Osseous Regeneration

Question 1

Procedures allowing the repop of a perio defect by cells capable of forming new CT attachment and alveolar bone

Answer 1

Guided Tissue Regeneration

Question 2

Desirable/Undesirable: Bone Cells

Answer 2

Desirable

Question 3

Desirable/Undesirable: Gingival Epithelial Cells

Answer 3

Undesirable

Question 4

Desirable/Undesirable: Gingival CT

Answer 4

Undesirable

Question 5

Desirable/Undesirable: PDL

Answer 5

Extremely Desirable

Question 6

Criteria (4) for GTR Success

Answer 6

• Primary soft tissue closure
• Secluded space maintenance
• Membrane stabilization
• Adequate healing period

Question 7

Qualities of an Ideal Membrane

Answer 7

Absorbable
Bio Compatible
Cell Occlusive
Space Maintenance
Tissue Integration
Clinically Manageable

Question 8

Non-Resorbable GTR Materials

Answer 8

ePTFE

Question 9

Resorbable GTR Materials

Answer 9

Cross-linked collagen membranes
Calcium Sulfate
PLA/PGA
Doxycycline 4%

Question 10

About ePTFE

Answer 10

2nd stage surgery required to remove (4-6 weeks) - use small incision, do not disturb tissue, cover new tissue with flap

Question 11

PLA/PGA

Answer 11

Degrades 4-6 weeks, one stage surgery

Question 12

Collagen, and what do you add to it

Answer 12

Cross-linked, adding zinc prevents breakdown, bovine of porcine source

Question 13

Functionally Graded Membranes

Answer 13

Stem cells
3 layers- core layer: protein
SL to epithelium= metornidazole
SL to bone= hydroxyapatite

Question 14

Space Maintenance Guidelines (2)

Answer 14

• Reinforce the membrane

- Create a scaffold - using tenting screws and fillers

Question 15

Bio Mechs of Graft Integration

Answer 15

Osteogenesis - viable cells
Osteoinduction - uncommitted CT cells induced
Osteoconduction- non viable scaffold

Question 16

Osteogenesis

Answer 16

Osteoblasts from the graft material contribute to bone growth

Question 17

Osteoinduction

Answer 17

Graft induces osteoprogenitor cells in the bone to form into osteoblasts and start producing bone

Question 18

Osteoconduction

Answer 18

Graft serves as a scaffold for new growth that is perpetuated by the native bone

Question 19

Conductive/Inductive/Genic? Autograft

Answer 19

Yes, Yes, Yes

Question 20

Conductive/Inductive/Genic? Allograft

Answer 20

Conductive and Usually Inductive, but NOT Genic

Question 21

Conductive/Inductive/Genic? Alloplast/xenograft

Answer 21

Conductive, but NOT Inductive or Genic

Question 22

Autogenous Grafts - Advantages

Answer 22

• Gold Standard- predictable

- Osteogenic

Question 23

Autogenous Grafts- Disadvantages

Answer 23

• second surgical site in same human
• insufficient material
• membranous bone vascularizes faster than endochondral bone
• membranous bone resorbs slower that endochondral bone

Question 24

Allografts - Advantages

Answer 24

• Availability
• No Donor Site
• Reduced surgical time
• Fewer complications

Question 25

Allografts - Disadvantages

Answer 25

- antigenicity - longer healing - less volume

Question 26

Alloplasts and Xenografts

Answer 26

- hydroxyapatite - bovine derived - tricalcium phosphate - synthetic bone material - coralline - hard tissue replacement polymer - bioactive glass

Question 27

Biological Mediators (2)

Answer 27

- Enamel matrix proteins | - rhBMP

Question 28

Human BMP-2 (INFUSE)

Answer 28

Stimulates bone formation | mix w/ water and applied to collagen sponges

Question 29

Enamel Matrix Derivative (Emdogain)

Answer 29

Forms layer of extracellular matrix on the root surface that promotes selective cell colonization - enhances mesenchymal adhesion and inhibits epithelial adhesion Use PrefGel to wipe smear layer off root

Question 30

Benefits of Emdogain (EMD)

Answer 30

Improved AL, pocket reduction formation of new bone, PDL, and cementum in primates

Question 31

PDGF in Tri-Calcium Phosphate (GEM21S)

Answer 31

PDGF stimulates migration of proliferation of osteoblasts, fibroblasts, and cementolblasts--> form new bone, PDL, cementum

Question 32

Effects of GEM21S

Answer 32

- greater radiographical bone fill - But, no AL gain - Good for furcations

Question 33

Furcation Defects Regeneration

Answer 33

- predictable GTR with Class 2 furcas on mand molars | - Consider GTR in areas with isolated Class 2 furcas

Question 34

Predictability of Furca Regeneration

Answer 34

- Most- Mand or Buccal Max class 2's - Mes or Dist Max class 2's - Least - Class 3's