Types of Grafts in Dentistry

Types of Grafts in DentistryTYPES OF GRAFTSOsseointegrated implants mass be combined with the following types of en transpose inlay, saddle, veneer, onlay (partial or full arch), and maxilla sinus grafts. (Triplett Schow, 1996)The mucoperiosteal flap should be designed to adequately expose the underlying residual ridge, maintain a broad base for vascular support, and all(prenominal)ow tension-free primary quill closure. A midcrestal incision is usually preferred because it maximizes the vascularity to the margins of the mucoperiosteal flaps and minimizes ischemia created by the vasculature traversing dense, keratinized tissue at the crest of the ridge. Labial vertical releasing incisions atomic number 18 make as needed to improve access. All grafts must be well adapted to the recipient site with no or minimal space betveen amidst graft and residual mug up. Hence, usually graft shaping and adaptation is unavoidable. The gGraft is positioned to its best adaptation to the under lying alveolus. A good fixation with titanium screws must be achieved to counteract the graft movement. Any movement of the graft increases the chance of soft tissues ingrowth between the graft and the recipient site, and thus the failure of the graft is likely. All voids or defects should be filled with particulate clathrate tog up and marrow to provide good contour and eliminate dead space. A primary, tension-free closure must be achieved to counter wound breakdown and graft exposure. A barrier membrane and filler graft may be used, if desired.Inlay GraftsSmall osseous defects at the dental crest can be inlaid with an autologous graft to regenerate the contour and volume of drop necessary to place an the implant and allow for a proper emergence profile.The defect is usually exposed through a crestal incision that is extended around the necks of one or two adjacent odontiasis on either side of the defect. A vertical releasing incision is made if necessary. A barrier membran e may be used to entertain these areas during healing.Saddle GraftIndicated where both horizontal and vertical ridge augmentationS1, this type of graft is also of considerable value. Aautogenous bone stabilized with rigid fixation to restore anatomic height and largeness is an excellent solution to this problem. A saddle of bone is obtained from the anterior-inferior border of the mandible (ipsilateral site) and secured in position from the buccal or crestal spirit with 1.5mm titanium screws with a stripped-down of 2 screws to achieve stable graft fixation.Veneer GraftA veneer graft is preferred where there is however a horizontal bone defect of less than 4 mm. TOnlay GraftThe design of onlay grafts can be segmental or arch in shape.Both the height and width of an atrophic ridge can be achieved with onlay grafts. Following Iindications include the followingS2 inadequate residual alveolar ridge height and width to support a functional prosthesis, contour defects that compromise i mplant support, function, or aesthetics, and segmental alveolar bone loss.- unconscious processs aimed at increasing the volume of attached mucosa (free soft tissue grafts, pedicle soft tissue grafts, and operative accompaniment of the vestibulum) have been recommended in areas of movable mucosa. 75,77,102111 S3(Esposito, Hirsch, Lekholm, Thomsen, 1999)There wasIt has also been also stated that cancellous grafts are more undefeated because of cortical plate (Buchman 1999 Cancelous bead stucture.pdf, n.d.)ResultsA pPositive correlation outcome was launch between shape up and missing teeth found in both groups A and B in the applied denary regression abstract (SPSS) pigeonholing A compend for correlation between the patients age and number of teeth missing outcome correlational statisticssPatients ageNumber of TeethPatients agePearson correlativity1.326**Sig. (2-tailed).000N120111Number of TeethPearson Correlation.326**1Sig. (2-tailed).000N111111**. Correlation is significa nt at the 0.01 level (2-tailed). sort out B outcomeCorrelationsPatients ageNumber of TeethPatients agePearson Correlation1.465**Sig. (2-tailed).004N4137Number of TeethPearson Correlation.465**1Sig. (2-tailed).004N3737**. Correlation is significant at the 0.01 level (2-tailed).A pPositive correlation was found between age and bone volume harvested in Group A. However, the correlation in Group B was non significant.Group A multiple regression analysis outputCorrelationsPatients age swot graft volumePatients agePearson Correlation1.244**Sig. (2-tailed).007N120120 prink graft volumePearson Correlation.244**1Sig. (2-tailed).007N120120**. Correlation is significant