JICDRO is a UGC approved journal (Journal no. 63927)

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CASE REPORT
Year : 2016  |  Volume : 8  |  Issue : 1  |  Page : 70-75

Autogenous bone graft for management of periodontal defects


Department of Periodontology, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India

Date of Web Publication12-Feb-2016

Correspondence Address:
Dr. Sneha Kataria
F-147, Opposite GRPF Police Station, Near Platform No. 1, South Civil Lines, Jabalpur - 482 001, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-0754.176261

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   Abstract 

The aim of this article is to present the use of autogenous bone graft for regenerative management of infrabony and furcation osseous defects. A trephine bur (Auto Chip Maker ® ) was used to obtain autograft from the anterior mandibular region. It is considered as the "gold standard" bone graft, but the difficulty in harvesting it and the increased chairside time have reduced its popularity. This report highlights the use of Auto Chip Maker ® to harvest autograft for management of periodontal osseous defects.

Keywords: Autogenous bone graft, furcation defect, infrabony defect, trephine bur


How to cite this article:
Kataria S, Chandrashekar KT, Mishra R, Tripathi V. Autogenous bone graft for management of periodontal defects. J Int Clin Dent Res Organ 2016;8:70-5

How to cite this URL:
Kataria S, Chandrashekar KT, Mishra R, Tripathi V. Autogenous bone graft for management of periodontal defects. J Int Clin Dent Res Organ [serial online] 2016 [cited 2020 Oct 27];8:70-5. Available from: https://www.jicdro.org/text.asp?2016/8/1/70/176261


   Introduction Top


Periodontal disease is one of the two major dental diseases that affect human populations worldwide [1] and is characterized by gingival inflammation, periodontal pocket formation, clinical attachment loss, and alveolar bone resorption. The primary goal of periodontal therapy is to arrest the progression of periodontal disease and maintain the natural dentition in health and function. [2] This goal can be accomplished by nonsurgical therapy in patients with mild to moderate periodontitis, whereas in advanced cases, particularly in the presence of osseous defects, surgical procedures that regenerate the supporting periodontal tissues may be employed. Periodontal regeneration can be achieved by application of root conditioning agents such as citric acid, tetracycline, enamel matrix derivative (EMD), bone replacement grafts, guided tissue regeneration (GTR), bone morphogenetic proteins, growth factors, tissue engineering, and stem cell therapy. [3]

Various bone grafts have been used for periodontal regeneration and are classified, on the basis of their sources, into autografts, allografts, xenografts, and alloplasts. [4] Autogenous bone grafts and demineralized freeze-dried bone allografts have shown potential for true periodontal regeneration, whereas alloplastic bone grafts merely act as inert fillers of bone defects. [5]

With the improvement in our understanding about molecular biology, genetics, and bioengineering, research is being focussed on incorporating these developments to achieve periodontal regeneration. [6] However, this technology is still in its initial phase and presently, autogenous bone grafts are considered as the "gold standard" bone replacement grafts.

Autogenous bone releases osteogenic growth factors such as bone morphogenetic proteins, which promote proliferation and differentiation of progenitor cells (osteoinduction) and provide a scaffold for osteoblasts to produce new bone (osteoconduction). Autogenous bone carries no risk of immunologic reaction or disease transmission, and provides optimal conditions for the penetration of new blood vessels to allow rapid revascularization and migration of osteoprogenitor cells. [7]

It may be obtained as a block graft or particulate graft. Particulate grafts are preferred over large bone blocks because they provide greater surface area for proliferating progenitor cells to attach and promote new bone formation. However, the viability of osteocytes is essential to ensure acceptance of a graft. [7] Hence, the method to harvest is also crucial. Trephine burs are used to obtain intraoral autogenous bone grafts. One such instrument, the Neo Auto Chip Maker ® , manufactured by Neobiotech, USA, can be used to harvest autografts from the mandibular molar or incisor region. It is provided with a stopper, which allows the bur to reach to a depth of only 4 mm and prevents it from going deeper.

The purpose of this case report is to describe the management of periodontal osseous defects using autogenous bone grafts obtained by a trephine bur (Auto Chip Maker) from the anterior mandibular region.


