• Archives of Plastic Surgery
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• v.44 no.3
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• pp.188-193
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• 2017

Alveolar cleft is a tornado-shaped bone defect in the maxillary arch. The treatment goals for alveolar cleft are stabilization and provision of bone continuity to the maxillary arch, permitting support for tooth eruption, eliminating oronasal fistulas, providing an improved esthetic result, and improving speech. Treatment protocols vary in terms of the operative time, surgical techniques, and graft materials. Early approaches including boneless bone grafting (gingivoperiosteoplasty) and primary bone graft fell into disfavor because they impaired facial growth, and they remain controversial. Secondary bone graft (SBG) is not the most perfect method, but long-term follow-up has shown that the graft is absorbed to a lesser extent, does not impede facial growth, and supports other teeth. Accordingly, SBG in the mixed dentition phase (6-11 years) has become the preferred method of treatment. The most commonly used graft material is cancellous bone from the iliac crest. Recently, many researchers have investigated the use of allogeneic bone, artificial bone, and recombinant human bone morphogenetic protein, along with growth factors because of their ability to decrease donor-site morbidity. Further investigations of bone substitutes and additives will continue to be needed to increase their effectiveness and to reduce complications.

• Archives of Reconstructive Microsurgery
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• v.15 no.1
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• pp.26-32
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• 2006

Purpose: The purpose of this study was to evaluate the effectiveness of limb reconstruction and functional recovery using vascularized fibular graft in the treatment of extensive bone defect of long bone caused by various diseases. Materials and Methods: From september 1995 to March 2005, 21 patients with segmental bone defects were managed with vascularized fibular graft: 13 males and 8 females, aged 39 years on average (range, $8{\sim}65\;years$). The reconstructed site was the humerus in 9 patients, the femur in 5, the tibia in 4 and the forearm bone in 3. The length of bone defect ranged from $8{\sim}17\;cm$. Results: Twenty grafts were successful. The mean period to obtain radiographic bone union was 5.7 months on average. Conclusion: Fibular grafts allow the use of a segment of diaphyseal bone and of sufficient length to reconstruct most skeletal defects of the long bone. The vascularized fibular graft is indicated in patients with intractable nonunions where conventional bone grafting has failed or large bone defects.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.39 no.4
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• pp.156-160
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• 2013

Objectives: Interest in bone graft material has increased with regard to restoration in cases of bone defect around the implant. Autogenous tooth bone graft material was developed and commercialized in 2008. In this study, we evaluated the results of vertical and horizontal ridge augmentation with autogenous tooth bone graft material. Materials and Methods: This study targeted patients who had vertical or horizontal ridge augmentation using AutoBT from March 2009 to April 2010. We evaluated the age and gender of the subject patients, implant stability, adjunctive surgery, additional bone graft material and barrier membrane, post-operative complication, implant survival rate, and crestal bone loss. Results: We performed vertical and horizontal ridge augmentation using powder- or block-type autogenous tooth bone graft material, and implant placement was performed on nine patients (male: 7, female: 2). The average age of patients was $49.88{\pm}12.98$ years, and the post-operative follow-up period was $35{\pm}5.31$ months. Post-operative complications included wound dehiscence (one case), hematoma (one case), and implant osseointegration failure (one case; survival rate: 96%); however, there were no complications related to bone graft material, such as infection. Average marginal bone loss after one-year loading was $0.12{\pm}0.19$ mm. Therefore, excellent clinical results can be said to have been obtained. Conclusion: Excellent clinical results can be said to have been obtained with vertical and horizontal ridge augmentation using autogenous tooth bone graft material.

• The Journal of the Korean dental association
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• v.46 no.4
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• pp.222-231
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• 2008

Various maxillary sinus floor augmentation techniques were common performed and in the most cases, many kinds of bone graft materials were used. The graft materials are autogenous bone or other biomaterials of human, animal or synthetic origin. But these cases report describes a new surgical technique by which dental implants are inserted in a void space created by elevating the sinus membrane without additional graft material in atrophic posterior maxilla. We created lateral bony window using piezoelectric device and elevated the schneiderian membrane in five patients and was repositioned with bony window in five patients, without any bone graft. From the clinical and histological results, it is found there is potential capacity for bone formation and placement of implants in the maxillary sinus without the use of bone grafts or bone substitutes.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.38 no.1
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• pp.2-8
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• 2012

