xenografts in dentistry
TRANSCRIPT
XENOGRAFTS
Dr. Dandu Sivasai Prasad ReddyII yr Post graduateDepartment of PeriodonticsMamata Dental College
Dr. Dandu Sivasai Prasad ReddyII yr Post graduateDepartment of PeriodonticsMamata Dental College
Introduction
Terminologies
Bone graft
History
Mechanism of bone grafting
Clinical objectives of bone grafting for periodontal
regeneration
Ideal properties of grafts
Indications of periodontal bone graft
CONTENTS
Classification of bone grafts
Xenografts
Calf bone
kiel bone
Anorganic bovine bone
Bio oss
Pepgen 15
Porcine derived bone graft
Osteobiol
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
Is the process by which the graft material acts as a nonviable
scaffold onto and within which the patients own natural bone
grows
They allow apposition from existing bone, but do not produce
or trigger bone formation.
Eg Alloplastic material
OsteopromotionOsteopromotion
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 infection
Facilitate vascularization
No root resorption or ankylosis
Strong and resistant
Stimulates osteoinduction- & framework for
osteoconduction
Easily adaptable
Readily and sufficiently available
Minimal surgical procedure with minimal post-operative sequelae
Predictability
Completely replaced by host bone of the same quality – quantity
Induce & enhance cementogenesis.
CONTD..,CONTD..,
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
XenograftsSource
CALF BONE - treated by detergent, sterilized and freeze dried. Used for
treatment of osseous defects.
KIEL BONE - Calf or Ox bone denaturated with 20% H2O2, dried with acetone, and
sterilized with ethylene oxide.
ANORGANIC BONE - Ox bone from which the organic material has been extracted by
ethylene diamine. Then sterilized by autoclaving.
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 availableBio – OssBio – Oss CollagenPepgen-P15
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.
Bio - Oss®
PACKAGING: 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 b
BIO-OSS CONTD..,
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.
BIO-OSS CONTD..,
Bio – Oss Collagen® (Osteohealth Co., Shirley, NY)
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.
ABB plus P-15 cell
binding peptide
(pentadecapeptide)
Mimics the cell
binding domain of
type I collagen
PepGen P-15
Hanadi Baeissa
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 choice for grade II furcation defects may be
bone graft alone.
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 81% at the
defect sites
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
1yr follow up
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 bone substitute that did not interfere with
the bone’s normal reparative processes.-Jose Luis
Calvo Guirado et al., 2013
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 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
Risk of disease transmission
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.
REFERENCES
•Nasr HF, Reidy AME, Yukna RA. Bone and bone substitutes. Periodontology
2000, 1999; 19: 74-86.
•Carranza FA, Takei HH, Cochran DL. Chapter-67, Reconstructive Periodontal
Surgery. Carranza's Clinical Periodontology, 10th edition: 968-969.
•Reynolds MA, Reidy AME, Branch-May GL, Gunsolley JC. The efficacy of bone
replacement grafts in the treatment of periodontal osseous defects. Ann
Periodontol 2003; 8(1): 227-265.
•Dental & Medical Device. Product information on Osteo-Biol ®, 2008.
•Dentsply-Friadent. Product information on PepGen P-15®, 2008.
•Rita Singh, Lanka Mahesh. Infections Resulting from Bone Grafting Biomaterials.
International Journal of Oral Implantology and Clinical Research, May-August
2013;4(2):68-71
•A.L. Dumitrescu, Chemicals in Surgical Periodontal Therapy, Bone Grafts and
Bone Graft Substitutes in Periodontal Therapy.
•Emmings et al. Chemically modified osseous material for restoration of bone
defects. J Periodontol 1974; 45:385.
•Boyne et al. Transplantation, implantation and grafts. Dent Clin N Am 1971; 15:
434.
•Krejci et al. Osseous grafting in periodontal therapy. Part I - Osseous graft
material. Comp. Cont. Edu. Dent. VIII 1987, No.10.
Thank you.,