Most dental practitioners are unaware or lack of bone biology, graft materials, membranes, bone harvesting or bone grafting as these topics are not uniformly explained in various hands-on cadaver, live-surgery or lecture programs. Intra oral bone grafts are used in the field of surgical oncology - head and neck. Extraoral autografts are gold standard but intraoral autografts are advantageous because their close proximity to the operating field. Also they minimize the need of second operative procedures for harvesting graft. Thus they emerge as a new alternative to classic extraoral autografts. They are also used in maxillofacial surgery, trauma, plastic surgery et cetera. This book will be useful for dental students, implantologists, prosthodontists, oral surgeons, oncosurgeons and orthopaedic surgeons.
Reconstruction of maxillofacial continuity defects has always been a challenging task for the scientists and surgeons over the years. The main objective of the maxillofacial region's reconstruction is to restore the facial form, function, complete rehabilitation of occlusion and articulation. A refinement in surgical technique and methods of reconstruction has improved patient’s quality of life. Bone Grafting is one of the commonest operations performed in Orthopaedics. Its indications include non-union, delayed union, packing bone cysts and cavities, elevating depressed articular fractures and reconstruction of large bone defects. Autografting from the iliac crest is the gold standard. Publications on mandibular reconstruction with free bone grafts date from as early as the end of the eighteenth century and beginning of the nineteenth century. Bardenheuer and Skyoff reported the first cases of mandibular reconstruction with autologous bone grafts harvested from the iliac crest, tibia, and rib. Considerable experience treating traumatic mandibular defects was gained during the First World War.
Table of Contents
Chapter 1
Introduction To The Bone Graft
Introduction
Defect classification system
Indications for bone grafting
Mechanism of action of bone grafts
Incorporation of bone grafts into the recipient site
Growth factors
Chapter 2
Biology of Bone Tissue: Structure, Function, and Factors.
Introduction
Functions of Bone
Blood Supply of Bone
Types of Bones
Bone remodeling
Chapter 3
Intraoral Maxillofacial Bone Grafts
Introduction
Symphysis block harvesting
Maxillary tuberosity harvest
Anterior palate graft harvesting
Retromolar bone graft harvest
Zygomatic process of maxilla graft harvest
Coronoid process of the mandible
Mandibular tori
Anterior maxillary wall graft harvest
Anterior Nasal Spine graft harvest
Ramus Bone graft harvest
Objectives and Topics
This work aims to provide a comprehensive clinical overview of intraoral bone grafting techniques used in maxillofacial surgery, focusing on autogenous donor site selection and the biological principles of bone healing. It addresses the challenges of reconstructive surgery, offering practitioners guidance on effective harvesting methods to restore form and function while minimizing donor site morbidity.
- Biological foundations of bone tissue, including growth factors and remodeling.
- Clinical classification systems for mandibulectomy and maxillectomy defects.
- Detailed surgical protocols for various intraoral donor sites (e.g., symphysis, ramus, tuberosity).
- Evaluation of surgical risks, complications, and mitigation strategies for graft harvesting.
Excerpt from the Book
Symphysis block harvesting
Symphysis graft processes are carried out more frequently than ever in clinical practice.Convenient surgical access, proximity of donor and recipient sites, low morbidity, accessibility of bigger amounts of bone over other donor locations, minimal resorption, no hospitalization, and minimal pain are some of the benefits of this operation over other intraoral locations.(6)
The anterior mandible offers either a block or a particulate configuration of bone. The symphysis can typically provide a sufficient quantity of bone in a block configuration to increase width deficiencies by 4 to 7 mm, length deficiencies by 15 to 20 mm (about one to three teeth), and height deficiencies by 10 mm. Studies on cadavers suggest this site can yield an average block of 21 × 10 × 7 mm or more.(7,8)Mandibular bone grafts result in an improved quality of bone with a shorter healing period when compared with other methods of bone repair.
Mandibular symphysis bone grafts have been used for alveolar repair to allow implant placements with favorable results. This location has two advantages over other intraoral sites: 1)topographic accessibility, and 2) significant volume of cancellous and cortical bone for harvesting.
Summary of Chapters
Chapter 1: Introduction To The Bone Graft: Provides a foundation on maxillofacial reconstruction, defect classification, and the physiological mechanisms of bone regeneration, including the role of growth factors.
Chapter 2: Biology of Bone Tissue: Structure, Function, and Factors.: Explores the histological characteristics of bone, the different types of ossification, and the regulatory processes of bone metabolism and remodeling.
Chapter 3: Intraoral Maxillofacial Bone Grafts: Describes specific clinical techniques for harvesting autogenous bone from various intraoral sites, evaluating their surgical procedures, indications, and associated risks.
Keywords
Bone Graft, Maxillofacial Surgery, Autogenous Bone, Mandibular Reconstruction, Osteogenesis, Osteoinduction, Osteoconduction, Symphysis Harvesting, Ramus Graft, Bone Remodeling, Growth Factors, Dental Implants, Surgical Technique, Donor Site Morbidity, Alveolar Augmentation.
Frequently Asked Questions
What is the primary focus of this publication?
The work focuses on intraoral autogenous bone grafting techniques for maxillofacial surgery, examining how to effectively harvest bone from within the oral cavity to repair bony defects.
What are the core thematic areas covered?
The book covers bone biology (structure and remodeling), defect classification systems, mechanisms of graft incorporation, and specific surgical protocols for harvesting bone from sites like the symphysis, ramus, and maxilla.
What is the ultimate goal of the procedures described?
The primary goal is the rehabilitation of occlusion, articulation, and facial form through the restoration of bony structures, ensuring long-term functional stability for the patient.
Which scientific methods are primarily discussed?
The text focuses on surgical harvesting techniques, biological principles of healing (osteogenesis, induction, conduction), and clinical algorithms for defect closure in the maxillofacial region.
What does the main body of the work address?
It provides an in-depth analysis of biological growth factors, detailed anatomical considerations for donor sites, and step-by-step surgical approaches, including the risks and benefits associated with each donor location.
What key terms characterize this research?
Key terms include bone grafts, autogenous harvesting, maxillofacial reconstruction, osteoblasts/osteoclasts, and specific anatomical donor regions such as the mandibular symphysis and retromolar area.
Why is the mandibular symphysis a preferred donor site?
It is preferred due to its topographic accessibility, the ability to provide both block and particulate bone, and the relatively low morbidity compared to extraoral sources.
What are the primary risks associated with retromolar bone graft harvesting?
Key risks include potential injury to the inferior alveolar nerve and neurovascular bundle, hemorrhage, and the risk of mandibular fracture if improper force is used during the harvesting procedure.
How does the text compare cortical and cancellous bone?
Cortical bone is described as dense and strong, ideal for structural support (onlay/inlay grafts), while cancellous bone is noted for its role in filling defects and its better healing properties due to cellular content.
- Citation du texte
- Dr. Venkatesh Hange (Auteur), 2018, Intraoral Maxillofacial Autografts. Bone Graft Site and Harvesting Technique, Munich, GRIN Verlag, https://www.grin.com/document/499904