Introduction: Auto-tooth bone graft material consists of 55% inorganic hydroxyapatite (HA) and 45% organic substances. Inorganic HA possesses properties of bone in terms of the combining and dissociating of calcium and phosphate. The organic substances include bone morphogenetic protein and proteins which have osteoinduction capacity, as well as the type I collagen identical to that found in alveolar bone. Auto-tooth bone graft material is useful as it supports excellent bone regeneration capacity and minimizes the possibility of foreign body reaction,genetic diseases and disease transmission. Materials and Methods: Implant placement combined with osteoinductive regeneration,preservation of extraction socket, maxillary sinus augmentation, and ridge augmentation using block type,powder type, and block+powder type autobone graft materialwere performed for 250 patients with alveolar bone defect and who visited the Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University from September 2009 to August 2011. Results: Clinical assessment: Among the 250 patients of auto-tooth bone graft, clinical assessment was performed for 133 cases of implant placement. The average initial stabilization of placed implants was 74 implant stability quotient (ISQ). Radiological assessment: The average loss of crestal bone in the mandible as measured 6 months on the average after the application of prosthesis load was 0.29 mm, ranging from 0 mm to 3.0 mm. Histological assessment: In the histological assessment, formation of new bone, densified lamellated bone, trabecular bones, osteoblast, and planting fixtures were investigated. Conclusion: Based on these results, we concluded that auto-tooth bone graft material should be researched further as a good bone graft material with osteoconduction and osteoinduction capacities to replace autogenous bone, which has many limitations.

• Journal of Korean Dental Science
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• v.12 no.2
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• pp.48-57
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• 2019

Purpose: To investigate whether there are specific surgical or clinical conditions where the use of autogenous bone (AB) is superior to the use of bone substitutes (BSs) for maxillary sinus floor augmentation (MSFA). Materials and Methods: We retrospectively analyzed 386 implants after MSFA in 178 patients. The implants were divided into five groups according to the sinus graft material used. Risk factors for implant failure in MSFA, and correlation between residual bone height (RBH) and graft materials in terms of implant survival were investigated. To investigate risk factors for implant failure in MSFA, implant survival according to graft materials, patients' sex/age, surgical site, RBH, healing period prior to prosthetic loading, staged- or simultaneous implantation with MSFA, the crown-to-implant ratio, prosthetic type, implant diameter, and opposite dentition were evaluated. Result: The cumulative 2- and 5-year survival rates of implants placed in the grafted sinus (independent of the graft material used) were 98.7% and 97.3%, respectively. None of the investigated variables were identified as significant risk factors for implant failure. There was also no statistical significance in implant survival between graft materials. Conclusion: There were no specific surgical conditions in which AB was superior to BSs in terms of implant survival after MSFA.

• Journal of Periodontal and Implant Science
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• v.27 no.1
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• pp.45-59
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• 1997

Platelet-derived growth factor(PDGF) has been shown to play an important role in periodontal regeneration. The purpose of the present study was to examine the distribution of PDGF in experimentally created periodontal intrabony defects after flap surgery with various bone graft materials. Six healthy mongrel dogs were used in this study. Three-wall bony defects were created in maxillary and mandibular premolars, inflammation induced by wire ligation and injection of impression material into the defects. Eight weeks later, the experimental lesions thus obtained were treated by plain flap surgery(control group), flap surgery plus autogenous bone graft(autogenous bone group), flap surgery plus Biocoral graft(Biocoral group), or flap surgery plus bioglass graft(bioglass group), which were randomly assigned to the defects. After 4, H, and 12 weeks postoperatively, 2 dogs were sacrificed at each time and 1he specimens were taken for histological examinations and immunohistochemical examinations for PDGF. In the control defects the amount of new bone formation was minimal. In the autogenous bone and Biocoral group new bone was deposited around implanted particles and the amount of new bone was increased with time. A large number of bioglass particles exibited a central excabation and bone formation could be observed in the central excabation as well as around the particles. The expression of PDGF was low in the control group. The expression of PDGF in Biocoral group was increased at 1, H week, but decreased at 12 week. The increased PDGF expression in autogenous bone and bioglass group was maintained to the end of the experiment.

• Journal of Periodontal and Implant Science
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• v.38 no.4
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• pp.723-728
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• 2008

