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Periodontics 2 > Osseous Surgery-Regeneration > Flashcards

Osseous Surgery-Regeneration Flashcards

1
Q

Osseous Regeneration
 Objectives of Bone Replacement
Grafting
(2)

A

 Regeneration* of lost periodontium
new bone, cementum and
periodontal ligament
 Reduce or eliminate the periodontal
pocket

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2
Q

 Autograft:

A

tissue transferred from one site
to another in the same individual

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3
Q

 Allograft:

A

tissue transferred between
individuals of same species

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4
Q

 Alloplast:

A

inert material used for graft

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5
Q

 Xenograft:

A

tissue transferred between
individuals of differing species

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6
Q

 Composite:

A

combination of grafts

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7
Q

Bone Replacement Grafts
 Indications for grafting
(5)

A

 Deep vertical defects
 Esthetic considerations
 Teeth critical to prosthesis
 When anatomy precludes other
procedures
 Guided Tissue Regeneration (GTR)

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8
Q

Contraindications
for grafting
(3)

A

 Poor plaque
control
 Medically
compromised
 Poor
maintenance
compliance

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9
Q

Bone Replacement Grafts
 Advantages of grafting
(3)

A

 Restores lost periodontal tissue
 Maintains teeth in healthy functional
state
 Enhances long term prognosis of
teeth

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10
Q

Disadvantages of grafting
 (2) sensitive
 — (?)
 May require — (?)
 Predictability?
 Requires —
 Longer, more frequent — needed
 — sometimes required
 Success decreases significantly in — and is —dependent

A

Technique and material
Expensive
two surgeries
Unpredictable
ideal wound closure
post-op care
Second surgical site
furcations, defect

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11
Q

Osteogenic-

A

viable osteoblasts are
transplanted

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12
Q

 Osteoconductive-

A

scaffold for bone
formation

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13
Q

 Osteoinductive-

A

release of material to
induce bone formation

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14
Q

 Osteoproductive-

A

production of bone by
a biologic mechanism?

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15
Q

Bone Replacement Grafts
 Healing Sequence
(5)

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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16
Q

Osseous Defects
 Suprabony versus Infrabony defects
 If the distance between the roots of the
teeth is ≥– mm then the defects will be a
vertical defect (amount of cancellous bone
present).
 If the distance is less than – mm then
horizontal bone loss will occur

A

2.5
2.5

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17
Q

Osseous Defect
Classification-Review
 Infrabony: apical to the alveolar crest
(4)

A

 One wall-(can be a hemiseptum)
 Two wall-(crater-the most common
defect)
 Three wall-(true intrabony defect)
 Combination-(of any of the above)

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18
Q

Success in regeneration is defect
dependent:
(4)

A

 Best success seen in three-wall defects
 Next are two-wall defects
 Then are one-wall defects
 Suprabony defects (horizontal bone loss)
have little to no success

19
Q

Bone Replacement Grafts
 Graft complications
(5)

A

 No regeneration**
 Sequestra
 Root resorption (rare)
 Donor site problems (at second site)
 Infection (less than 1%)

20
Q

Grafting Variables
 (2) at time of surgery
 Local — before surgery
 — design*
 — penetration*
 — of graft material
 — treatment or modification
 Use of —
 — and graft success*
 — and graft success

A

Pre-scaling or scaling
drug delivery
Flap
Intramarrow
Hydration
Root
antibiotics
Endodontics
Smoking

21
Q

Intraoral Bone Sources
 Intraoral
(4)

A

 Cortical bone chips (no longer used)
 Osseous coagulum**
 Healing extraction socket (timing very
important)
 Chin or ramus block graft

22
Q

Intraoral Bone Sources
 Extraoral
(2)

A

 Iliac crest
 Ribs

23
Q

Allografts
 Types
(3)

A

 Freeze-dried bone allograft (FDBA)
 Demineralized freeze-dried bone allograft
(DFDBA)
 Solvent-treated (Puros®)

24
Q

 Safety-

A

shown in HIV/AIDS donors

25
Q

 Inductive ability -

A

amount of BMP
available?

26
Q

 Hydration-

A

materials and amounts

27
Q

 Controversies-

A

resorption of graft?, BMP

28
Q

Alloplasts
 Types
(4)

A

 Calcium Sulfate (CapSet ®)
 Calcium Phosphates
resorbable
 HTR®
 Bioactive glass ceramics

29
Q

 Calcium Phosphates
(2)

A

 Beta tri-calcium phosphate
(resorbable)
 Hydroxyapatite (resorbable and non-

30
Q

CaSO4 /Regeneration
Rationale for adding calcium sulfate to FDBA
(2)

A
  • Binds bone particles to prevent washout
  • Accelerates bone formation by:
    Enhancement of BMP
    Providing a source of Ca ++ ions to aid
    in mineralization
    Sottasanti 92
31
Q

Skipped
CaSO4
(3)

A
  • Composite animal graft success: Kim,
    98, with histology
  • Animal graft success: Kim, 98 with
    histology; MacNeill 99 with histology
  • Composite human graft success:
    Pepelassi, 91; Orsini 01: composite
    grafts = GTR; Kim 98; Maragos 02;
    Aechelmann-Reddy et al, 04; Harris 04
    SRM
    Case of Dr. Mark Blue
    SRM SRM
32
Q

Bioactive glass is composed of

A

silicon dioxide
(45%), calcium oxide (24.5%), sodium
oxide (24.5%), and phosphorus pentoxide
(6%)
“…when implanted in vivo the pH of the local
environment increases >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”

33
Q

One brand has a particle size from —um
Other brand has a particle size of —um
* …”formation of hollow calcium phosphate
growth chambers occurs 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.

