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CHIR IV > CHAP 5- Bone regeneration > Flashcards

CHAP 5- Bone regeneration Flashcards

1
Q

1rt years exodontia

A

Mandible 4-6 mm
Maxilla 2-4 mm

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2
Q

After first years reabsorption

A

slow and progressive
more intense in the mandible tan in the maxillary bone
3/1 o 4/1
Manible : Arc widening
Maxilla : arc narrowing

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3
Q

Important Factors in Bone Regeneration

A

❖ Aesthetic and functional requirements of the patient
❖ Budget
❖ Tobacco
❖ Patient’s oral hygiene habits
❖ Availability of suitable donor sites ( in case of autologous grafting)
❖ Intraoral soft tissue status

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4
Q

Autologous graft

A
  • Graft from the recipient’s own
  • Body Extraoral and intraoral donor
    sites
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5
Q

Homologous graft
allograft
allogenic graft

A
  • Grafts from the same species
  • Mineralised freeze-dried bone/des
    (FDBA,DFDBA), fresh frozen
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6
Q

Heterologous graft or Xenografts

A
  • Grafts from different species
  • Bovine bone
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7
Q

Alloplastic or synthetic graft

A
  • Laboratory synthesized inert material
  • Bioceramics (HA, B-TCP), Polymers, Bioactive Glasses
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8
Q

Classification of Bone Grafts
BY ITS STRUCTURE
SPONGIOUS

A

+ o s t e o g e n i c c e l l s
- s t r u c t u r a l
s t i f f n e s s
+ r e s o r p t i o n
+ v a s c u l a r i z a t i o n

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9
Q

CORTICAL

A
  • o s t e o g e n i c c e l l s
    + s t r u c t u r a l s t i f f n e s s
  • r e s o r p t i o n
    + o s t e o c o n d u c t i v e c a p a c i t y
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10
Q

Particulated bone

A
  • Auto, Alo, Xeno,
  • Alloplastic
  • By itself, with plasma, with blood
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11
Q

Composite

A

Mixed with each other

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12
Q

Classification of Bone Grafts
BY Regeneration Mechanism
OSTEOGENESIS

A
  • It is the formation of bone tissue starting from living
    cells coming from the graft. ==> Autologous
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13
Q

OSTEOINDUCTION

A
  • It is a process by which mesenchymal cells in the
    recipient site a re-transformed into osteoforming cells .
  • This stimulus is provided by growth factors.
    ==>Autologous bone and Autograft
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14
Q

OSTEOCONDUCTION

A
  • It is a phenomenon in which the graft serves as a guide for bone neoformation .
  • It is colonized by blood vessels and osteoprogenitor cells of the recipient site .
  • As it is resorbed, it is replaced by neoformed bone tissue .
    ==>All of grafts
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15
Q

Autologous dentin

A

❖ Studies with a larger sample size, and especially with a longer follow-up time, are needed to confirm the long-term stability of this material.
❖ Human dentin and bone tissue have a similar chemical composition.
❖ Autogenous dentin possesses osteoconduction and osteoinduction properties.
❖ Good results in terms of bone gain and consistency, and even better results compared to other materials

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16
Q

Gold standard

A

Autologous bone

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17
Q

Autologous bone = PROS

A

❖ No additional biomaterial cost
❖ No immunological reaction
❖ Osteo-gene/inducer/conducer

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18
Q

Autologous bone = CONS

A

❖ Donor area (additional surgery)
❖ Increased morbidity (2 fields)
❖ Limited availability of intraoral grafts
❖ Extraoral grafts: AG, QX…
❖ High resorption rate
❖ Not storable

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19
Q

DONOR SITES FOR AUTOGRAFTS

A
  • Cortical/spongious
  • Block/Particulated
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20
Q

Intraoral regions

A

Intramembranous: less reabsorption
Mandibular ramus
Mandibular body
Mandibular symphysis
Tuberosity

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21
Q

Extraoral regions

A

Endocondral: more reabsorption
Iliac crest
Tibia
Fibula
Calotte

22
Q

objet for get bone

A

BONE SCRAPERS

23
Q

rotatory instrument

A

Harvesting burs
Biological harvesting slow velocity

24
Q

BONE SCRAPERS

A
25
Q

P A R T I C U L A T E G R A F T S

A

ABSENCE OF STIFFNESS/MECHANICAL STRENGTH
===>
SOFT TISSUE COLLAPSE OVER THE GRAFT
+
PARTICLE COMPRESSION
==>
LOSS OF STABILITY
+
ACCELERATED RESORPTION

26
Q

PA RT I C U L AT E G R A F T S
IN CASES OF DEFECTS OF MORE THAN ONE WALL, IT IS NECESSARY TO USE

A

TITANIUM MEMBRANES OR
MESHES THAT WILL KEEP THE GRAFT FREE OF TENSIONS.

