osseous sx- regen

Question 1

Objectives of Bone Replacement Grafting

Answer 1

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

Question 2

 Indications for grafting (bone)
 Defect type?
 looks?
 Teeth critical to?
 anatomy?
 GTR?

Answer 2

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

Question 3

Contraindications for grafting

Answer 3

 Poor plaque control
 Medically compromised
 Poor maintenance compliance

Question 4

pros of grafting

Answer 4

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

Question 5

 Disadvantages of grafting
 sensitve?
 cost?
 May require?
 prediction?
 wound closure?
 post-op care?
 Second surgical site?
 Success decreases significantly in? dependent on?

Answer 5

 Technique and material sensitive
 Expensive (?)
 May require two surgeries (?)
 Unpredictable
 Requires ideal wound closure
 Longer, more frequent post-op care needed
 Second surgical site sometimes required
 Success decreases significantly in furcations and is defect-dependent

Question 6

biologic responses of grafting

Answer 6

 Osteogenic
 Osteoconductive
 Osteoinductive
 Osteoproductive

Question 7

osteogenic

Answer 7

viable osteoblasts are
transplanted

Question 8

osteoconductive

Answer 8

scaffold for bone
formation

Question 9

osteoinductive

Answer 9

release of material to induce bone formation (BMP)

Question 10

osteoproductive

Answer 10

production of bone by
a biologic mechanism??

Question 11

healing sequence of bone grafts

Answer 11

 Incorporation (clot formation)
 Revascularization
 Resorption of graft material with release of factors (BMP) to induce bone formation
 Bone formation
 Bone remodeling and maturation

Question 12

type of loss

Answer 12

vertical defect (>2.5mm)

Question 13

how can a graft be done in a two wall defect?

Answer 13

use of membrane to act as a third wall

Question 14

Vertical defect from root fx tx?

Answer 14

take that mf out

Question 15

can we graft with furcation involvement?

Answer 15

not ideal, poor prognosis

Question 16

Success in regen is dependent on?

Answer 16

defect, best success with three-wall defects

Question 17

suprabony defect (horizontal) and regen

Answer 17

little to no success

Question 18

Graft complications

Answer 18

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

Question 19

Grafting Variables
 scaling?
 drug delivery?
 Flap?
 Intramarrow?
 Hydration?
 Root?
 Use of?
 Endodontics?
 Smoking?

Answer 19

 Pre-scaling or scaling at time of surgery
 Local drug delivery before surgery
 Flap design*
 Intramarrow penetration*
 Hydration of graft material
 Root treatment or modification
 Use of antibiotics
 Endodontics and graft success= endo 1st
 Smoking and graft success= no

Question 20

intraoral bone sources

Answer 20

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

Question 20

extraoral bone sources

Answer 20

 Iliac crest
 Ribs

Question 20

types of allografts

Answer 20

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

Question 21

safety of allografts (HIV)

Answer 21

shown in HIV/AIDS donors

Question 22

inductive ability of allografts based on?

Answer 22

based on amt BMP?

Question 23

hydration allografts?

Answer 23

materials and amts?

Question 24

controversies of allografts?

Answer 24

resorption of graft? BMP? did they kill Kennedy?

Question 25

types of alloplasts

Answer 25

 Calcium Sulfate (CapSet ®)
 Calcium Phosphates: Beta tri-calcium phosphate (resorbable) and Hydroxyapatite (resorbable and non- resorbable
 HTR®
 Bioactive glass ceramics

Question 26

CaSO4/Regeneration
rationale for adding it?

Answer 26

Rationale for adding calcium sulfate to FDBA
* Binds bone particles to prevent washout
* Accelerates bone formation by:
 Enhancement of BMP
 Providing a source of Ca ++ ions to aid in mineralization

Question 27

bioactive glasses composed of:

Answer 27

silicon dioxide (45%),
calcium oxide (24.5%),
sodium oxide (24.5%)
phosphorus pentoxide (6%)

Question 28

bioactive glass sizes

Answer 28

can be different, used by sales reps

Question 29

Bioactive glass reported properties

Answer 29

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

Question 30

types of xenografts

Answer 30

 Bovine bone
 Bovine bone with cell-binding peptide-15 attached
 Fetal pig enamel matrix derivative to induce cementogenesis and bone formation

Question 31

GTR will provide

Answer 31

provide
epithelial exclusion

Question 32

Platelet Rich Plasma (PRP)

Answer 32

newer technique, concentration of growth factors
 Addition of synthetically-produced Growth Factors
 Recombinant human Platelet Derived Growth Factor (rhPDGF) added to beta tricalcium phosphate
 Recombinant Bone Morphogenetic Protein (rBMP) added to beta tri-calcium phosphate
Edentulous ridges ONLY

Question 33

autograft

Answer 33

tissue from one site to another in same person

Question 34

allograft

Answer 34

tissue from one individual to another

Question 35

alloplast

Answer 35

inert material used for graph

Question 36

xenograft

Answer 36

interspecies graft

Question 37

composite graft

Answer 37

combo of grafts

Question 38

how long until you can probe regen areas

Answer 38

6mo