Bone Grafts

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Bone grafts from Intraoral Donor Sites

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Bone grafts from Intraoral Donor Sites Introduction and principles

In the orthopedic fi eld, bone, tendon and ligament, cartilage, nerve, fascia, and skin have all been transplanted. Among these tissue transplantations, bone grafting is a widely popular surgical procedure. As materials for bone grafting, autografts, synthetic bone substitutes, and banked bone allografts have mainly been used in Japan. Autografts have the predominant property of osteoinduction and osteoconduction, however, there are limitations to the volume, shape, and size of autografts that can be excised. Excision of autogenous bone is also an invasive procedure. Therefore, synthetic bone substitutes and banked bone allografts are of service instead of autografts. Synthetic bone substitutes have a variety of shapes and biomechanical characteristics, and some of them are bioabsorbable.

Bone grafting of the resorbed dental alveolus is often necessary prior to dental implantation. Many allografts and alloplastic materials have been used as bone graft substitutes, but autogenous corticocancellous bone grafts have still remained the gold standard for the reconstruction of alveolar bone. Research in the field of oral and maxillofacial surgery has produced new surgical techniques and bone harvesting donor sites for bone augmentation in deficient sites. The goal of these studies is the same - to reduce complications and post-operative morbidity, and to minimize the economic costs of the treatment. The use of the extra-oral bone harvesting donor sites, such as the anterior and posterior iliac crest, is still the standard when large reconstructions are performed in the maxillo-mandibular region for example after tumor surgery or in dental implant treatment to totally edentulous jaws.

However, the current trend when implant surgery is done to partially edentulous resorbed dentoalveolar ridges is to harvest bone from an intra-oral donor site. The use of the dental implants for the reconstruction of edentulous jaws has been a progressively growing treatment modality since the late 1970´s. Brånemark and coworkers published their first follow-up report of osseointegrated implants in the treatment of the edentulous jaw in 1977. Bone grafting of the resorbed alveolus for dental implants was employed later and Breine and Brånemark (1980) Kahnberg (1989), Sailer (1989) and Adell (1990) reported results on prosthetic reconstruction of the resorbed edentulous jaws with autologous bone grafts and dental implants (Kahnberg et al. 1989, Sailer 1989, Adell et al. 1990). Boyne and James were the first to report experiences with inlay bone grafting of the maxillary sinus for dental implants (Boyne & James 1980). After these studies dozens of articles were published concerning alveolar bone augmentation in edentulous or partially edentulous alveolar ridges prior to or in conjunction with dental implant placement. The first reports of intra-oral bone harvesting and bone grafting for dental implants were published at the beginning of the 1990´s .

Most of these reports highlighted the intra-oral harvesting sites as having convenient surgical access. The ischemic time of the bone graft has reported to be short. Furthermore, since both the donor and recipient sites are intra-oral, there was no morbidity ...
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