Guided Bone Regeneration Flashcards

1
Q

Ridge Augmentation Techniques

A
  • Distraction Osteogenesis
    • high risk of infection & failure
  • Guided Bone Regeneration (GBR)
  • Block Autograft
  • Block Allograft
  • Ridge Split Techniques
  • Combination
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2
Q

GBR vs GTR

A
  • GBR
    • on edentulous ridges
  • GTR
    • around teeth
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3
Q

Guided Bone Regeneration

A
  • Use barrier membranes to direct growth of new bone & soft tissue
    • sites w/insufficient volumes or dimensions
    • used for fxn, esthetics, or restoration
  • Based on Guided Tissue Regeneration (GTR) principles
  • Introduced by Dahlin
    • rats
    • 1988
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4
Q

GBR Regeneration Process

A
  1. Blood Clot
  2. Angiogenesis
    1. develop new blood vessels
  3. Granulation Tissue
  4. Osteogenic cells migrate
    1. periphery→center
  5. Deposits woven bone
  6. Lamellar bone forms
  7. Remodeling
    1. resembles bone growth
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5
Q

GBR: PASS Principle

A
  • Primary Closure
    • periosteal releasing incision
    • remove membranes after 4-6 mos
  • Angiogenesis (Blood Flow)
    • formation of new BVs
  • Stability
    • Suture and anchor membrane and flaps
  • Space Maintenance
    • membrane b/w bone graft and gingiva
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6
Q

What is the Principle of Combination Therapy

A
  • Membrane
    • provides barrier
  • Graft
    • scaffold
    • space maintenance
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7
Q

Ideal Membrane Characteristics

A
  • Biocompatible
  • Cell Occlusiveness
  • Tissue Integration
    • protect blood clot
    • wound stabilized
  • Space making
    • for progenitor cells
  • Manage Clinical
  • Facilitate migration and proliferation of progenitor cells
  • Bacterial infection resistant
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8
Q

Types of Barrier Membranes

A
  • Non-Resorbable
    • ePTFE, dPTFE
      • socket grafting)
    • Millipore
      • Cellulose acetate
    • Titanium
  • Resorbable:
    • Collagen
    • Synthetic: PLA, PGA, PLGA
    • ADM
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9
Q

New Membranes

A
  • Alginate
  • New degradable copolymers
  • Hybrid or nanofibrous membranes
  • Amniotic membranes
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10
Q

Porosity Principle

A
  • Porosity
    • 50-100 um → Bone ingrowth
    • > 100 um (101-150)→ High vascular tissue
    • > 150 um→ Bone with osteons
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11
Q

GBR: Other Principles

A
  • Thin layer of soft-tissue ingrowth
    • under the membrane
    • initial blood clot shrinks→air entrapped or membrane micromovement
  • Micromovement:
    • Fibrous Tissue
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12
Q

Osteogenesis

A
  • cells in graft form new bone
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13
Q

Osteoinduction

A
  • Chemical Process
  • BMPs convert neighboring cells→ osteoblasts→form Bone
    • BMPs=molecules in graft
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14
Q

Osteoconduction

A
  • Physical Effect
  • Graft Matrix forms scaffold
    • outside cells penetrate the graft → form new bone
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15
Q

Osteopromotion

A
  • Materials that support:
    • wound healing
    • tissue regeneration
  • do not initiate de novo tissue formation
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16
Q

Autograft

A
  • Same person
  • intraoral or extraoral
    • tuberosity, chin, ramus, calvarium, tibia, iliac crest
  • osteogenesis
  • osteoconduction
  • osteoinduction
17
Q

Allograft

A
  • From a different person
  • DFDBA, DFBA, Puros
  • Osteoinductive
  • Osteoconductive
18
Q

Xenograft

A
  • From a different species
  • Bovine (Bio-Oss), Horse (Equimatrix)
  • Osteoconductive
19
Q

Alloplasts

A
  • Synthetic
  • GEM21
  • osteoinductive
  • osteoconductive
20
Q

Growth Factors

A
  • GFs
    • rhBMP2
    • PDGF-BB
    • FGF2
  • Controversial Evidence
    • Rapid Clearance→ insufficient GF conc in bone defects
    • Deliver w/supra-physiological non-standard doses → therapeutic efficacy
21
Q

Neo-osteogenesis

A
  • de novo bone formation beyond genetic skeletal envelope
  • achieved by applying GBR principle
22
Q

Factors that Influence GBR Success

A
  • Patient Factors
    • smoking
  • Excessive Swelling
  • Passive Flap tension
  • Cortical Penetration
  • Defect morphology
    • length
    • angle
  • Membrane fixation
  • Materials used
  • Horizontal Augmentation
    • predictable and successful
  • Vertical Augmentation
    • More challenging
    • Less than horizontal gain
    • Decreased implant success & survival
23
Q

Block Graft

A
  • Block Graft vs GBR
    • Greater Ridge Width Gain
    • Lower Implant Success
  • Block Graft vs Autogenous Particular Graft
    • Greater:
      • bone to implant contact
      • Bone Fill
    • Less Mean height Gain
24
Q

Khoury’s Split Bone Block Technique

A
  • Bone Block + GBR
25
Q

Ti-Mesh Membranes

A
  • Titanium Meshes
  • used w/particulate bone for large defects
  • oxide layer promotes
    • cell colonization
    • differentiation of osteogenic lines
  • Not mainstrem
    • technique sensitive
    • Cost
26
Q

Alveolar Ridge Split (ARS)

A
  • Aka:
    • alveolar corticotomy
    • ERE-edentulous ridge expansion
  • Splits crest cortical bone
    • creates horizontal dimensions for immediate or delayed implant placement
  • can be combined with GBR
  • Only D3 or D4 bone Types
27
Q

Alveolar Ridge Split: 4 Anatomical Requirements

A
  • Minimal horizontal bone width= 2 mm
  • Minimal Vertical Bone Height=10 mm
  • No concavity
  • Horizontal osteotomes ≥ 1mm from tooth