at the 0.01 level (2-tailed).Group B SPSS multiple regression analysis outputCorrelationsPatients ageBone graft volumePatients agePearson Correlation1.203Sig. (2-tailed).203N4141Bone graft volumePearson Correlation.2031Sig. (2-tailed).203N4141The distribution for harvested overall bone volumes was found to be normal in both gro ups A and B and a significant correlation was found between clinitianclinician A and clinitianclinician B and their harvested bone volumes.Distribution analysis output. HistogramMultiple regression analysis output for ClinitianClinician AANOVAa manakinSum of SquaresdfMean SquareFSig.1Regression9317266.32619317266.32631.994.000bResidual42518278.360146291221.085 make out51835544.6851472Regression16022829.75928011414.87932.437.000cResidual35812714.927145246984.241 meat51835544.685147a. Dependent Variable Bone graft volumeb. Predictors (Constant), Number of Teethc. Predictors (Constant), Number of Teeth, Procedure PerformerAssociation between a patients gender and performed clinicians A ands B found to be non statistically significant applying SPSS multiple regression analysis.The SPSS output for multiple regression analysisGroup StatisticsProcedure PerformerNMeanStd. DeviationStd. Error MeanPatients ageAP4138.8511.5991.811SG12039.0511.8761.084Case Processing SummaryCasesValid missTota lNPercentNPercentNPercentProcedure Performer * Patients Gender161100.0%00.0%161100.0%Procedure Performer * Patients Gender despoil tabulationPatients GenderTotalMaleFemaleProcedure PerformerAPCount83341Expected Count10.730.341.0SGCount3486120Expected Count31.388.7120.0TotalCount42119161Expected Count42.0119.0161.0Chi-Square TestsValuedfAsymp. Sig. (2-sided)Exact Sig. (2-sided)Exact Sig. (1-sided)Pearson Chi-Square1.233a1.267Continuity Correctionb.8181.366Likelihood Ratio1.2861.257Fishers Exact Test.309.184Linear-by-Linear Association1.2261.268N of Valid Cases161a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 10.70.b. Computed only for a 22 tableThe Aassociation between a patients age and clinitiansclinicians A and B was also not statistically significant (Reszults, n.d.). P value was more than 0.05. So the hypothesis that there is no variation between patientspatients age and performed clinitianclinician A and B harvested bone volumes can not be r ejected the hypothesis.Nominal variables (number of teeth) were not equally distributed. So, a nonparametric Kruskal-Wallis Test was applied to trial run the hypothesishypostasis that there wasis no difference between the number of teeth missing and harvested bone volumes in group A and B. The hypothesis washypostasis rejected in Group A because the P value was less than 0.05. However, there was no difference in a Ggroup B (p value more than 0.05)Number of teeth and harvested bone volumes distribution for Group AKruskal-Wallis hypothesis testing outputRanksNumber of TeethNMean RankBone graft volumeOne tooth2240.95 cardinal teeth3843.41Three teeth3068.45Four and more teeth2176.76Total111Test Statisticsa,bBone graft volumeChi-Square23.851df3Asymp. Sig..000a. Kruskal Wallis Testb. Grouping Variable Number of TeethSPSS output for Kruskal-Wallis Test Group BRanksNumber of TeethNMean RankBone graft volumeOne tooth1114.59Two teeth1119.45Three teeth1120.27Four and more teeth426.38Total37Te st Statisticsa,bBone graft volumeChi-Square3.855df3Asymp. Sig..278a. Kruskal Wallis Testb. Grouping Variable Number of TeethA bone volumes distribution was tested by drawing a histogram to determent determine a parametric or non parametric test was needed to applyin order to test the hypothesisS4. The data was not equally distributed in both groups A and B. Hence, the non parametric Mann-Whitney test was applied to test the null hypothesis of if whether there is was no all difference in harvested bone volumes and the performance of theed clinicians. The P value was less than 0.05, so the null hypothesis was rejected and there is was a significant difference between cclinician As and clinicians B performances.ClinitianClinician A and B harvested bone volumes distributionsDescriptive StatisticsNMeanStd. DeviationMinimumMaximumBone graft volume1611121.5017622.0416880.003380.00Procedure Performer1611.75.43712SPSS output Mann-Whitney TestRanksProcedure PerformerNMean RankSum of RanksBon e graft volumeAP4146.891922.50SG12092.6511118.50Total161Test StatisticsaBone graft volumeMann-Whitney U1061.500Wilcoxon W1922.500Z-5.427Asymp. Sig. (2-tailed).000a. Grouping Variable Procedure PerformerConclusionsA mandibular ramus donor site can provide sufficient autologous bone volume to restore dentoalveolar defects prior to dental implantation.PThe cocksure correlations