Xenografts and other augmentation materials based on granules do not provide initial stability of the implanted graft. In order to stabilize these types of grafts in the defect and to prevent particle migration, the dentist often use a membrane.
Xenografts and other types of granular materials that are either non-resorbable or are slowly resorbed are used in cases where a longer period of time or space maintaining is required, such as lateral augmentation, vertical sinus lift or any defect that is larger than 10 mm with less than three wall bony support. The outcome is bone repair rather than bone regeneration. However, in order to obtain optimal and complete bone regeneration, it is necessary to use a space maintainer with a resorption manner that matches the bone formation rate.
Bone resorption will occur at sites of inflammation or prolonged excessive stimulation. The main contributing factors to bone resorption are local inflammation from plaque accumulation and trauma from occlusion. Periodontal disease from plaque inflammatory response, and subsequent bone resorption can result from the following:
- Direct action of plaque products on bone progenitor cells induce their differentiation into osteoclasts.
- Plaque products directly on bone, destroying it through a non cellular mechanism.
- Plaque products stimulate gingival cells, causing them to release mediators which in turn induce bone progenitor cells to differentiate in osteoclasts.
- Plaque products cause gingival cells to release agents that can act as cofactors in bone resorption.
- Plaque products cause gingival cells to release agents that destroy bone by direct chemical action without osteoclasts.
Resorbable Tissue Replacement (RTR) mixed with patient’s blood
Hyaluronic Acid is a natural occurring substance found in our joints, eyes and neural tissues with the highest concentration in the connective tissue and skin. It plays an important role in tissue repair and regeneration but unfortunately it gets depleted as we age. Extensive research has shown that this can be reproduced and prescribed as a supplement to minimize inflammation and accelerate wound healing. Aside from dental implant placement, its various dental applications are for: gingivitis, periodontitis, tooth extraction and bone grafting.
Titanium mesh and autogenous bone graft was first introduced by Boyne in 1969, and was re-introduced by Von Arx and others in 1996 as the TIME technique. It is characterized by the use of microtitanium augmentation mesh. Although this technique is widely used for alveolar ridge augmentation, data in the literature regarding the amount of bone gain and the comparison with other augmentation technique is still not sufficient.
In a study of Dr. Tetsu Takahashi, the use of titanium mesh for alveolar ridge augmentation in atrophic jaws was evaluated in the overall success rate, magnitude of ridge augmentation and the rate of complications. Several complication can occur, but most of the trouble are not influenced by the implant treatment results. The results demonstrate that autogenous bone graft with titanium mesh has shown enough alveolar bone reconstruction quantitatively and qualitatively for the implant placement.
Puros Cortical Particulate Allograft by Zimmer
Zimmer Puros Cortical Particulate Allograft
offers the density and strength of a cortical autograft
without the need for costly and invasive bone harvesting. It can be used alone or as a composite graft in space maintenance and volume enhancement procedures. It also maintains an open network for the proliferation of bone-forming cells. It is denser than cancellous bone and has been used in applications where cortical particulate is needed. Puros Cortical Particulate retains the natural collagen matrix and mineral structure of human cortical bone
Cortical Particles remodel into a dense lamellar structure without sacrficing ridge contour, and into natural viable bone with similar density to native bone. When used in a sandwich technique for the treatment of localized buccal dehiscence defects, Park and Wang reported an average gain of 1.8 mm in bone thickness. While according to Anoticel Sej Method, an average of 1.9 mm of bone thickness was gained. Combining Puros Cortical Allograft with a combination sandwich and mucogingival puch flap technique, one study achieved 1.5 mm to 3.5 mm gain in mean ridge thickness, and 84% to 100% gain in mean ridge height.