xenograft in persevation alveolar ridge

XENOGRAFTS

  

Dr. Dandu Sivasai Prasad Reddy

  II yr Post graduate Department of Periodontics Mamata Dental College

Dr. Dandu Sivasai Prasad Reddy

  II yr Post graduate Department of Periodontics Mamata Dental College

CONTENTS

• Introduction
• Terminologies
• Bone graft
• History
• Mechanism of bone grafting
• Clinical objectives of bone grafting for periodontal regeneration
• Ideal properties of grafts

Classification of bone grafts Xenografts

• Calf bone
• kiel bone
• Anorganic bovine bone
• Bio oss
• Pepgen 15 Porcine derived bone graft

• Corrolline calcium carbonate
• Combination procedures
• Risk of disease transmission
• Conclusion
• References

INTRODUCTION

• Periodontal diseases
• Graft ????

TERMINOLOGY

• Reattachment  New attachment
• Periodontal repair

•  Periodontal regeneration

• Regenerative therapy

Historically, bone grafting has consisted of: A surgical procedure to harvest the patients own bone from a secondary site

Utilization of an organic or artificial material to replace missing bone

  Structural scaffolds & matrices for attachment & proliferation of anchorage dependent osteoblasts

  Evolution Bone grafting accomplished through

  

Formation and development of new bone by viable cells contained in the graft Eg: Autogenous graft Provide a biologic stimulus (proteins and growth factors) that induces the progression of mesenchymal stem cells and other osteoprogenitor cells toward the osteoblast lineage

  Eg: DFDBA

  nonviable Is the process by which the graft material acts as a

scaffold onto and within which the patients own natural bone

grows do not produce

  They allow apposition from existing bone, but or trigger bone formation.

   Eg Alloplastic material

  

Osteopromotion

Osteopromotion

  

Osteopromotion involves the enhancement of

osteoinduction without the possession of osteoinductive

properties.

  Clinical objectives of bone grafting for periodontal regeneration

•     Probing depth reduction
•     Clinical attachment gain
•    Bone fill of the osseous defect and
•   Regeneration of new bone, cementum and periodontal ligament as determined by histologic analysis.

    In a review of animal histologic studies, Mellonig found that 75% of these studies indicated favorable regenerative results when periodontal defects were treated with grafting; none showed that non-graft control sites were superior to grafted ones.

• Non-toxic-Non-antigenic with patient acceptance
• Resistant to infec>Facilitate vasculariza>No root resorption or ankylosis
• Strong and resis>

   Stimulates osteoinduction- & framework for osteoconduction

• Easily adaptable

CONTD.., CONTD..,

• Readily and sufficiently available
• Minimal surgical procedure with minimal post-operative sequelae
• Predictabi
• Completely replaced by host bone of the same quality – quantity  Induce & enhance cementogenesis .

Indications of periodontal bone graft

  1.Deep intraosseous defect

  2.Tooth retention

  3.Support for critical teeth

  

4.Defects associated with aggressive

periodontitis

  5.Esthetics

  6.Furcation

Classification

• Conge et al, 1978
• AAP 1986
• Carranza FA 1990
• Rosenberg& Rose 1998
• Nasr et al, 1999

   Resorption of the graft and replacement by new bone depends upon

• Particle size
• Pore size

  Xenografts Source

• - treated by detergent, sterilized and freeze dried. Used for treatment
• CALF BONE of osseous defects.
₂
• - ₂

  Calf or Ox bone denaturated with 20% H O , dried with acetone, and

• KIEL BONE sterilized with ethylene oxide.
• - ethylene diamine. Then sterilized by autoclaving.

  Ox bone from which the organic material has been extracted by

• ANORGANIC BONE

•  Recently a natural, anorganic, microporous, bovine-derived hydroxyapatite bone

  matrix, in combination with a cell-binding polypeptide that is a synthetic clone of 15 amino acid sequence of type I collagen is been used.

