What are Dental bone grafts?
A dental bone graft is required when bone loss occurs in the jaw. A dentist performs this surgery before the insertion of dental implants or when bone loss affects surrounding teeth. They are fillers and scaffolding materials used to encourage bone growth and wound healing.
These grafts are bioresorbable and do not elicit an antigen-antibody response. These bone grafts serve as a mineral store, stimulating the production of new bone. This blog talks about dental bone grafts, why bone grafts are used in dentistry, how bone grafts work in dentistry, and much more.
What is a dental bone graft?
Ridge abnormalities due to surgery, infection, trauma, or congenital anomalies. The insufficient quantity of bone due to tooth loss causes rapid resorption of alveolar bone due to a lack of intraosseous stimulation by periodontal ligament (PDL) fibers, such as pneumatization of the maxillary sinus after tooth loss. The goals of osseous replacement are to maintain shape, decrease postoperative infection, and eliminate dead space, improving bone and soft tissue recovery.
Bone grafting is a surgical treatment that replaces missing bone with material from the patient′s own body, an artificial, synthetic, natural alternative, or a combination of the two. Bone grafting is achievable because bone tissue can repair if allowed enough space to expand. A fully integrated patch of new bone is produced when natural bone replaces the graft material as it grows.
In simple words, A dental bone graft is a transplant procedure used in dentistry to enhance the amount of bone in the jaw before the placement of an implant. It is a procedure used when a patient does not have enough healthy bones in their mouth to support dental implants. Face injury, Gum disease, trauma, or an empty area following a tooth extraction can all cause deterioration of the mouth's natural bones.
In regions where bone loss has occurred, dental bone graft provides density and volume to your jaw. The bone graft material can come from your own body (autogenous), from a human tissue bank (allograft), or from an animal tissue bank (xenograft). In other cases, the bone graft material is synthetic (alloplast).
Material-based classification of bone grafts:
- Allograft bone grafts use allograft bone alone or in conjunction with other components like Grafton and OrthoBlast.
- Natural and recombinant growth factors, such as platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-beta), fibroblast growth factors (FGF), and bone morphogenetic protein, are utilized alone or in combination with factor-based bone transplant (BMP).
- Cell-based bone grafts use cells to build new tissue independently or in variety with a support matrix, such as mesenchymal stem cells.
- Calcium sulphate, calcium phosphate, and bioglass are ceramic-based bone graft alternatives that can be used alone or in combination; for example, ProOsteon, OsteoGraf, and OsteoSet.
- Degradable and nondegradable polymers are used alone or in combination with other materials in polymer-based bone grafts, such as open porosity polylactic acid polymer.
Why are bone grafts used in dentistry?
Bone Grafts are used to treat patients for conditions like:
- Saving Teeth: Bone loss brought on by periodontal disease can result in a tooth being loose.
- Tooth Extractions: When a tooth is extracted, it is standard practice to employ bone grafting material in the empty socket to facilitate the placement of a dental implant.
- Dental Implants: For dental implants to succeed, sufficient bone volume and density must be adequate.
The vascularized, grafted fibulas have been utilized to replace bone fragments lost to trauma or malignant tumor invasion and to repair the skeletal integrity of long bones in limbs with congenital bone abnormalities. The most frequent use of bone grafting is during the installation of dental implants to replace the edentulous region left by a missing tooth. To better adapt bone grafts to a deficiency, they are typically placed in block form (from the chin or the ascending ramus area of the lower jaw) or as particulates.
In addition to its primary application in dental implants, bone grafting is used to mend fractured bones with bone loss and shattered bones that have not yet healed. The periosteum and nutrient artery are removed along with the bone piece for the bone graft to survive and grow when transplanted into a new host site. Once the transplanted bone is fixed, the blood flow to the bone to which it was linked usually returns.
Types and Tissue Source of Dental Bone Grafts
Different types of bone transplants are used depending on the severity of the bone loss and the location. Among the several varieties are:
The goal of a socket graft is to prevent alveolar bone atrophy from occurring. The grafts also reduce post-surgery discomfort. A human donor is required and is inserted into the socket, preventing the socket from collapsing. After that, you'll be ready for a dental implant in four to six months.
Lateral Ridge Preservation Graft
This graft, which comes from a human donor, is utilized to widen the jawbone to install a dental implant. Healing takes four to six months.
Block Bone Graft
This bone graft is required when there are significant deformities in the jaw. A tiny block of the jawbone is used and inserted into the defect. Titanium screws hold it in place. Healing takes four to six months.
Sinus Lift Procedure
Horse bone is used to expand the transplant in these cases. This treatment is required when a dental implant in the upper jaw is not robust enough to hold an implant on its own.
Autologous or autogenous bone grafting includes using bone from the same graft recipient. Nonessential bones, such as the iliac crest, mandibular symphysis (chin area), and anterior mandibular ramus, can be harvested for bone (coronoid process). While doing a block transplant, autogenous bone is favored since there is reduced danger of graft rejection because the graft is derived from the patient′s body.
It would be osteogenic, osteoinductive, and osteoconductive all at the same time. The disadvantage of autologous grafts is that an additional surgical site is necessary, which adds to the possibility of postoperative pain and problems.
