Osseous Graft Research Articles

Management of hemimandibulectomy using guide flange

Patients with mandibular deviation following surgical hemi/segmental/subtotal mandibulectomy for a variety of reasons (squamous cell carcinoma being the most common cause) are administered a guide flange. The physician must wait for the lesion to heal, the graft to heal, or the radiotherapy effects to subside before proceeding with planned procedures like secondary osseous grafting. A definitive prosthesis cannot be planned until the graft has healed. The patient has to receive a prosthesis during this period of time in order to correct mandibular deviation caused by a unilateral muscle pull. Furthermore, if bone grafting fails or the patient refuses a second operation, there are situations in which a definitive prosthesis must be postponed. This report describes the fabrication of such a mandibular guide flange prosthesis.

Mandibular guiding flange prosthesis to guide mandibular deviation following partial mandibulectomy and partial maxillectomy for squamous cell carcinoma: A case report.

Squamous cell carcinoma is one of the most prevalent cancers affecting the oral cavity. Rehabilitation following surgical treatment requires a multidisciplinary approach and care. Multiple disabilities such as dysarthria, dysphagia, unesthetic appearance, and psychosocial disorders following the surgery for carcinoma can greatly impact the quality of life of such patients, thereby necessitating multidisciplinary intervention. The clinician has to wait for the healing of the lesion and the effects of radiotherapy to be dwindled in case a secondary osseous grafting is planned. During this time lag until a more definitive prosthesis is planned, an interim prosthesis is must to correct the mandibular deviation due to the unilateral muscular pull. This case presentation describes the utilization of guiding flange prosthesis (GFP) as an interim modality for the establishment of a stable and functional maxillomandibular relationship following combined ipsilateral partial mandibulectomy and maxillectomy.

Anterior Wall of Maxillary Sinus as a New Autogenic Graft Source: A Case Report

This study introduces the anterior wall of the maxillary sinus as a viable and accessible graft site for small to moderate bone defects in the maxilla that pose challenges for implantation. A healthy 40-year-old woman was referred by a prosthodontist due to malpositioned implants. Following a comprehensive assessment, the decision was made to remove the implants. Upon executing this treatment plan, a medium-sized defect was revealed. The flap was elevated to expose the anterior wall of the maxillary antrum, from which an osseous graft was obtained. This graft was then fixed as a buccal wall of the defect and supported by a membrane. After a healing period of 6 months, two implants were successfully inserted. The anterior wall of the maxillary sinus can serve as a beneficial graft source. However, more extensive studies with appropriate design are required to reach a definitive conclusion.

Decontamination and Repair Protocol Promotes Positive Outcomes in Implants Affected by Peri-implantitis: A Human Case Series.

This study assessed the effectiveness and predictability of a readily available protocol to treat peri-implantitis utilizing mechanical debridement, chemical antiseptic surface detoxification, and osseous grafting. Nine patients (7 women, 2 men; mean age: 56.5 years) with 15 implants with peri-implantitis were included. Pocket probing depth (PPD), bleeding on probing (BOP), and standardized digital periapical radiographic measurements were taken. Surgical flaps were elevated, and the implant threads were cleaned with a plastic curette. Chemical decontamination was performed by scrubbing solutions of 0.25% sodium hypochlorite (NaClO) and 1.5% hydrogen peroxide (H2O2) around the exposed implant using cotton pellets. Bony defects were filled with a 50/50 mixture of bovine hydroxyapatite and nanocrystalline calcium sulfate (CaSO4). A porcine collagen membrane was placed over the grafted bony defect. Follow-up appointments were scheduled 1 week, 2 weeks, 3 months, 6 months, 9 months, and 1 year posttreatment. Clinical and radiographic parameters were assessed and compared. At baseline, PPD ranged from 5 to 7.5 mm (mean: 6 ± 0.7 mm). At 12 months, PPD ranged from 1.5 to 4.2 mm (mean: 2.5 ± 0.8 mm). The mean PPD reduction of 3.6 mm (59.2%) was statistically significant (P < .001). The number of bleeding sites around each test implant decreased significantly from 4 to 0.4 sites between baseline and 12 months (P < .001). Mean radiographic bone loss decreased from 4.8 ± 1.3 mm to 2.7 ± 1.2 mm (P < .001). The proposed method of mechanical decontamination, chemical detoxification, and bone regeneration is clinically effective and reproducible. Clinical peri-implant parameters and radiographic bone levels were improved and maintained their stability for 1 year using this peri-implantitis treatment protocol.