A

90-710
300-355

34
Q

Bioactive Glasses
Reported in several articles to have:
(4)

A
  • superior manageability
  • hemostatic properties
  • osteoconductive
  • may act to retard epithelial downgrowth
35
Q

SKIPPED
Bioactive Glasses
(8)

A

Ong 98: contralateral defects vs flap debridement (-)
Froum 98: versus flap debridement (+)
Lovelace 98: paired defect study vs DFDBA (+)
Hall 99: animals/implants/vs DFDBA (-)
MacNeill 99: (animal study) (-)
Nevins 00: (histology: no regeneration)
Froum 02: (histology: no regeneration)
Series of case reports or clinical studies without
controls that reported advantage of bioactive glass
Sohrabi 12: meta-analysis: bioactive glasses superior
to flap debridement (.6mm in CAL gain) (+

36
Q

Xenografts
 Types
(3)

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

37
Q

Skipped
Regeneration with Enamel Matrix
Proteins
Positive Effects with use:
(6)
Rasperini 0

A
  • Yukna and Mellonig 00: human histology
    showed inconsistent and variable results in ten
    patients
  • Sculean 03: 2 pts, human histology showed
    +regeneration; Sculean 05: human histology
  • Cochran 03: animal histology, +regeneration
  • Greenstein 00: review
  • Clinical success seen in Okuda 00; Heden 00;
    Camargo 01; Tonetti 02; Sculean 02,03,05,06;
38
Q

Skipped
Regeneration with Enamel Matrix
Proteins
No effect with use:
(6)

A
  • Sculean et al, 03: used with non-surgical
    therapy
  • Donas et al, 03: EMP vs F/C
  • Vandara et al, 04: EMP vs F/C
  • Regazzini et al, 04: EMP with and without
    GTR, control; animal study with histology
  • Rosing et al, 05: EMP vs F/C
  • Hoidal et al 08: EMP with/without DFDBASRM
39
Q

Guided Tissue
Regeneration: GTR
Membrane will provide

A

epithelial exclusion

40
Q

SKIPPED
Guided Tissue Regeneration
(6)

A
  • Interdental Denudation (Pritchard)
  • Soft Tissue Grafts over Osseous Grafts
    (Ellegard)
  • Citric Acid Application (Loma Linda
    Studies)
  • Micropore® Filter (Nyman)
  • Gore-Tex® (Non-Resorbable) Membranes
  • Resorbable Membranes
41
Q

Newer Techniques
 Platelet Rich Plasma (PRP) (concentration of growth
factors)
 Addition of synthetically-produced Growth Factors

A

 Recombinant human Platelet Derived Growth Factor
(rhPDGF) added to beta tricalcium phosphate (e.g.
GEM 21 ®)
 Recombinant Bone Morphogenetic Protein (rBMP)
added to beta tri-calcium phosphate (e.g. Infuse ®).
Edentulous ridges ONLY

42
Q

Skipped
Platelet Rich Plasma Concentrate
(3)

A

Anunziata et al, 05: PRP in vitro stimulated
PDL and fibroblast cell line growths and
keratinocyte growth rate was inhibited.
Hanna et al, 05: split mouth clinical trial with
matched defects of 13 pts. PRP improved
results significantly.
Fabbro et al, 12: systemic review and meta-
analysis; PRP may exert a positive adjunctive
effect with graft materials, but not with GTR

43
Q

Skipped
Current Trends in Regeneration
Platelet Rich Plasma Concentrate
(5)

A
  • Okuda et al, 03
  • 20 healthy patients had blood taken and PRP
    performed
  • Platelets increased 283% compared to
    control
  • 182 ng/ml of PDGF which is 440% increase
  • 141 ng/ml of TGF-beta which is 347%
    increase
44
Q

Skipped
Current Trends in Regeneration
rhPlatelet Derived Growth Factor or rBMP
(5)

A

Carmello 03: 4 pts, rhPDGF with DFDBA; histology
showed +regeneration
Miranda et al, 05: rBMP-2 used in baboon alveolar ridge
defects versus control and produced a two fold
+increase in width and +bone density.
Nevins et al, 05: multicenter study using rhPDGF-BB in
180 pts. At six months a 57% radiographic bone fill vs
18% for the control
McQuire et al, 06: followed four pts of previous study at
18-24 months and same results found as at one year.
Mellonig et al ,09: histology for four pts with treated
furcations, variable results

Periodontics 2 (13 decks)

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