Interesting Facts About Bone Grafting

Can Bovine Spongiform Encephalopathy Affect Patients With Bone Grafts Of Bovine Origin ?

Bovine bone is one of the most popular xenogenic bone substitute used for regenerative procedures. Several patients and dentists are concerned over the transmission of cattle diseases to the human recipient. Risk assessment studies by A. Sogal and A.J. Tofe concludes that "Based on the risk analysis, it is evident that the risk of BSE infection from BGS is several orders of magnitude less than that posed by the risk of death related to, lightning, tornadoes, or similar remote events. However, this low risk can only be maintained as long as an effective and active risk management program is implemented in operations that involve processing xenogenic tissue for human use." Journal of Periodontology September 1999, Vol. 70, No. 9, Pages 1053-1063 , DOI 10.1902/jop.1999.70.9.1053

What Is The Thickness Of Cortical Plate ?

The average thickness of buccal cortical plate in dentulous mandible is 2.76 mm (± 0.13 mm) while in edentulous mandible is 2.52 mm (± 0.32 mm). The study was performed on cadevors.All these cases exposed the inferior alveolar nerve. So the safer side would be to keep the thickness below the mentioned data. 

http://www.joponline.org/doi/abs/10.1902/jop.2009.090417

Can A Previous Donor Site Be Used Again For Bone Harvesting ?

5 patients underwent bone grafting from symphyseal region. 5 months later there was a need to harvest more bone for implant placement. As the are showed new bone formation in the previous site, once again the bone was harvested from the same area, months later the implants were placed. Both the areas, the donor site and implants site showed proper healing. It can be concluded that bone can be harvested once again from the previous donor site. 
Journal of Periodontology 2009, Vol. 80, No. 5, Pages 865-869 , DOI 10.1902/jop.2009.080602

Novel Technique Of Bone Harvesting For Implant Placement

A new technique has been devised by Kyung-Gyun Hwang, Kwang-Sup Shim, Seung-Min Yang,and Chang-Joo Park that utilizes only the cortical bone of the ramus. This technique overcomes the drawbacks associated with conventional techniques e.g. postoperative pain and swelling to impaired inferior alveolar nerve function. The chances of inferior alveolar nerve damage are abolished because the strategic choice of the site. It is a safe, predictable and reproducible technique for bone harvesting.
Journal of Periodontology 2008, Vol. 79, No. 5, Pages 941-944 , DOI 10.1902/jop.2008.070408

By: Dr. Hamid Raihan
Jaipur Dental College
Jaipur.

Technorati Authority Of Discovering Dentistry Reaches 108

Technorati Authority of my blog Discovering Dentistry reaches 108. Exciting enough.

By: Dr. Hamid Raihan
Jaipur Dental College
Jaipur.

Recent Advances In Implants Every Dentist Ought To Know

How To Manage Papillary Deficiencies Between Implants ?

A number of cases show deficiency of papilla in the interdental area, which may be between implants, or an implant and teeth. This can impose critical esthetic problem for the patient as well as the dentist. The most recent advancement in this field is the injection of hylauronic acid commercially availabel as Restylane (TM). The effect lasts for 6-24 months after which a new dose is required. (1)

Maxillary Sinus Floor Augmentation

Recently Calcium sulfate has been used for maxillary sinus floor augmentation. Calcium sulfate placement showed significant maxillary sinus bone formation. Placement of implants after this procedure led to successful implant placement and loading. (2)

Can Bone Regeneration Occur In Uncontrolled Diabetic Patients ?

Diabetic Patients reporting for implant placement with angular bone loss require bone regenerative techniques before proceeding with implants. Experiments on rats with artificially created bone defects and uncontrolled, drug induced diabetes were carried out. The results were encouraging as it showed significant de novo bone formation via GBR even in uncontrolled diabetics. (3)

Is Osseointegration Possible In Diabetics ?
A review study of MEDLINE/PubMed articles published from 1982 up to and including July 2009 were carried out by researchers. 33 articles were selected. It was concluded that proper glycemic control and HbAA1c in normal range will lead to successful implant osseointegration in diabetics similar to normal individuals. (4)

How Do Implants Fare In Periapically Infected Bone?
Placement of implants in fresh extraction sockets has been taking place for long. How ever a question was intriguing, that whether an immediate implant can survive if placed in an extraction socket of a periapically infected tooth. A 24 months follow up of patients showed 100% success rate in implants placed in the sockets of teeth previously infected at the periapical region. (5)

References:

1. Clinical Implant Dentistry and Related Research  Digital Object Identifier (DOI)
10.1111/j.1708-8208.2009.00247.x
2. Clinical Implant Dentistry and Related Research Digital Object Identifier (DOI) 10.1111/j.1708-8208.2009.00249.x
3. Clinical Oral Implants Research Digital Object Identifier (DOI) 10.1111/j.1600-0501.2009.01805.x
4. Journal of Periodontology 2009, Vol. 80, No. 11, Pages 1719-1730 , DOI 10.1902/jop.2009.090283
5. Journal of Periodontology Posted online on November 4, 2009. http://www.joponline.org/doi/abs/10.1902/jop.2009.090505

By: Dr. Hamid Raihan
Jaipur Dental College
Jaipur.