Cultivating Healthy Smiles: Exploring Regenerative Therapy in Periodontics

Regenerative therapy is a cutting-edge therapeutic strategy used in periodontics with the goal of restoring the health and functionality of the tissues that support teeth, including the periodontal ligament, bone and gums. These supporting tissues can be destroyed by periodontal disorders, including gingivitis and periodontitis, which may result in tooth loss. Regenerative therapy encourages the regeneration of missing or damaged tissues in an effort to undo or heal this damage. Biological solutions to biological problems are emerging as a new paradigm in dentistry and medicine. Scientific discoveries in cellular, developmental and molecular biology have truly revolutionized our collective understanding of biological processes, human genetic variations, the continuity of evolution and the etiology and pathogenesis of thousands of human diseases and disorders. There have been a number of encouraging developments in periodontics and regenerative therapy. Guided Tissue Regeneration (GTR), osseous grafting and newer techniques like Platelet-Rich Plasma (PRP) and Platelet-Rich Fibrin (PRF), stem cell therapy, growth factors and biomaterial, gene therapy, 3D-printing and tissue engineering, anti-inflammatory drugs, microbiome-based therapy and minimally invasive methods have all advanced from these earlier approaches. The current improvements in regenerative therapy for periodontics that yield superior results are contextualized in this research.

Treatment of an ossifying fibroma of the mandible with endodontic microsurgery and grafting with a biphasic calcium sulfate material: a case report.

Following endodontic surgery placement of osseous graft material via Guided Tissue Regeneration to fill the defect aids to accelerate fill of the defect on a healthy 26-year-old female patient. A case discussing the one-step treatment of an ossifying fibroma of the anterior part of the mandible following endodontic microsurgery with associated retrograde fill of the apex, then site grating with biphasic calcium sulfate (Bond Apatite®) used in regeneration of the osseous defect related to the lesion and resulting surgery. Histologically, the ossifying fibroma is dominated by connective tissue containing cell rich areas with a few fragments of fibrosis. Moreover, in the connective tissue numerous small fragments of spongy and compact bone with areas of partial necrosis present and a significant number of inflammatory cells are observed. Surgical removal of the cyst with thorough curettage of the osseous walls and grafting of the defect provides predictable healing and the desired clinical results sought. Utilization of the biphasic calcium sulfate graft material allows the elimination of the need to overlay the area with a membrane before the flap due to its hard set and the prevention of soft tissue ingrowth into the graft material during the healing phase. Additionally, the hard set of the material allows tenting of the area to maintain the desired volume and ridge contour. Conversion of the graft material depending on the volume placed to host bone occurs over a 3-6 month period. The case report presented, as well as the authors experience mimics the literature on biphasic calcium sulfate in its use as an osseous graft material and is an effective method for the repair of osseous defects that result from the removal of tumors and cysts of the maxilla and mandible. Treatment of an ossifying fibroma is an ideal application of the use of this biphasic calcium sulfate material allowing tenting of the surgical site over the defect created after cyst removal without the need for resorbable collagen membranes. This simplifies its use and decreases material costs that may hamper patient acceptance of treatment without a decrease in expected clinical results.

Guide Flange Prosthesis: A Case Report

Patients who have undergone surgical hemi/segmental/subtotal mandibulectomy for various reasons with resulting mandibular deviation are given a guide flange. If secondary osseous grafting is planned, the doctor must wait for the graft, lesion, or radiotherapeutic effects to resolve. A definitive prosthesis can be planned only when the graft has been healed. During this time lag, the patient must be fitted with a prosthesis to rectify mandibular deviation caused by unilateral muscle strain. Furthermore, in some circumstances, a definitive prosthesis must be postponed due to bone grafting failure or the patient's unwillingness to undergo a second surgery. This clinical case report shows a mandibular guide flange prosthesis fabricated for a patient.

Treatment of mandibular Grade II furcation defects using demineralized freeze-dried bone allograft alone or in combination with guided tissue regeneration membrane – A randomized controlled clinical trial.