In the transplanted site, all bones require a blood supply. An additional blood supply may be necessary depending on the transplant's location and the graft's size. Extraction of surrounding blood vessels, the periosteum, and the donor's bone is essential for these transplants. A free flap graft is the name given to this type of graft.
Humans are used to creating allografts. Allograft bone is obtained from cadavers who have donated their bone to be utilized for living individuals in need; it is commonly obtained through a bone bank. The distinction is that allograft is received from someone other than the graft recipient.
There are three kinds of bone allografts:
- Fresh or fresh-frozen bone
The use of allografts for bone regeneration frequently necessitates sterilization and the deactivation of proteins prevalent in healthy bone. The full cocktail of bone proteins, growth factors, and other bioactive materials required for osteoinduction and successful bone healing is contained in the extracellular matrix of bone tissue; the desired characteristics and proteins are removed from the mineralized tissue using a demineralizing agent such as hydrochloric acid. The mineral composition of the bone deteriorates, and the osteoinductive agents persist in a demineralized bone matrix (DBM).
A flexible hydrogel-hydroxyapatite (HA) composite with a mineral-to-organic matrix ratio similar to human bone. Ceramics such as calcium phosphates (e.g., HA and tricalcium phosphate), bioglass, and calcium sulphate are biologically active depending on their solubility in a physiological setting. To improve biological activity, these materials are combined with growth agents, ions such as strontium, or mixed with bone marrow aspirate. The presence of elements like strontium can lead to increased bone mineral density (BMD) and osteoblast proliferation.
Xenografts are bone grafts from other species, such as bovine, employed as a calcified matrix.
Alloplastic grafts can comprise hydroxyapatite, a naturally occurring mineral (the major mineral component of bone), and bioactive glass. Hydroxyapatite is a synthetic bone graft commonly utilized today due to its hardness, osteoconduction, and acceptance of bone. Some synthetic bone grafts are constructed of calcium carbonate, which is becoming less popular because it is resorbable quickly and simplifies bone breaking. Lastly, tricalcium phosphate, combined with hydroxyapatite, is employed, influencing osteoconduction and resorbability.
Ceramic-based bone graft substitutes
Most available bone transplants use ceramics alone or in conjunction with another material (e.g., bioactive glass, calcium sulfate, and calcium phosphate). The ceramics, such as calcium phosphates, is calcium hydroxyapatite, which is osteoconductive, osteointegrative, and osteoinductive in some situations. They have brittle characteristics and require high temperatures to produce scaffolds.
- Plaster of Paris is another name for calcium sulphate. After 30-60 days, it is biocompatible, bioactive, and resorbable. Degradation causes a significant loss of mechanical characteristics, making it an unsuitable material for load-bearing applications:
- OsteoSet is a pill that is used to pack defects. It will decay after about 60 days.
- Allomatrix is a putty or injectable paste made from Osteoset and DBM. OsteoSet is a calcium sulphate tablet intended to treat bone defect areas, whereas allometric is an injectable paste or solid putty made from calcium sulphate and DBM.
Bioactive glass (bioglass) is a biologically active silicate-based glass with a high modulus and brittle nature that has been used in conjunction with polymethylmethacrylate to form bioactive bone cement and with metal implants as a coating to form a calcium-deficient carbonated calcium phosphate layer that facilitates the chemical bonding of implants to the surrounding bone. Tricalcium phosphate, synthetic hydroxyapatite, and coralline hydroxyapatite are all calcium phosphates in pastes, putties, solid matrices, and granules.
Bio-Oss and OsteoGraft are two calcium phosphates products. Hydroxyapatite is used in both products as a particulate (Bio-Oss) or as blocks and particulates (OsteoGraft). Pro-Osteon is a one-of-a-kind substance derived from sea coral and processed from calcium carbonate to calcium hydroxyapatite. The structure of coral, which is comparable to that of trabecular bone, is a benefit of this material.
Polymer-based bone graft substitutes
Natural polymers and synthetic polymers are two types of polymers. Degradable and nondegradable kinds are distinguished. The following polymer-based bone graft alternatives are available:
- Healos is a natural polymer-based product that is approved for spinal fusions. It is a polymer-ceramic composite comprised of collagen fibers coated with hydroxyapatite.
- Cortoss is a resin-based injectable solution having uses in load-bearing areas.
Like natural polymers, the body absorbs synthetic polymers that degrade. The advantage of having the implant resorbed by the body is that the body can mend itself entirely without any foreign bodies behind it.
Are bone grafts painful?
A dental bone graft that does not require bone material from the patient's body is a modest surgery. You will be sedated throughout the surgery, not feeling any pain until the anaesthetic wears off. The pain is usually acceptable with over-the-counter pain medicines for the next few days. Prescribed pain relievers may also be appropriate.
Depending on how much work is done, you may be in pain for several weeks while recovering. But, if bone material is derived from your body, recuperation may be more challenging because surgery is performed in two areas: your hip and jaw. Because the amount of bone extracted and grafted is usually modest, the period of discomfort should be brief.