safety concerns for dz transmission - Allografts

Answer 28

almost NONE! Not one reported yet.

screen donors, do HIV test, autopsy, blood cultures, lymph node studies, serologic test for hep and syphilis

Question 29

potential safety for xenografts

Answer 29

Creutzfeldt-Jacob disease has been linked to transmission of bovine spongiform encephalopathy