Background– Periodontal disease, if not interfered, will headway further with attachment loss involving the bifurcation or trifurcation of multirooted teeth. Furcation involved molar teeth respond less favorably to conventional periodontal therapy alone resulting into tooth loss. Combining osseous grafting with guided tissue regeneration membrane may enhance the response to treatment as compared to graft – only therapy by achieving mechanical stabilization and preventing micromovement of the bone graft material.&#x0D; &#x0D; Aim &amp; Objective – To compare the efficacy of demineralized freeze-dried bone allograft alone or in combination with guided tissue regeneration membrane in the treatment of mandibular Grade II furcation defects.&#x0D; &#x0D; Materials &amp; method - In this study a total number of 20 patients with 20 mandibular sites (buccal grade II furcation involvement) were evaluated. They were divided into two groups: Control group (bone graft only) and test group (bone graft + GTR). The clinical parameters assessed were vertical probing depth, horizontal probing depth and relative clinical attachment level.&#x0D; &#x0D; Results – In this study the statistical analyses comparing test and control sites at baseline revealed no significant differences between the two groups for any of the clinical parameters considered. At 6 month evaluation, significant difference was found between two groups regarding VPD, HPD and rCAL.&#x0D; &#x0D; Conclusion – It was concluded that there is a significant enhanced effect of using DFDBA bone graft in combination with GTR membrane over bone graft alone for the treatment of mandibular Grade II furcation defects.&#x0D;

Need, Strategies and Requirements in the Medical System for Bone Banks: A Review Article.

An orthopedic bone bank's creation and management is a challenging procedure where medical organization and legal requirements interact. There are no formal regulations for the management and organization of an orthopedic bone bank in the Netherlands or any other nation in Europe. The recently revised "law of security and quality for utilizing human materials in the Netherlands establishes guidelines for the technical and administrative elements of using human tissue and cells. The bone bank's processes involve a rigorous questionnaire for choosing donors, a complete bacteriological, histological, and serological examination, as well as industry-standard, practices for registering, processing, preserving, distributing, and storing bone allografts. This article explains how an approved bone bank is run, and it may be used as a suggestion for formal regulation or as a model for additional orthopedic bone banks in Europe. Osseous graft manufacture, testing, packing, storage, and transportation are all handled by bone banks. Their primary responsibility is to guarantee the transplants' biological characteristics and microbial cleanliness by legal and quality criteria. All orthopedic surgeons face the challenge of reconstructing bone defects; to address this issue, there are several methods, including the use of autografts, allografts, and bone substitutes to enhance and speed bone recovery. Although autografts have superior biological qualities, their volume is constrained and they are linked to donor site morbidity. Allografts are readily accessible, however, there are still worries about the possibility of infections, and they lack osteosarcoma qualities.

Role of Biomaterials Used for Periodontal Tissue Regeneration-A Concise Evidence-Based Review.

Periodontal infections are noncommunicable chronic inflammatory diseases of multifactorial origin that can induce destruction of both soft and hard tissues of the periodontium. The standard remedial modalities for periodontal regeneration include nonsurgical followed by surgical therapy with the adjunctive use of various biomaterials to achieve restoration of the lost tissues. Lately, there has been substantial development in the field of biomaterial, which includes the sole or combined use of osseous grafts, barrier membranes, growth factors and autogenic substitutes to achieve tissue and bone regeneration. Of these, bone replacement grafts have been widely explored for their osteogenic potential with varied outcomes. Osseous grafts are derived from either human, bovine or synthetic sources. Though the biologic response from autogenic biomaterials may be better, the use of bone replacement synthetic substitutes could be practical for clinical practice. This comprehensive review focuses initially on bone graft replacement substitutes, namely ceramic-based (calcium phosphate derivatives, bioactive glass) and autologous platelet concentrates, which assist in alveolar bone regeneration. Further literature compilations emphasize the innovations of biomaterials used as bone substitutes, barrier membranes and complex scaffold fabrication techniques that can mimic the histologically vital tissues required for the regeneration of periodontal apparatus.

PERIODONTAL REGENERATION WITH OSSEOUS GRAFTS: A REVIEW

Modern periodontics strives on the maintenance of teeth and their supporting structures in the prime of their health. Most periodontal practices focus on prevention of disease, initial therapy and corrective surgical treatment to eliminate deep periodontal pockets. However, restoring supporting tissues to their healthy level is a critical area that offers a much more appealing and in fact a more desired outcome for the patients. Over the last decades different modalities of regenerative treatments have been developed and applied clinically. One such treatment is use of osseous grafts, this article discusses the various types of osseous grafts, their mechanism and advances in regenerative periodontal therapy.

The combined anterolateral thigh-Partial iliac crest minihybrid free flap for mandibular reconstruction.

