Options with Autogenous

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 the existing bone level dictates.

We can utilise several different types of biomaterial to help regenerate new bone. This article concentrates on a graft derived from the patient’s own tissue – be that 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. Long regarded as the gold standard for bony augmentation autogenous bone or dentin possesses osteoconductive, osteoinductive and osteogenic properties.

RETRIEVAL

When implants were provided by maxillo-facial surgeons bone was often sourced from the hip and transplanted into the mouth. 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 a proprietary biomaterial to bulk out the volume or change the resorption profile (see below).

A variety of tools are available from Regen Store to help secure intra-oral autogenous bone.

Bone Collector Drill (Re-usable)

Available in 4mm or 5mm diameter with two or three spiral blades the re-usable bone collector drill is fitted with a safety drill stopper which restricts drilling depth to around 4mm.

Fitting: Contra angle handpiece.
Rotation speed: Up to 50 rpm without irrigation or 100 rpm+ with irrigation. Durability: ~25 Procedures.

Bone Collector Drill Kit.

For maximum flexibility, an autogenous bone collector kit is also available which includes four drills of diameters 4.0mm, 5.0mm, 6.0mm and 7.0mm each with a peek safety stopper. Re-usable collectors offer the least expensive way to acquire bone of good quality.

Bone scraper (Single Use).

Bone scrapers offer a quick and efficient collection of cortical bone shavings. Constructed from transparent material for easy intra-oral visualisation and formed in an ergonomic shape for easy intra-oral handling, Dental Studio scrapers use a heat-treated blade which can be rotated giving four fresh cutting edges.

Dental Studio autogenous bone scrapers offer excellent value for money at 30% less than safe scrapers*

Micro Bone scraper (Multi-Use).

Micro scrapers offer a minimally invasive autogenous bone collection which allows clinicians to better harvest bone in narrow, difficult-to-reach areas. Each reusable micro scraper is produced in steel with a circular blade and spring-loaded action for removing the retrieved shavings.

Autologous Dentin.

When teeth are extracted they can be recycled as a bone graft using the KometaBio system. Just like autogenous retrieved bone, dentin-derived grafts provide growth factors plus the mineral structure to support osteoconduction. The bone regenerated is shown to be of excellent quality with new bone directly fused to the existing bone bed.

Dentin-derived bone grafts are the most cost-effective with one molar generating up to 2.5cc of usable graft at modest consumable costs.

What is needed to create a Dentin-derived bone graft from an extracted tooth?

• The KometaBio grinding and sorting unit.
• A single-case KometaBio grinding chamber.
• Single case KometaBio cleaning and irrigating solutions.

After cleaning, the tooth is dried, ground and sieved inside the single-use chamber. Granules of two sizes are available which can be mixed or used individually depending upon the case. The chosen granules are cleansed and washed in the provided KometaBio solutions after which they are ready to be used.

Demineralised option.

If a quicker resorbing graft is required then an additional soaking in the optional KometaBio demineralising solution can be undertaken. When using the smaller sieved granules this provides for the quickest resorbing graft. Large sieved granules without a demineralizing solution wash will be more resilient to remodelling with corresponding preservation of volume.

COMPOSITE GRAFTS USING AUTOLOGOUS TISSUE

Collected autogenous bone and processed dentin can be used alone or augmented with blood, PRF, Ti-oss xenograft or Powerbone synthetic granules.

Why create a bone mix?

BULK OUT THE GRAFT

Mix with Powerbone (silicate substituted BetaTCP) Granules.

In some cases the additional trauma to collect more autogenous bone is not considered appropriate in which case retrieved autogenous bone can be mixed with a proprietary alternative. Mixing with Powerbone Synthetic Granules increases the osteoconductive characteristics whilst maintaining the osteoinductive and full resorption character of the autogenous bone

PROLONG THE VOLUME

Mix with Powerbone (Biphasic) Granules or Ti-oss xenograft.

These two materials offer resistance to remodelling and when added to autologous bone or dentin will prolong the volume of the regenerated site whilst retaining the osteoinductive characteristics of the autologous tissue. Powerbopne Biphasic is a synthetic and Ti-oss is a xenograft.

CREATE A STICKY BONE

Mix with Centrifuged blood or PRF Membrane.

Combine Autogenous bone shavings or KometaBio-prepared Dentin with a freshly prepared PRF membrane (slug) to create an osteoinductive sticky bone graft. (Protocol)

INCREASE THE HEALING

Flowable PRF can be created at low centrifuge speeds by using a plastic tube with an anticoagulant coating.

Platelet-rich fibrin and particulate graft materials appear to exhibit a synergistic effect during bone tissue healing. The platelet-rich fibrin clot is formed by a natural cross-linking process during the centrifugation of blood in the presence of a physiological amount of fibrinogen and thrombin. Alone, PRF shows a quick resorption that does not sustain long-term volume stability. Combining with a bone substitute is recommended to repair large bone defects. Studies show such mixtures enhance bone growth in sockets and alveolar jaw defects. (Ref)

DELIVER DRUGS OR AQUEOUS AGENTS –Pharmaceutical 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 or advanced gingivitis with implants or root surfaces.

Contact Regen Store to discuss any of the products mentioned in this article.

ask@regen-store.co.uk