  ANORGANIC BOVINE ( BONE(ABB

New processing and purification methods have been

utilized which make it possible to remove all organic

components from a bovine bone source and leaving

behind a non-organic bone matrix in an unchanged

inorganic form.

Commercially available

  Bio – Oss Bio – Oss Collagen Pepgen-P15

  ® Bio - Oss

• Osteoconductive

• Chemical & physical characteristics

  similar to human mineral matrix

• Porosity similar to human cancellous

  bone

• Large mesh interconnecting pore

  system facilitates angiogenesis and

  migration of osteoblasts.

  1. SPONGIOSA GRANULAT

Particle Size: 0.25 – 1mm

Quantity: 0.5, 2gms.

  2. SPONGIOSA GRANULAT Particle Size: 1 – 2mm Quantity: 0.5, 2gms  

  3. SPONGIOSA BLOCK Block 1x1x2 cm  

  4. BIO-OSS COLLAGEN

100mg Spongiosa Granulat + 10% Collagen

USES:

  1. Treatment of defect sizes up to 2 alveoli, but can be used for defect size larger than 2 alveoli.

  2. Sinus floor elevations.

  3. When combined with autogenous bone, it can be used for large ridge augmentation.

  ® (Osteohealth Co., Shirley, NY)

Bio – Oss Collagen

  Bio Oss spongiosa granules + 10% highly purified porcine collagen

Collagen component enables convenient handling to be easily

adapted in the defect but does not function as a barrier Collagen component is resorbed within 4 – 6 weeks .

  Studies

Stefano Sartori et al., analyse the amount of Bio-Oss

ossification in a case of maxillary sinus augmentation,

recording and comparing histomorphometric data 8 months, 2

and 10 years after surgery.

  Eight months after surgery they observed a mean amount of bone tissue (including medullar spaces) of 29.8% (and 70.2% of Bio-Oss) . At 2years the bone tissue increased to 69.7% and 10years after surgery it was 86.7% .

  

Effect of low-level laser therapy irradiation and Bio-Oss graft

material on the osteogenesis process in rabbit calvarium defects:

a double blind experimental study- Alireza Rasouli et al., 2014

  The mean amount of new bone was 15.83 and 18.5 % in the controls on the 4th and 8th week; 27.66 and 25.16 % in the laser-irradiated group; 35.0 and 41.83 % in Bio-Oss and 41.83 and 47.0 % in the laser + Bio-Oss treated specimens with significant statistical differences . Application of

LLLT in combination with Bio-Oss can promote bone healing.

PepGen P-15

  ABB plus P-15 cell binding peptide (pentadecapeptide) Mimics the cell binding domain of type I collagen

  

Available forms

  

Clinical and radiographic evaluation of human periodontal

osseous defect (mandibular grade II furcation) treated with

PepGen P-15 and a bioresorbable membrane (Atrisorb)- 2012 KL Vandana et.,al

  It can be concluded from this study that the reduction in furcation defect using PepGen P-15 alone and a combination of PepGen P-15 and Atrisorb were equivocal. It can be suggested that the combined use of GTR barrier and bone graft did not prove beneficial for the clinical outcome of the mandibular grade II furcation defect treatment. Hence, the cost effective and economical treatment of

  

A Novel Combination Of Platelet Rich Fibrin And Pepgen P-15

Xenograft, In The Treatment Of Intrabony Defects: A Volumetric CT

Scan Analysis. 2013

  At 6 and 9 month follow-up examination, it was observed that PD reduced in range of 3 to 5 mm with 1 to 2 mm coronal shift in PGM and again in CAL of 2 to 5 mm . A three-dimensional (3D) reconstructed Dentascanimages acquired at 9 month interval, confirmed positive changes in the defect morphology, with a linear bone growth of 1.5- 3mm( 33 to 37 %).The volumetric analysis showed a bone fill of 55 to

  Interdisciplinary Management of an Isolated Intrabony Defect- 2014 A 24 year male patient reported with the complaint of food lodgment and occasional pain in relation to right lower first molar. Clinical examination

revealed deep periodontal pocket measuring 9 mm on distal aspect of 46 and no

  mobility 

Treatment of Intrabony Defects with Anorganic Bone Matrix/P-15 or Guided Tissue Regeneration in Patients with Aggressive

  Periodontitis -2013

Treatment of intrabony periodontal defects in patients with G-

AgP with ABM/P-15 and GTR improved significantly the clinical

outcomes. The use of ABM/P-15 promoted a better

radiographic bone fill.

