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Bone Regeneration (Autosaved)
Bone Regeneration (Autosaved)
REGENERATION
PRESENTED BY :AYA ADEL MEKKY
OUTLINES
• Definition
• Bone healing
• Bone graft
• GBR
• Tissue engineering
• Biologicaly mediated strategies
• Gene therapy
DEFINITION
Bone regeneration is a complex, well-organized process of bone
formation.
xenografts
3 4
Bone regeneration can be accomplished through three different
mechanisms: osteogenesis, osteoinduction, and osteoconduction.
Disadvantage :
• There is the potential risk of additional discomfort and a
secondary procedure.
Grafted autogenous bone can be trabecular (cancellous), cortical
or corticotrabecular.
cancellous bone has more osteogenic potential than cortical
bone due to presence of hematopoietic marrow and a greater
amount of pleuripotential cells in cancellous bone .
Cortical graft has fewer surviving osteogenic cells but provides
the most bone morphogenetic protein (BMP) .
cancellous crushed
block
XENOGRAFTS
Xenografts are tissue grafts obtained from a species other than the
host species.
The representative xenograft materials are natural hydroxyapatite
(HA) and deorganified bovine bone (anorganic bone matrix or
ABM). These graft materials are inert osteoconductive filler
material, which serves as a scaffold for new bone formation.
Disadvantages
• Increased risk of a host-immune response
• They have low resorption rate may negatively impact the
healing of the grafted site and compromise the mechanical and
biological properties of the regenerated bone.
In cases where bone grafts from human or animal sources are not
feasible, synthetic graft materials (alloplasts) are used.
GBR (GUIDED BONE
REGENRATION )
is a surgical procedure that uses barrier
membranes with or without particulate bone
grafts or/and bone substitutes.
Osseous regeneration by GBR depends on
the migration of pluripotential and osteogenic
cells (e.g. osteoblasts derived from the
periosteum and/or adjacent bone and/or bone
marrow) to the bone defect site and exclusion
of cells impeding bone formation(e.g.
epithelial cells and fibroblasts) .
To accomplish the regeneration of a bone
defect, the rate of osteogenesis extending
inward from the adjacent boney margins must
exceed the rate of fibrogenesis growing in
from the surrounding soft tissue.
Surgical procedures for ridge augmentation are designed based on biological principles of bone regeneration. First, space-
maintenance where new bone formation is needed is achieved by use of grafts and/or membranes. In order for bone formation to
occur, grafts need to be osteoconductive acting as a scaffold onto which bone resorption and deposition occurs. Most graft materials
allow for their resorption by osteoclasts prior to bone deposition by osteoblasts ( A ). Since the turnover rate of soft tissues is higher
than that of bone, grafts are used alone when their surfaces have low resorption rates, or in combination with membranes that
separate the graft from soft tissues, when their surfaces have high resorption rates; This approach ensures that soft tissues are
prevented from occupying the space where bone formation is intended ( B ); Bone deposition by osteoblasts is facilitated by
adequate blood flow through the graft and osteoinductive properties of the graft that provide the growth factors necessary for
osteoblast differentiation and function ( C ). Some grafts (autologous) act as osteogenic materials when they contain sufficient
amount of osteoblasts precursors and growth factors
SEQUENCE OF EVENTS
1. Within the first 24 hours after a bone graft, the graft material/barrier
created space is filled with the blood clot
2. blood clot releases growth factors (e.g., platelet derived growth
factor) and cytokines (e.g., IL-8) to attract neutrophils and
macrophages.
3. The clot is absorbed and replaced with granulation tissue which is
rich in newly formed blood vessels.
4. Through these blood vessels, nutrients and mesenchymal stem
cells capable of osteogenic differentiation can be transported and
contribute to osteoid formation.
5. Mineralization of osteoid forms woven bone , which later serves as
a template for the apposition of lamellar bone .
6. This transformation of primary sponge work would eventually
constitute both compact and reticular bone with mature bone
marrow.
7. These events occur 3 to 4 months post-surgery
TISSUE ENGINEERING
Tissue engineering is defined as ‘a process that affects the
structure and architecture of any viable and non-viable tissue
with the aim to increase the effectiveness of the construct in
biologic environments.