were found between a patients age and missing teeth, between clinicians A and B and their harvested bone volumes, and between harvested bone volume and a patients age in a group A but this was not significant in Group B., Bbetween a patients age and gender in both groups A and B there was no significant correlation based on the multiple regression analysis outcome SPSS.To conclude, with thean increasinge in age there were a higher number of teeth missing in both groups A and B. Although, the diameter of bone reconstructive memory were was greater because of a more missing teeth, the harvested volumes were gre ater only in the Group A harvested by cClinician A (pis was a significant difference between clinicians A and B and their harvested bone graft volumes in Group A and B (pthe person who operatesor.In aAdditionally to mandibular, ascending ramus bone can be harvested at intraoral sites and can be considered incrementally to the performed procedure, S5such as the contralateral ramus site, chin, and maxillary tuberosity, where when greater bone volumes are required. Moreover, the bone materials can be also added too, increase the further if the bone volume is yet not yet sufficient. And finally, based on the literature review findings, the majority of iliac crest bone graft can be successfully replaced with ascending ramus bone grafts as the studies revealed that the harvested bone grafts are not significantly greater.The outcome of implant therapy has been summarized in several recent reviews (Cochran 1996, Esposito et al. 1998, Fritz 1996, Fiorellini et al. 1998, Gotfredsen 1999, Meri cske-Stern 1999, Van Steenberge et al. 1999) and evaluations are often reported in success and survival rates. The interpretation of the results, however, relies on the concept that different investigators use similar criteria for implant success and survival. Variations in hit the books design and study period, and an improper definition of the selection of patients are factors that may further affect the interpretation of the data.First, autologous bone grafts of various types to different locations can be successfully used to improve the ability to place endosseous implants. Complications that lead to failure can be minimized with experience and adherence to the basic surgical principles of rigid fixation and tension-free primary closure of the soft tissue flaps. Second, most of the grafting failures are associated with infection or exposure of the graft to the oral enclosed space because of mucosal flap dehiscence. Early loading of grafts with a transitional prosthesis is also a potential cause of graft compromise or failure. Third, the successful placement of endosseous implants in autologous grafts is more predictable when they are placed secondarily after bone graft consolidation and. fFourth, whether placed immediately with the bone graft, or secondarily, failure of individual implants does not imply failure of the bone graft.Frenuloplasty, Frenectomy, Vestibuloplasty Technique (Liposky, 1983) oOr Mandibular Anterior Ridge Extension Modification of the Kazanjian (Al-Mahdy Al-Belasy, 1997), Vestibule and floor-of-mouth extension procedures, Soft-tissue grafts (full thickness or connective)Although COHRANE stated that autologous is not in favour, this statement needs to be taken considered very carefulycarefully because the outcome does not measure all aspects in convensionalconventional terms of success. As stated before, a simple implants survival is no longer a single preferable outcome today. Cohrane agrees that there is littleare hardly a(prenomi nal) randomized controlled trials and for most that are conducted today are at a high risk of bias remains.Further more, bone augmentation, such as synteticsynthetic bone materials, provide a poorer outcome rather thaen animal retrieved bone materials. However, because of culture cultural or religious reasons animal products may not be judge for a certain groups of patient and therefore autologous bone grafts are then isremain a single oaption to augment the alveolar crest defects.AeEsthetics and harmony in dental implant placement was well described by Belser et al., 1998. Buccal bone thickness has toshould be a minimum of 2mm and ideally 3mm from the implant buccal surface.1S1Not sure about this. Does it relate to the heading i.e. Saddle graft is Indicated where both horizontal and vertical ridge augmentationS2Please check I havent changed the meaningS3Are these page numbers? Should it be (Esposito, Hirsch, Lekholm, Thomsen, 1999 75,77, 102111)S4Please check S5Please check this one. Ive read it many times and am a little confused