Today, thanks to the advances in techniques and technology we can regenerate bone at the same time or before implant placement meaning we can insert the fixture in the optimal restorative position rather than where existing bone dictates.
We have multiple types of biomaterial to help regenerate new bone. This article concentrates on a bone graft derived from the patient’s tissue – bone or dentin.
AUTOLOGOUS BONE GRAFTING – Autologous Bone.
An autogenous or autologous graft is one harvested from a site and used to regenerate bone in another site of the same individual. Autogenous bone or dentin possesses osteoconductive, osteoinductive and osteogenic properties.
AUTOGENOUS IN IMPLANTOLOGY
Maxillo-facial surgeons often sourced bone from the hip and transplanted it into the mouth. This was associated with significant additional trauma and cost. Today, with General Practice dominating the placement of dental implants autogenous bone retrieved from intra-oral sites is more popular. This can be used alone or mixed with an autogenous substitute bone material sharing similar properties or a slow turnover material to add bulk and preserve the volume be that synthetic or xenograft. (see below).
RETRIEVAL OF AUTOGENOUS BONE
If Dentin-derived autogenous tissue is unavailable then a variety of tools exist to assist retrieval of intra-oral autogenous bone.
Bone Collector Drill (Re-usable)
Available in various options the re-usable bone collector drill is fitted with a safety drill stopper which restricts drilling depth to around 4mm.
Bone Collector Drill Kit.
For added flexibility, autologous retrieval kits which include four drills of diameters 4.0mm, 5.0mm, 6.0mm and 7.0mm are available with safety stoppers.
Re-usable collector drills offer the least expensive way to acquire autogenous bone.
Bone scrapers (Single Use).
Bone scrapers offer quick collection of cortical bone shavings when a flap is raised. Featuring a heat-treated blade within a transparent and ergonomic body Dental Studio scrapers cost 30% less than alternative brands such as safe scrapers*
Micro Bone scrapers
Micro scrapers offer bone retrieval from narrow, difficult-to-reach areas and require a smaller, less traumatic flap. Each micro scraper is produced in steel with a circular blade and spring-loaded action.
Autologous Dentin.
Extracted teeth can be processed into an autologous bone graft using the KometaBio system. Just like intra-oral bone, dentin-derived grafts provide growth factors with the additional structure to support osteoconduction. Numerous studies demonstrate the bone regenerated to be excellent with new bone directly fused to the existing bone bed.
One molar tooth can generate up to 2.5cc of usable graft making KometaBio derived autologous dentin very cost-effective in terms of consumable costs per cc. The KometaBio protocol can be seen in this video.
What is needed to create a Dentin-derived bone graft from an extracted tooth?
After cleaning, the dried tooth is ground and sieved inside the single-use chamber. Granules of two sizes are produced. These can be mixed or used individually. The granules are cleansed and washed with KometaBio solutions after which they are ready to use or store for a delayed procedure.
COMPOSITE GRAFTS MIXED WITH AUTOLOGOUS TISSUE
Collected autogenous bone, processed dentin and autogenous substitute bone can be supplemented with blood, PRF or liquid medications.
BULK OUT THE AUTOGENOUS GRAFT WITHOUT ALTERING THE PROPERTIES
In some cases, the additional trauma to collect more autogenous bone is not inappropriate. In this situation add Powerbone (silicate substituted BetaTCP) Granules autogenous substitute bone to the autogenous bone. This innovative product attracts cells, supports new bone healing and resorbs in line with remodelling. Unlike allograft or xenograft this option avoids adding animal or human tissues.
PROLONG THE VOLUME:
Mix with Powerbone (Biphasic) Granules or Ti-oss xenograft. These materials offer resistance to remodelling and when added to autologous bone or dentin will prolong the volume of the graft whilst retaining the osteoinductive characteristics of the autologous tissue. Powerbopne Biphasic contains no animal or human tissue. Ti-oss is a processed xenograft formed only from bovine cancellous bone.
CHANGE THE FORM – CREATE A STICKY BONE
Mix with Centrifuged blood or PRF Membrane. Combining Autogenous bone shavings or KometaBio-prepared Dentin with a freshly prepared PRF membrane creates an osteoinductive sticky bone graft. (Protocol)
INCREASE THE HEALING – MIX WITH PRF
Flowable PRF can be created at low centrifuge speeds by using tubes with an anticoagulant coating. Platelet-rich fibrin and particulate graft materials exhibit a synergistic effect during bone tissue healing. Alone, PRF shows a quick resorption that does not sustain long-term volume stability. Combining with a bone substitute is recommended with studies showing such mixtures enhance bone growth in sockets and alveolar jaw defects.
DELIVER CHEMICAL OR MEDICINAL AGENTS
Antibiotics, antiseptics or other pharmaceutical agents with an aqueous (water) base can be incorporated with granules of autogenous bone, KometaBio dentin or Powerbone Synthetic Granules. Antibiotics delivered in a fully resorbing graft are beneficial when performing revision procedures associated with peri-implantitus.
Contact Regen Store to discuss any of the products mentioned in this article.
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Email Implant Store on ask@implant-store.co.uk
Email Regen Store on ask@regen-store.co.uk
*VAT is charged on UK-delivered orders. Exports are nil VAT.
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