27
Q

GUIDED BONE REGENERATION

A

BIOLOGICAL PRINCIPLE THAT CONSISTS OF PREVENTING ACCESS TO THE AREA TO BE REGENERATED BY
CELLS FROM THE CONNECTIVE TISSUE AND EPITHELIUM, ALLOWING COLONIZATION OF THE SPACE BY
CELL LINES FROM THE BONE

28
Q

WHAT IS MEMBRANE

A

ISOLATION BARRIER BETWEEN CONNECTIVE TISSUE AND THE BONE BED
==>
TARGETED DIFFERENTIATION OF BONE TISSUE TO PROMOTE BONE REGENERATION

29
Q

M E M B R A N A E S
==>
P R O P E R T I E

A

Exclude gingival fibroblasts and epithelial cells from the regeneration zone
Mechanical stability : provide a stable space and protect clot and graft
biocompatible
integrate with surrounding tissues
Manageable
Low cost

30
Q

M E M B R A N A E S
==>
USE

A

Extend 2 to 3 mm beyond the margins of the defect
good adaptation
Resorbable: hydrate before
Correct stabilization

31
Q

RESORBABLE MEMBRANES
==>
NATURAL OR SYNTHETIC

A

Most used: Collagen tendons, , skin or pericardium / bovine or porcine
They vary according to: type, structure, degree of cross-linking (cross-linked) and collagen treatment.

32
Q

Resorb/Resorption

A

FAST : 2-4 mouths
Medium : 4-mouths
Slow: more than 6 mouths

33
Q

resorb/Membranes
Advantages

A

No 2nd surgery removed
Easy adaptation and handling
Good biocompatibility

34
Q

resor/Membranes
Iconvenient

A

Lack of stiffness
Unpredictable degree of resorption
If exposed rapid resorption

35
Q

Non Resorbable membranes/Mesh
ADVANTAGES

A

Dense surface to soft tissue.
Avoids fibrous tissue in the bone defect

36
Q

Non Resorbable membranes/Mesh
Inconvenient

A

2nd surgery for removal
More complicated management
Higer rate of exposure (infection)

37
Q

Resorbable membranes
Indications

A
  • L O C A L A L V E O L A R R I D G E D E F E C T S ( L I M I T E D H O R I Z O N T A L O R V E R T I C A L )
  • P E R I - I M P L A N T B O N E R E G E N E R A T I O N
  • D E H I S C E N C E S A N D F E N E S T R A T I O N S A S S O C I A T E D W I T H I M P L A N T P L A C E M E N T
  • B O N E D E F E C T S A S S O C I A T E D W I T H O S S E O I N T E G R A T I O N F A I L U R E S
  • B O N E L E S I O N S
  • C O V E R A G E O F S I N U S M E M B R A N E
    P E R F O R A T I O N S I N S I N U S L I F T S
38
Q

Non resorbable membranes / Mesh
INDICATIONS

A

ALL (same as resorbable)
More advantages but more difficult to work with and higher rate of complication incidence
Large defects (longer time and bone maturation): Vertical and some horizontal regenerations

39
Q

PARTICULATE GRAFTS
OPTIMAL PARTICLE SIZE

A

0,25MM- 2 MM

40
Q

CLINICAL USES OF PARTICULATE GRAFTS

A

(SOCKET PRESERVATION)
FENESTRATIONS AND DEHISCENCES (GUIDED BONE REGENERATION)
MAXILLARY SINUS ELEVATION
PERI-IMPLANT DEFECTS

41
Q

FENESTRATIONS AND DEHISCENCES

A

NARROW ALVEOLAR RIDGES OR BUCCAL CONCAVITIES
DEHISCENCE(couvre pas jusqu’a l’apex): THE MOST CORONAL SPIRES ARE EXPOSED WITHOUT BONE COVERING.
FENESTRATION(fenetre): LACK OF BONE COVERING OF THE IMPLANT IN ITS APICAL PORTION.

42
Q

GUIDED BONE REGENERATION

A

Tinti’s Technique
Vertical augmentation with immediate IOI
placement

43
Q

GUIDED BONE REGENERATION
URBAN TECHNIQUE
SAUSAGE TECHNIQUE
(VERTICAL/HORIZONTAL AUGMENTATION)

A
  • MIXTURE 1:1 : AUTOLOGOUS H. AND XENOGRAFT
  • SLOWLY RESORBABLE MEMBRANE OF COLLAGEN FIXED WITH PINS.
  • WAIT 8-9 MONTHS FOR IOI
44
Q

PASS
Principe for predictable bone regeneration

A

Primary wound closure
Angiogenesis
Space creation/maintenance
Stability of initial blood clot and implant fixture

45
Q

BLOCK GRAFTS
Sequence of block grafts

A
  • Preparation of the recipient area
  • Graft harvesting (in case of intraoral: chin, branch, tuberosity)
  • Adaptation + fixation of the block
  • Soft tissue coverage of the recipient site
  • Closing of donor area
  • Re-entry
46
Q

Instruments for graft harvesting

A
  • Crack milling cutter
  • Oscillating saw
  • Discs
  • Trephines
  • Piezoelectric
47
Q

CLINICAL USES OF BLOCK GRAFTS
Khoury’s technique
Vertical and horizontal regeneration

A
  • Procurement of autogenous block graft from retromolar area and split into two thin cortical
    lamellae.
  • In the recipient area, the sheets are arranged in a box shape with micro-screws.
  • Subsequently, the space is filled with autologous particulate bone.
  • Waiting 4 months and placement of IOI
  • In 2nd phase soft tissue augmentation
48
Q

Complications
Intraoperative

A
  • Hemorrhage
  • Injury to vascular-nerve structures
  • Bone fractures
49
Q

Post-operative

A

Suture dehiscence and wound opening
Membrane and graft exposure
Infection

50
Q

Complications
Resorption

A

❖ Bone grafts in apposition: high rate of resorption in the short and medium term
❖ Resorption rates during the first 6 months of 11-41.5%.
❖ If the graft is not subjected to mechanical stimulation: 92% resorption rate.
❖ Intramembranous bone resorbs less and revascularizes faster than grafts of endochondral origin

CHIR IV (5 decks)

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