   Case Reports Top


Case report 1

A 35-year-old male patient reported to the outpatient Department of Periodontology with the chief complaint of bleeding gums for the past 2 years. On the first visit, the case history, clinical parameters including the gingival index, and clinical attachment level were recorded using UNC-15 probe with an acrylic stent [Figure 1]. Intraoral periapical radiographs were taken with the long-cone paralleling technique using a holder and grid [Figure 2]. The oral hygiene status of the patient was poor. On intraoral examination, generalized periodontal pockets were present and a clinical attachment level of 9 mm was seen in relation to tooth number 46. Based on the above findings, a diagnosis of chronic generalized periodontitis was arrived at.
Figure 1: case 1. pre operative

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Figure 2: case 1. pre operative radiograph

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Case report 2

A 45-year-old female patient reported to the outpatient Department of Periodontology with the chief complaint of difficulty in mastication for the past 2 years. Case history, clinical parameters [Figure 3], and intraoral periapical radiograph [Figure 4] were obtained. The oral hygiene status of the patient was fair. On intraoral examination, grade II furcation involvement was seen with relation to tooth number 36. A diagnosis of chronic localized periodontitis in relation to #36 was made.
Figure 3: case 2. pre operative

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Figure 4: case 2. pre operative radiograph

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The treatment plan was explained to both the patients and informed consent was obtained. Oral hygiene instructions were given, and phase I therapy was initiated. On further appointments, oral hygiene status and gingival status were recorded for improvement. Henceforth, periodontal regenerative procedures were instituted.

Surgical procedure

Presurgical rinse with 0.12% chlorhexidine was done. Under local anesthesia, a full-thickness mucoperiosteal flap was elevated in the concerned region [Figure 5] and [Figure 6]. Thorough surgical debridement was performed and irrigation with isotonic saline was done to reveal the underlying osseous defect [Figure 7]. Another incision was made in the mucobuccal fold in the mandibular anterior region [Figure 8] and [Figure 9] to expose the underlying bone. Autogenous bone graft was obtained from this region using the Auto Chip Maker (speed 300 rpm, torque 50 Ncm) [Figure 10] and [Figure 11]. The corticocancellous bone graft was collected and packed in the defect area [Figure 12] and [Figure 13]. The flaps were sutured with 4-0 black silk sutures [Figure 14] and [Figure 15], periodontal dressing was applied, and postoperative instructions were given. Postoperative medications included amoxycillin 500 mg thrice a day and diclofenac sodium 50 mg thrice a day for 5 days. The sutures were removed after 1 week. Postoperative healing was uneventful.
Figure 5: case 1. flap reflection and debridement

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Figure 6: case 2. flap reflection and debridement

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Figure 7: case 2. measurement of defect depth

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Figure 8: case 1. donor site

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Figure 9: case 2. donor site

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Figure 10: case 1. harvesting of ABG using ACM

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Figure 11: case 2. donor site after graft harvestation

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Figure 12: case 1. placement of ABG at defect site

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Figure 13: case 2. placement of ABG at defect site

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Figure 14: case 1. sutures

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Figure 15: case 2. sutures

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Recall appointments consisted of reinforcement of oral hygiene instructions, scaling if required, and periapical radiographs of the involved tooth. During the follow-up visits at 3 months, 6 months, 9 months, and 12 months, significant reductions in gingival index and periodontal probing depth were recorded for both the patients. For the first case, attachment loss reduced from 9 mm at baseline to 3 mm after 6 months, which was also maintained after 1 year [Figure 16]. In the second case, reduction in horizontal probing depth [Figure 17] was observed along with increase in radiographic bone density in the periapical area after 1 year [Figure 18] and [Figure 19], indicating successful resolution of the periodontal disease and bone fill in the region.
Figure 16: case 1. 12 months follow up

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Figure 17: case 2. 12 months follow up

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Figure 18: case 1. 12 months post operative radiograph

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Figure 19: case 2. 12 months post operative radiograph

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   Discussion Top


The use of bone grafts for reconstructing osseous defects dates back to Hegedus in 1923, when the tibia was used as the source of graft for treatment of periodontal defects. Autogenous bone grafts are considered as the "gold standard" by many authors due to their multiple advantages over other graft materials available. [8] They can be obtained from both extraoral and intraoral sources. Although extraoral autogenous bone grafts from iliac cancellous bone and marrow were of high interest due to their high potential for true osteogenesis, [2] ankylosis and root resorption (2.8%) have been reported with their use, which has limited their clinical use. Therefore, intraoral sources provide a better alternative. Common donor sites include the symphysis, ramus, and body of mandible; the coronoid process; the maxillary tuberosity; the zygomatic buttress, bone from healing extraction wound and edentulous ridges; Bone trephined from within the jaw without damaging the roots; bone removed during osteoplasty and ostectomy (tori, exostoses); and scraped bone.