Purpose: During guided bone regeneration procedures for the augmentation of deficient alveolar ridge, primary closure of flap is necessary. For primary flap closure, flap is repositioned coronally and the zone of attached keratinized mucosa may decreased. The need for attached keratinized mucosa around dental implants is still controversial, but sufficient peri-implant attached keratinized mucosa would be beneficial for functional and esthetic aspects. This case report presents three cases that demonstrated free gingival graft for increasing the zone of peri-implant attached keratinized mucosa which was decreased after guided bone regeneration. Materials and Methods: In first case, maxillary incisors were extracted and guided bone regeneration was performed simultaneously. Because the membrane was exposed at 3 weeks after operation, the membrane was removed and free gingival graft was performed for primary flap closure. Free gingival graft was performed again at implant placement for the increase of attached keratinized mucosa. In second case, guided bone regeneration was performed on lower right first molar area, and implant was placed with free gingival graft. In third case, lower right molar area showed insufficient attached keratinized mucosa after implant placement with guided bone regeneration. When abutments were connected, free gingival graft with apically positioned flap was performed. Result: In these three cases, the zone of attached keratinized mucosa around dental implants was decreased after guided bone regeneration. And the increase of peri-implant attached keratinized mucosa could be obtained effectively by free gingival graft. Conclusion: Free gingival graft could be a effective treatment method increasing the zone of attached keratinized mucosa which was decreased after guided bone regeneration procedures.

• The Journal of Advanced Prosthodontics
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• v.10 no.3
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• pp.167-176
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• 2018

PURPOSE. The purpose of this study was to compare the new bone formation capability of zirconia with those of other synthetic bone grafts. MATERIALS AND METHODS. Twelve rabbits were used and four 6-mm diameter transcortical defects were formed on each calvaria. Each defect was filled with Osteon II (Os), Tigran PTG (Ti), and zirconia (Zi) bone grafts. For the control group, the defects were left unfilled. The rabbits were sacrificed at 2, 4, and 8 weeks. Specimens were analyzed through micro computed tomography (CT) and histomorphometric analysis. RESULTS. The Ti and Zi groups showed significant differences in the amount of newly formed bone between 2 and 4 weeks and between 2 and 8 weeks (P<.05). The measurements of total bone using micro CT showed significant differences between the Os and Ti groups and between the Os and Zi groups at 2 and 8 weeks (P<.05). Comparing by week in each group, the Ti group showed a significant difference between 4 and 8 weeks. Histomorphometric analysis also showed significant differences in new bone formation between the control group and the experimental groups at 2, 4, and 8 weeks (P<.05). In the comparison of newly formed bone, significant differences were observed between 2 and 4 weeks and between 2 and 8 weeks (P<.05) in all groups. CONCLUSION. Zirconia bone graft material showed satisfactory results in new bone formation and zirconia could be used as a new synthetic bone graft material.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.34 no.2
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• pp.220-229
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• 2008

Purpose: The present study was aimed to examine the effect of acellular dermal matrix ($AlloDerm^{(R)}$) grafted to the experimental tissue defect on tissue regeneration. Materials and Methods: Male albino rabbits were used. Soft tissue defects were prepared in the external abdominal oblique muscle. The animals were then divided into 3 groups by the graft material used: no graft, autogenous dermis graft, and $AlloDerm^{(R)}$ graft. The healing sites were histologically examined at weeks 4 and 8 after the graft. In another series, critical sized defects with 8-mm diameter were prepared in the right and left iliac bones. The animals were then divided into 5 groups: no graft, grafted with autogenous iliac bone, $AlloDerm^{(R)}$ graft, $AlloDerm^{(R)}$ graft impregnated with rhBMP-2, and $AlloDerm^{(R)}$ graft with rhTGF-${\beta}1$. The healing sites of bone defect were investigated with radiologic densitometry and histological evaluation at weeks 4 and 8 after the graft. Results: In the soft tissue defect, normal healing was seen in the group of no graft. Inflammatory cells and foreign body reactions were observed in the group of autogenous dermis graft, and the migration of fibroblasts and the formation of vessels into the collagen fibers were observed in the group of $AlloDerm^{(R)}$ graft. In the bone defect, the site of bone defect was healed by fibrous tissues in the group of no graft. The marked radiopacity and good regeneration were seen in the group of autogenous bone graft. There remained the traces of $AlloDerm^{(R)}$ with no satisfactory results in the group of $AlloDerm^{(R)}$ graft. In the groups of the $AlloDerm^{(R)}$ graft with rhBMP-2 or rhTGF-${\beta}1$, there were numerous osteoblasts in the boundary of the adjacent bone which was closely approximated to the $AlloDerm^{(R)}$ with regeneration features. However, the fibrous capsule also remained as in the group of $AlloDerm^{(R)}$ graft, which separated the $AlloDerm^{(R)}$ and the adjacent bone. Conclusions: These results suggest that $AlloDerm^{(R)}$ can be useful to substitute the autogenous dermis in the soft tissue defect. However, it may not be useful as a bone graft material or a carrier, since the bone defect was not completely healed by the bony tissue, regardless of the presence of osteogenic factors like rhBMP-2 or rhTGF-${\beta}1$.