  Porcine derived bone graft:

Xenografts derived from porcine cortical and cancellous bone

have also been developed to be used as bone substitutes

  

OsteoBiol® It is a commercially available xenograft of porcine origin.

  It is heterologous cortico cancellous collagenated bone mix. It always be hydrated before use

Advantages: It can act as a carrier for various therapeutic agents

  

The collagen present in this bio material facilitates blood clotting

and the subsequent invasion of repairing and regenerative cells thus

favouring bone formation.

  It also provides cohesive environment for graft particle.

Experimental Model of Bone Response to Collagenized Xenografts of Porcine Origin (OsteoBiol® mp3): A Radiological and

  Histomorphometric Study

After 4 months, radiological images revealed bone defects with

a decrease in graft volume and the complete repair of the

osseous defect.

  

The biomaterial used proved to be biocompatible,

bioabsorbable, and osteoconductive and as such, a possible

CORROLLINE CALCIUM CARBONATE

  Biocoral is a calcium carbonate Natural coral, Primarily of aragonite.

  It is biocompatible and resorbable Porous size of 100-200um

  Combination procedures

  A combination of autogenous bone and bone substitute is widely used in oral surgery procedures

  

Systematic review recommended a proportion of 1:2 (Merkx et al. 2003).

  

Pripatnanont et al. (2009) assessed new bone formation generated using

  three different proportions of autogenous bone (AB) and deproteinized bovine bone (BDX) in cortical skull defects in rabbits.

  1:1 1:2 1:4 In deep intrabony defects treatment, at 12 months evaluation, the combined use of autogenous spongiosa with bovine-derived xenograft led to significantly greater gain of clinical attachment and hard tissue formation compared to the use of autogenous spongiosa alone

• (Zafiropoulos et al. 2007)

  

Efficacy of Using PDGF and Xenograft With or Without Collagen

Membrane for Bone Regeneration Around Immediate Implants

With Induced Dehiscence-Type Defects: A Microcomputed

Tomographic Study in Dogs- 2013

  GBR around immediate implants with dehiscence defects using PDGF and xenograft alone resulted in higher BBT, BBV, VBH, and BIC than when performed in combination with CM.

  

A clinical and radiological evaluation of the relative efficacy of

demineralized freeze-dried bone allograft versus anorganic bovine bone

xenograft in the treatment of human infrabony periodontal defects: A 6

months follow-up study- 2014

The use of anorganic bovine bone mineral matrix combined with TGFβ-1

seemed to be effective in the treatment of intrabony defects. This showed an

improvement in the clinical outcome of periodontal therapy superior to the use

of anorganic bovine bone on its own.

  Risk of disease transmission

Risk of transmission of prion mediated diseases – bovine

spongiform encephalopahty In humans – Creutzfeldt – Jakob disease WHO – bone as type IV (no transmission)for prion diseases

Segal and Tofe (1999) conducted an extensive review of current

literature on the status of risk assessment of BSE transmission the

risk of disease (BSE) transmission was negligible

CONCLUSION

  Although complete periodontal regeneration is unpredictable with any regenerative therapy currently used, periodontal bone grafts show strong potential. Requirements for a successful graft includes Patient Selection, material Selection, Proper Flap Reflection and Wound Stability, Revascularization, Root Debridement, Postsurgical care .A large body of clinical evidence clearly indicates that grafts consistently lead to better bone fill than nongrafted controls. As more is learned about the biologic process of periodontal regeneration, new graft materials are expected to make the task of periodontal regeneration even more predictable.