How To Incise Mucosal Tissues With Dental Lasers?

Dr.de la Pena demonstates the step by step procedure for the removal of excess oral tissue with the help of dental lasers. It is a very good video for initial learning of the use dental lasers.

By: Dr. Hamid Raihan
Jaipur Dental College
Jaipur.

Latest Clinically Applicable Periodontal Researches

Antimicrobial photodynamic therapy has shown promising results when used an adjunctive therapy during the treatment of periodontitis. It enhances the bacterial killing esp Porhyromonas gingivalis and deactivates its enzymes. It also diminishes the host cytokines that impair healing.(1)
Diabetic patients under proper glycemic control can receive implants and show successful osteointegration, similar to normal individuals. The serum glycemic level and Hb A1c should be in the normal range for the success of implant osseointegration. (2)

Iron deficiency anemia in female patient is not a direct risk factor for periodontal diseases. (3)

Combined regenerative therapy  is very successful approach in the treatment of human mandibular classII furcation involvements. The combined regenerative therapy consists of a composite graft consisting of bioabsorbable hydroxyapatite and tetracycline (3:1), a guided tissue regeneration barrier, and a coronally advanced flap. (4)

Biphasic Calcium Composite a novel material proves to be equivalent to Autogenous Bone Graft and superior to Simple Flap Operation with debridement in the treatment of intrabony periodontal defects or Vertical Bone Loss. (5)
References:

1. Journal Of Periodontology 2009, Vol. 80, No. 11, Pages 1790-1798 , DOI 10.1902/jop.2009.090214
   
2. Journal Of Periodontology 2009, Vol. 80, No. 11, Pages 1719-1730 , DOI 10.1902/jop.2009.090283 
3. Journal Of Periodontology 2009, Vol. 80, No. 11, Pages 1750-1755 , DOI 10.1902/jop.2009.090209
4. Journal Of Periodontology 2009, Vol. 80, No. 11, Pages 1756-1764 , DOI 10.1902/jop.2009.080605
5. Journal Of Periodontology 2009, Vol. 80, No. 11, Pages 1774-1782 , DOI 10.1902/jop.2009.090229

PERIIMPLANTITS: Challenge in Implant Success

Periimplantitis is an inflammatory process affecting the hard and soft tissues around the functional implant with progressive marginal bone loss eventually resulting in loss of osseointegration

Etiology: Poor oral hygiene, implant design, occlusal disharmony, surgical trauma, periimplant microgap.

Pathophysiology:

Periimplantitis can occur in two different ways depending on the type of etiology:

1. Traditional pathway

Accumulation of plaque debris around the implant leads to the inflammation of periimplant tissues subsequently damaging the supporting osseous tissues.

2. Retrograde pathway

o Occlusal trauma or defective restorations causes micro fractures of the bone-implant interface leading to bone loss and loosening of implant.
o Implant contamination

Diagnostics:

(a)Clinical diagnosis: Based on the following parameters

* Bleeding on probing
* Probing depth
* Mobility
* Suppuration
* Erythema
* Flaccidity of tissues

(b)Microbiological diagnosis:

* Bacterial cultures
* Antibiotic sensitivity tests

(c)Radiological diagnosis:

* Level and amount of bone loss
* Depth of pocket

Differential diagnosis: Peri-implant mucositis

Management: 3 approaches

1. Therapeutic:

* Antimicrobials(Metronidazole, Vancomycin, Amoxicillin) +surgical debridement

* Decontamination(0.10 ml,0.12 % chlorhexidine and saline-Submucosal + 0.2 w/w Minocycline HCl –Subtopical)
* Ozone therapy
* Radiation therapy(Er:YAG laser,CO2 laser, Vector R System)

2. Surgical methods:

* Resective surgical techniques

* Guided tissue regeneration
* Bone grafts/barrier membranes

All these procedures when formulated and performed as a single management plan it is termed as Cummulative Interceptive Supportive Therapy (CISP)

About The Author:

Dr. Dipika Bumb; www.omrcafe.blogspot.com;

Contact email: drdipikabumb@gmail.com

PG,MDS Oral Medicine and Radiology