Tumors of the oral cavity often require extensive resections leading to significant hard and soft tissue defects. Microvascular free flaps, consisting of both hard and soft tissue, are often required in reconstructions. Hybrid flaps, composed of two different joint free flaps, offer potential alternatives for head and neck reconstruction. This report presents our results with a modified hybrid ALT/DCIA, that is, minihybrid free flap (MH-flap) composed of the anterolateral thigh (ALT) and a partial inner lamina iliac crest only (partial DCIA) for reconstruction of the mandibular region. Eight patients underwent oral cancer reconstruction of the mandible with the MH-flap. The MH-flap was harvested sparing the outer crest and lamina of crista, and its pedicle was combined to the distal pedicle of ALT. Clinical data and postoperative complications were analyzed. The mean length of the osseous graft was 64 mm (range 54-78 mm). None of the patients had complications requiring surgical intervention. No donor site complications were observed. The overall survival rate was 100%. The mean length of follow-up was 16 months (range 7-30 months). According to our results, the ALT-partial DCIA MH-flap has postoperative outcomes comparable to those of the fibular flap. The flap is a good option with excellent bone properties for reconstruction of limited mandibular defects not suitable for fibular or scapular reconstruction.

Autogenous Dentin With Calcium Sulfate as Graft Material: A Case Series.

There have been recent reports of successful use of fragmented autogenous dentin being used as a graft material in implant dentistry. This may reduce morbidity and the need for a second donor site or for the use of alloplasts or allografts. This article discusses the background, preparation, and use of autogenous dentin as an oral osseous graft material. A series of cases where autogenous dentin is used to graft immediate dental implant sites is presented. After 21 months, one case biopsy showed only bone and no remnant dentin. Pulverized autogenous dentin may be an appropriate graft material in implant dentistry.

Role of PRGF (Plasma Rich in Growth Factors) in Periodontal Regeneration

Platelet-rich-growth-factors (PRGF), a modification of fibrin glue made from autologous blood, is beingused to deliver growth factors in high concentration to sites requiring osseous grafting. Growth factorsreleased from the platelets include platelet-derived growth factor(PDGF), transforming growth factor-beta(TGF-ß), platelet-derived epidermal growth factor (PDGF), platelet-derived angiogenesis factor, insulin-likegrowth factor 1(IGF1), and platelet factor 4. These factors signal the local mesenchymal and epithelial cellsto migrate, divide, and increase collagen and matrix synthesis. Anitua et al in 2001 introduced the concept ofPRGF and since then it has been used for a variety of purposes in the field of dentistry and oral implantologyfor proper wound healing and regeneration of periodontal tissues. This review aims to give a brief ideaabout the various uses of PRGF and the possibility of utilization in the future taking into consideration manystudies that have been done. The main advantage of using PRGF is that it lacks the leukocyte content thuspreventing damage to the tissues during healing due to the acid hydrolases and proteases released from theneutrophils. It has been previously used for treating intrabony defects, to increase the implant-bone contactarea, for recession coverage etc. In other fields of medicine, it has been used to cure osteoarthritis, to treatchronic ulcers as well. Therefore, PRGF is a very effective blood concentrate with a high concentration ofgrowth factors and its use should be increased in the clinical practice.

Bone Grafting for Implant Surgery.

Osseous grafting serves to restore form and function to craniofacial defects. These grafts have been used with the aim of enhancing osteoinductive, osteoconductive, and osteogenic properties to address vertical and horizontal defects so as to render the edentulous ridge more amenable to implant placement. As the biology of bone grafts continues to be unearthed, the use of adjuvants to augment grafts has proved effective. Three-dimensional printing, tissue engineering with the use of stem cells, immunotyping and hormonal therapy all hold promise for the future in the thrust to discover the ideal graft.

Mandibular guidance prosthesis: Conventional and innovative approach: A case series.

Surgical resection of the lower jaw due to the presence of a benign or malignant tumor is the most frequent cause of mandibular deviation. Location and extent of the tumor decide the surgical modality of mandibulectomy to be performed. The clinician must wait for an adequate span of time for completion of the healing and acceptance of the osseous graft before considering a definitive prosthesis. During the inceptive healing period, prosthodontic intervention is of utmost priority for preventing the mandibular deviation. A corrective appliance termed “guide flange prosthesis (GFP)” is indicated to limit this clinical manifestation. The basic intention of rehabilitation is to train the mandibular muscles and to re-establish an acceptable occlusal relationship so that the patient can adequately control the opening and closing movements. This case series describes early prosthodontic management of three patients who had undergone hemimandibulectomy, with different techniques of fabrication of a GFP. The three techniques described consist of two conventional methods of fabrication while the third technique is a new innovative approach.

