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TEXTBOOK FALL EXAM 2021 > Regeneration/ Reconstruction & Khoury CH 11 > Flashcards

Regeneration/ Reconstruction & Khoury CH 11 Flashcards

1
Q

What is the type of grafting material that has been shown to have the most gain in zero wall defects?

A

Autograft- Iliac bone and marrow have the most osteogenic and regenerative potential

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2
Q

How does decalcification in DFDBA promote maximum osteoinduction

A

a. only 2% or less residual calcium

b. Demineralization of FDBA will make BMP accessible

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3
Q

What is the Osteogenic potential between cancellous and cortical bone?

A

a. Cortical = little osteogenic potential

b. Cancellous bone – contains hematopoietic marrow provides better osteogenic potential

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4
Q

Calcium Sulfate–> How is it resorbed when used as a regenerative membrane?

A

Giant cell reaction

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5
Q

What are the advantages of Resorbable membranes?

A
  1. More tissue compatible
  2. Timing of resorption can be regulated by the amount of cross-linkage
  3. No second surgery
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6
Q

Which BMP is the primary Osteoinductive protein?

A

BMP - 2

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7
Q

How does biogide degrade?

A

Collagenases and subsequently by gelatinases and peptidase

Biogide is a PORCINE resorbable membrane

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8
Q

What are collagen membranes made from?

A

a. Porcine or bovine

b. Either Type I collagen or a combination of Type I and Type III

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9
Q

What determines is a wound Regenerates vs Repair?

A

Cell type that repopulates

Regeneration = mesenchymal cells from the PDL or perivascular region of bone

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10
Q

How do you most accurately assess regeneration?

A

Histology

*Radiographs (standardized)

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11
Q

What does dense HA most likely heal with, histologically?

A

a. HA is an anorganic Alloplast (Ceramic)

b. Healing occurs through fibrous encapsulation of the HA particles in the intraosseous defect
c. Long Junctional Epithelium and CT attachment
d. Does NOT induce new attachment or bone formation

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12
Q

What are Competence and Progression Factors?

A

Competence:

a. Prime the cell to enter the cell proliferation cycle
b. PDGF (Platelet derived growth factor)

Progression:

a. Required for cell division
b. IGF-1

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13
Q

What is regeneration?

A

A. Formation of new bone
B. Cementum
C. Functionally oriented PDL

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14
Q

What is reattachment?

A

Non-diseased site

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15
Q

What is repair

A

a. “non-functional types of scar tissue” or new attachment
i. Long Junctional Epithelium
ii. New CT attachment
iii. Ankylosis

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16
Q

What is a root conditioner?

A

a. Remove smear layer from root surface to expose collagen fibers and opened dentinal tubules.
b. Citric acid: (pH 2-3)
c. Tetracycline and EDTA:

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17
Q

What is osteogenic?

What determines Osteogenic Potential?

A

a. Has vital cells in the graft
b. Capable of producing new bone

autograft
Osteogenic Potential–> Amount of cancellous bone

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18
Q

What is osteoinductive

A

a. Induces bone formation by recruiting undifferentiated mesenchymal cells, is mitogenic for pre-osteoblasts, and induces differentiation of these cells into bone forming osteoblasts)

Examples:

b. FDBA
c. DFDBA ( demineralization of cortical bone allograft     exposed BMP
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19
Q

What is osteoconductive?

A

a. Acts as scaffold
b. Chemically treated to remove organic components to leave trabecular and porous scaffolding for new bone formation

Example: Xenograft

20
Q

What is a xenograft

A

Different species
Scaffold
Osteoconductive

**Longest graft type to resorb

21
Q

What is alloplast

A

Inorganic material (synthetic)

22
Q

What is Guided Tissue Regeneration?

A

A barrier membrane allowing formation of new periodontium

23
Q

What are the available membrane types

A

Resorbable

Non Resorbable

24
Q

Positives of Non- Resorbable membrane?

A

a. Space maintenance
b. Clot Protection
c. Barrier Formation—especially in large defects

25
Q

Negatives of non resorbable membrane?

A
  1. 2nd surgery needed

2. Frequent exposure to the oral cavity which leads to failed osseous reconstruction

26
Q

Positives of Resorbable membrane?

A

i. More tissue compatible
ii. No 2nd surgery required
iii. Variable times of resorption

REPEAT QUESTION

27
Q

Negatives of resorbable membrane?

A

Lack of rigidity/ Tight scaffold

28
Q

Discuss emdogain

A

a. It is OSTEOPROMOTIVE
b. True regeneration is possible
c. Harvested from developing porcine teeth, contains a protein preparation that mimics the matrix proteins that induce cementogenesis

29
Q

Discuss PDGF

A

Platelet derived growth factor

a. mitogenic and chemotactic factor for mesenchymal cells
b. Type of Competence factor

30
Q

What are BMPs?

A

a. Regulatory glycoproteins that are members of the TGF-beta superfamily, and they stimulate mesenchymal stem cells to differentiate into chondroblasts and osteoblasts. (Cartilage and Bone)

Risk of ankylosis

31
Q

What are some thing that influence the success of regeneration? (4)

A

i. Plaque control/compliance
ii. Smoking
iii. Tooth/defect factors
iv. Characteristics of defects - depth, width, # of walls

32
Q

How do resorbable membranes break down?

A

Resorption

Krebs Cycle

33
Q

What is the ideal material for ridge preservation?

A

Osetoconductive

a. Needs to be a scaffold for new bone formation but also minimal in volume at implant placement

34
Q

What is the point of Decortication, is it worth it?

A

a. Purpose is to open marrow spaces and allow osteoprogenitor cells to migrate to the site

35
Q

What factors affect bone graft Osteoinductive potential

A

Age of Donor

36
Q

Why does regeneration fail? (3)

A
  1. Mechanical Instability
  2. Poor blood supply
  3. Competing tissue
37
Q

When do you graft and bolt?

A

Ridge < 4 mm wide and you need primary stability

38
Q

Why do you get early membrane exposure?

A
  1. Not using aseptic techniques
  2. No passive closure
  3. Inadequate flap mobility
  4. Smoking
  5. Diabetes
  6. Pressure from prosthesis
  7. Shallow vestibule
39
Q

What bacteria colonize exposed membranes?

A
  1. P Gingivalis

2. Aa

40
Q

How much Bone resorption of the ridge following tooth extraction?

A

40-60% horizontal resorption in 3-12 months

41
Q

What is PASS

A

Primary closure
Angiogenesis
Space Maintenance
Stability

42
Q

What is the gain in a ridge split (Distraction Osteogenesis)?

A

3.5 mm

43
Q

Ignore this question– wasn’t in our lecture

How long auto/allograft block grafts last?

A

3/12

Not sure what this means

44
Q

How much vertical bone can you gain with a block graft?

A

3 - 5 mm

45
Q

How do you obtain vertical augmentation?

A

Onlay block graft
Distraction
Ortho Extrusion

TEXTBOOK FALL EXAM 2021 (11 decks)

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