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Perio II > Osseous Regeneration > Flashcards

Osseous Regeneration Flashcards

1
Q

what are the objectives of bone replacement grafting

A
  • regeneration of lost periodontium - new bone, cementum, and PDL
  • reduce or eliminate the periodontal pocket
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2
Q

what are the types of bone replacement grafts

A
  • autograft
  • allograft
  • alloplast
  • xenograft
  • composite
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3
Q

what is an autograft

A

tissue transferred from one site to another in the same individual

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4
Q

what is an allograft

A

tissue transferred between individuals of same species

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5
Q

what is an alloplast

A

inert material used for graft

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6
Q

what is a xenograft

A

tissue transferred between individuals of differing species

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7
Q

what is a composite graft

A

combination of grafts

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8
Q

what are the indications for grafting

A
  • deep vertical defects
  • esthetic considerations
  • teeth critical to prosthesis
  • when anatomy precludes other procedures
  • guided tissue regeneration
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9
Q

what are the contraindications for grafting

A
  • poor plaque control
  • medically compromised
  • poor maintenance compliance
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10
Q

what are the advantages of grafting

A
  • restores lost periodontal tissue
  • maintains teeth in healthy functional state
  • enhances long term prognosis of teeth
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11
Q

what are the disadvantages of grafting

A
  • technique and material sensitive
  • expensive
  • may require two surgeries
  • unpredictable
  • requires ideal wound closure
  • longer, more frequent post op care needed
  • second surgical site sometimes required
  • success decreases significantly in furcations and is defect dependent
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12
Q

what are the biologic responses for bone replacement grafts

A
  • osteogenic
  • osteoconductive
  • osteoinductive
  • osteoproductive
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13
Q

what is an osteogenic repsonse

A

viable osteoblasts are transplanted

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14
Q

what is a osteoconductive response

A

scaffold for bone formation

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15
Q

what is an osteoinductive response

A

release of material to induce bone formation

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16
Q

what is an osteoproductive repsonse

A

production of bone by a biologic mechanism

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17
Q

what is the healing sequence of bone replacement grafts

A
  • incorporation (clot formation)
  • revascularization
  • resorption of graft material with release of factors (BMP) to induce bone formation
  • bone formation
  • bone remodeling and maturation
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18
Q

how do you tell if the defect will be a vertical defect

A
  • amount of cancellous bone present
  • if the distance between the roots of the teeth is greater than or 2.5mm then the defects will be a vertical defect
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19
Q

if the distance is less than ____- then horizontal bone loss will occur

A

2.5mm

20
Q

what is an infrabony defect and what are the types

A
  • apical to the alveolar crest
  • one wall (can be a hemiseptum)
  • two wall (crater the most common defect)
  • three wall (true infrabony defect)
  • combination
21
Q

the success in regeneration is:

A

defect dependent

22
Q

best success seen in what defects

A

three wall defects

23
Q

second best success seen in what defects

A

two wall defects

24
Q

what type of defects have little to no success

A

suprabony AKA horizontal bone loss

25
Q

what are the graft complications

A
  • no regneration
  • sequestra
  • root resorption (rare)
  • donor site problems (at second site)
  • infection ( less than 1%)
26
Q

what are the grafting variables

A
  • pre-scaling or scaling at time of surgery
  • local drug delivery before sugery
  • flap design
  • intramarrow penetration
  • hydration of graft material
  • root treatment or modification
  • use of antibiotics
  • endodontics and graft success
  • smoking and graft success
27
Q

what are the introral bone sources

A
  • cortical bone chips - no longer used
  • osseous coagulum
  • healing extraction socket (timing very important)
  • chin or ramus block graft
28
Q

what are the extraoral bone sources

A
  • iliac crest
  • ribs
29
Q

what are the types of allografts

A
  • freeze dried bone allograft
  • demineralized freeze dried bone allograft
  • solvent treated
30
Q

how is safety shown in allografts

A

in HIV/AIDS donors

31
Q

what does the inductive ability in allografts depend on

A

amount of BMP available

32
Q

what does hydration depend on in allografts

A

materials and amounts

33
Q

what are the controversies in allografts

A

resorption of graft
BMP

34
Q

what are the types of alloplasts

A
  • calcium sulfate (CapSet)
  • calcium phosphates: beta tri-calcium phosphate (resorbable), hydroxyapatite (resorbable and non-resorbable)
  • HTR
  • bioactive glass ceramics (perioglas, biogran)
35
Q

what is CaSO4/Regeneration a rationale for

A

adding calcium sulfate to FDBA

36
Q

what does CaSO4 do

A
  • binds bone particles to prevent washout
  • accelerates bone formation by:
  • enhancement of BMP
  • providing a course of calcium ions to aid in mineralization
37
Q

what is bioactive glass composed of

A

silicon dioxide (45%), calcium oxide (24.5%), sodium oxide (24.5%), and phosphorus pentoxide (6%)

38
Q

what happens when bioactive glass is implanted in vivo

A

the pH of the local environment increases more than 10 and a silicon- rich gel is formed on the bioactive ceramic surface with the outer layer serving as a bonding surface for osteogenic cells and collagen fibers

39
Q

what are the sizes of bioactive glass

A
  • one brand has a particle size of 90-710 micrometers
  • other brand has a particle size of 400-355 micrometers
40
Q

how do bioactive glasses work

A

formation of hollow calcium phosphate growth chambers occur with this size because phagocytosing cells can penetrate the outer silica gel layer and resorb the gel. this leads to formation of pouches where osteoprogenitor cells can adhere, differentiate and proliferate

41
Q

bioactive glasses are reported in several articles to have

A
  • superior manageability
  • hemostatic properties
  • osteoconductive
  • may act to retard epithelial downgrowth
42
Q

what are the types of xenografts

A
  • bovine bone (BioOss)
  • bovine bone with cell binding peptide 15 attached (PepGen)
  • fetal pig enamel matrix derivative (Emdogain) to induce cementogenesis and bone formation
43
Q

GTR will provide ______

A

epithelial exclusion

44
Q

what are the types of GTR

A
  • interdental denudation
  • soft tissue grafts over osseous grafts
  • citric acid application
  • Micropore filter
  • Gore Tex membranes
  • resorbable membranes
45
Q

what is platelet rich plasma

A

concentration of growth factors

46
Q

what are the synthetically produced growth factors

A
  • recombinant human platelet derived growth factor (rhPDGF) added to beta tricalcium phosphate
  • recombinant bone morphogenetic protein (rBMP) added to beta tri-calcium phosphate edentulous ridges ONLY
47
Q
A

Perio II (6 decks)

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