Current Research Directions in Regenerative Therapy

Chronic periodontitis has been the principal cause behind the irreparable destruction of the periodontium. Inthe field of surgical periodontal therapy, regeneration of damaged tissues by utilizing our body’s naturallyproduced growth factors along with various other biomaterials either synthetically formulated or animallyderived has piqued the attention of the dental practitioner. The human body has a natural capacity andpotency of regenerating the lost tissue up to an extent; this characteristic is tapped in the regenerativetherapy. Presently this therapy is bounded by the limited research and knowledge on the materials that can beused, instruments that are required for a successful procedure and method devised to gain desired outcomespresently available and the body’s natural capability for regeneration. Tissue engineering use of stem cell,gene therapy and research on various aspects of regenerative therapy, has produced predicted results inexciting new treatment method for clinicians shortly. Traditional treatment modalities like mechanicalinstrumentation, curettage and open flap debridement result in keeping the inflammation in check andlong junctional epithelium formation which leads to only periodontal repair and not regeneration. Manypractitioners frequently use a combined method of putting both barrier membrane and bone grafts to curbthe limitations posed by the down growth of epithelium and sagging of the non-rigid barrier used to maintainthe grafts in place. This has led to enhanced interest in the Hence, there has been increased attention in thetreatment of chronic diseases of the periodontium further elevating the quality of life of the patients. Thisreview article aims to review diverse obtainable bio-materials, scaffolds, barriers and osseous grafts alongwith the plethora of procedures applied in periodontal regenerative therapy.

Efficacy of ankaferd blood stopper on healing after osseous grafting in the treatment of periodontal intrabony defects.

Abstract Objective: Periodontal diseases are multifactorial infections lead to destruction of the periodontal. The present study was designed to verify effect of ABS in conjunction with β-TCP on healing in the treatment of periodontal intrabony defects. Subjects and Methods: A total of 20 intrabony periodontal defects were treated in ten patients with Periodontal pocket depth ≥ 6 mm and radiographic osseous defect depth ≥ 4 mm, Interventional split mouth; 1st group (control group) Ten defects were treated by β-TCP and 2nd group (Test group) Ten defects were treated by (mixing 0.5 ml of ABS with β-TCP ). Phase I therapy was performed for all chosen patients to provide an oral environmental more favorable to wound healing. The following clinical indices measurements Plaque index, Gingival index, Periodontal pocket depth and Clinical attachment level. All indices were recorded at baseline, 6 and 12 months after surgery. The following Radiographic measurements bone density, M-D width of the defect and depth of the defect were recorded at baseline, 6 and 12 months after surgery under constant conditions. Results: β-TCP/ABS group showed a less mean plaque index, gingival index, clinical attachment loss, M-D width of the defect and depth of the defect and a high mean bone density than β-TCP group. Conclusion: Both treatment modalities demonstrated good standards of oral hygiene, with minimal inflammatory signs around teeth‏ and minimal marginal ‎bone loss. ABS combined with a synthetic bone graft may enhance the healing and regenerative processes and lead to more bone fill.

Efficacy of Ankaferd Blood Stopper® on healing after osseous grafting in the treatment of periodontal intrabony defects

Efficacy of Ankaferd Blood Stopper® on healing after osseous grafting in the treatment of periodontal intrabony defects

Membrane fixation for osseous graft stabilization in periodontally accelerated osteogenic orthodontics: a comparative study

BackgroundPeriodontally accelerated osteogenic orthodontics (PAOO) is a treatment for bone defects associated with a lack of bone graft stability, especially in coronal locations. This study aimed to compare a modified technique of membrane fixation that utilizes periosteal sutures (using a pouch design) with the traditional approach, which does not use membrane fixation.MethodsTwenty-eight patients with a total of 168 teeth treated were divided into two groups: 1-A, in which patients were treated using the modified technique (with membrane fixation), and group 2-B, in which patients were treated using the traditional technique (without membrane fixation). The postoperative bone thickness was evaluated via radiographic examination.ResultsPostoperative improvements in bone augmentation were detected in both groups. At 12 months, the values of the CHBT (measured from the midpoint of the coronal third to the labial cortical surface, 0.84 ± 0.33 mm) and the values of VBL (measured from the alveolar crest to the cemento-enamel junction, − 2.35 ± 0.80 mm)were significantly greater in the modified technique group than those in the traditional technique group (CHBT:0.12 ± 0.21 mm and VBL:-1.39 ± 0.99 mm; P = 0.00 and P = 0.01).ConclusionsThis study shows that compared to the traditional technique, the modified PAOO technique with membrane fixation using periosteal sutures provides improved graft stabilization, superior coronal augmentation and satisfactory vertical volume.