Autogenous bone grafts have shown improved results in bone fill in periodontal osseous defects and bone augmentation procedures for implants. They have been used as a guided bone regeneration material, for implant stabilization, and in treatment of periimplantitis. Al-Sulaimani et al. (2013) showed that the filling of the periimplant bone defects with autogenous bone grafts showed a better outcome compared to unfilled defects. [9] Pandit et al. (2012) reported improved prognosis of hopeless teeth when treated with autogenous bone graft. [10] Verdugo and d'Addona (2012) described successful resolution of bilateral mandibular vertical defects on both molars and premolars and the eradication of subgingival periopathogens by the use of autogenous bone graft. [11]

The case reports presented here describe the management of periodontal osseous defects, which have been treated with autogenous bone graft obtained by using a trephine bur (Auto Chip Maker ® ). The cases were followed for a period of 1 year to gather clinical and radiographic evidence of attachment gain.

The major limitation of autogenous bone grafts is the limited availability of bone graft and increased chairside time. With the advancement in commercially available trephine burs, these limitations can be successfully overcome and autogenous grafts can be used widely for better results.


   Conclusion Top


Within the limitations of the present study, it can be concluded that periodontal defects can be successfully treated with autogenous bone graft, which can be easily procured using newer trephine burs such as the Auto Chip Maker ® .

Acknowledgments

This work was supported by Hitkarini Dental College and Hospital, Jabalpur, M.P., India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Petersen PE, Ogawa H. Strengthening the prevention of periodontal disease: The WHO approach. J Periodontol 2005;76:2187-93.  Back to cited text no. 1
    
2.
Rosen PS, Reynolds MA, Bowers GM. The treatment of intrabony defects with bone grafts. Periodontol 2000 2000;22:88-103.  Back to cited text no. 2
    
3.
El-Haddad SA, Razzak MY, Saudi HI, Ghorab NM. Evaluation of bioactive glass and autogenous bone in the treatment of Grade II furcation involvement: A randomized controlled trial. J Interdiscip Dentistry 2014;4:13-23.  Back to cited text no. 3
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4.
Nasr HF, Aichelmann-Reidy ME, Yukna RA. Bone and bone substitutes. Periodontol 2000 1999;19:74-86.   Back to cited text no. 4
    
5.
Reynolds MA, Aichelmann-Reidy ME, Branch-Mays GL, Gunsolley JC. The efficacy of bone replacement grafts in the treatment of periodontal osseous defects. A systematic review. Ann Periodontol 2003; 8:227-65.  Back to cited text no. 5
    
6.
Grover V, Malhotra R, Kapoor A, Verma N, Sahota JK. Future of periodontal regeneration. J Oral Health Comm Dent 2010;4 (Suppl):38-47.  Back to cited text no. 6
    
7.
Miron RJ, Hedbom E, Saulacic N, Zhang Y, Sculean A, Bosshardt DD, et al. Osteogenic potential of autogenous bone grafts harvested with four different surgical techniques. J Dent Res 2011;90:1428-33.  Back to cited text no. 7
    
8.
Zaner DJ, Yukna RA. Particle size of periodontal bone grafting materials. J Periodontol 1984;55:406-9.  Back to cited text no. 8
[PUBMED]    
9.
Al-Sulaimani AS, Mokeem SA, Anil S. Peri-inplant defect augmentation with autogenous bone: A study in beagle dogs. J Oral Implantol 2013;39:30-6.  Back to cited text no. 9
    
10.
Pandit N, Pandit IK, Malik R, Bali D, Jindal S. Autogenous bone block: A hope for hopeless teeth. Contemporary Clinical Dentistry 2012;3:437-42.  Back to cited text no. 10
    
11.
Verdugo F, D′Addona A. Long-term stable periodontal regeneration by means of autologous bone grafting in patients with severe periodontitis. Int J Periodontics Restorative Dent 2012; 32:157-64.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15], [Figure 16], [Figure 17], [Figure 18], [Figure 19]



 

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