Senior Lecturer, Dept. of Pedodontics and Preventive Dentistry, VDCH, Garhwa, Jharkhand, India
Key Words: Autogenous, Bone graft, Autologus, intra-oral bone graft site
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Autogenous bone grafts have been considered to be gold standard among all graft materials, it fulfills all the regenerationtriad(ie.Osteoconductive,osteoinductiveand osteogenic properties).[2][12] Intraoral bone grafting donor sites are being preferred over the years due to its easy harvestingtechniquesandlesscomplicationsascomparedto other extra oral bone graft donor sites. To enhance peripheral volume gain bone graft block along with bone particulatecanbeused.[8][9]
1Senior Lecturer, Dept. of Oral and Maxillofacial Surgery, VDCH, Garhwa, Jharkhand,India
3Final year PG student, Dept. of Pedodontics and Preventive Dentistry, MGSDC&RC, Ganganagar, Rajasthan, India
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Abstract There are several etiological factors related to the loss of intra oral bone (maxilla/mandible) they may be trauma, tumor and cysts surgeries,periodontalpathologies,or may be result of prolonged edentulism following dental extraction.[1] Dependingontheamountofboneloss/resorption that has occurred, there may be functional and/or aesthetic alterations that may lead to difficulty in the conventional rehabilitation. These problem can be solved by using autologous bone, allografts, xenografts, or alloplastic grafts with or without membrane [1] Amongallpreviouslymentioned alternatives, autogenous bone grafts are consideredtobebest because of their superior osteogenic, osteoinductive and osteoconductive properties as well as they constitue growth factors andare nonimmunogenic [2][12] Conventionally for the defects intra orally, extra oral grafts were used but with changingtime for small intra oraldefectsintra oralgraftsare being considered for their advantages over others.[12] Therefore the objective of this study is to review the various intra oral bone grafts donor sites along with theirindications, amount of graft generated, advantage, disadvantages and complications.
Intraoralbonelossisinevitableprocessfollowingtrauma, tumororcystsurgeriesandperiodontalpathologiesormay be result of prolonged edentulism following tooth extraction.[1][3] For the purpose of esthetic and functional outcomesseveralbonereconstructionprocedureshavebeen developed.Boneaugmentationprocedureshavebeenused toallowimplantplacementsortheproperconstructionof dentures.Decisionofiftheboneaugmentationprocedureis tobecarriedoutseparatelyorsimultaneouslydependson theamountofboneloss.[10]
4Lecturer, Dept. of Oral and Maxillofacial Surgery, VDCH, Garhwa, Jharkhand, India ***
1 INTRODUCTION
The main advantage of intraoral bone graft donor sites is theireasysurgicalaccess,astheyareneartotooperating site, it reduces the operative and anesthesia time and are idealforoutpatientsurgery.[6][11] Thepurposeofthisstudy was to find out various intra oral bone graft donor sites availablealongtheiradvantages,disadvantages,indications andcomplicationfacedwhileusingthesegrafts.
Atriangularpieceofbonegraftcanbeharvestedfromthe coronoidprocessofthemandiblebyanintraoralapproach during many maxillofacial surgical procedures. It can be usedinthe reconstruction ofvarious maxillofacial defects like orbital defects after extended maxillectomy, blowout fractureoforbit,temporomandibularjointankylosissurgery, chinaugmentation,defectintheanteriorwallofmaxilladue totraumaothermandibulardefectslikeboneaugmentation. It is intramenbranous in origin, average amount of bone harvested is around 19X18X26 mm triangular area with 6mmthickness. 2.1.1 Indication
Possible Intra-Oral Autogenous Bone Graft Donor Sites: A Review Article Nikhil KR Dwivedi1, Sanjeev Kumar2 , Palak3, K. Suvidya4
2
2. Various autogenous bone graft donor sites available 2intra-orally.1Coronoid process[15]
Coronoid process bone graft can be used to repair small bonedefects. itcanbeusedasablockorparticulatebonegraft. itcanbeusedforthereplacementofcondyleincasesoftmj ankylosis.itcanbe used for reconstruction of orbital floor, nasal deformationandmandibularreconstructionforimplantand otherdefects.
AdvantagesThe:recipientsiteisadjacenttodonorsite. Itshowslowrateofresorption.
2.3.1 Indications
3.3.4 Complications infratemporalfossaperforation perforationoftheschneiderianmembrane. alteration in the sensivity of the infraorbital and zygomaticofacialnerve.
2.1.2 Advantage and disadvantages
Complications
Majorcomplicationthatisbeingencounteredistrismusand riskofinjurytothetemporomandibularjoint.
itcan beusedtorepairsmallormediumbonedefects. itcanbeusedinmaxillarysinusfloorelevationincaseof implantsurgeries. can be used in alveolar bone reconstruction or preservation.itcanbeusedasblockorparticulatebonegraft.
2.2.2 Advantages and disadvantages
Advantages:lowriskofmorbiditygoodamountofbonevolume. nodamagetotheteethandotherstructures.
2.2 Anterior maxillary sinus wall[16]
Bonegraftharvestedfromtheanteriorwallofthemaxillary sinus is used in the reconstruction of several small bone defectsbutnowbeingmostcommonlyusedintheclosureof oro antral fistula. It is intramembranous in origin, approximately 0.5ml to 2ml of total volume can be harvested. 2.2.1 Indication itcanbeusedtorepairsmalltomediumbonedefectslike oroantralfistula. itcanalsobeusedasparticulateorblockbonegraft. can be used for maxillary sinus floor elevation for the purposeofimplantplacementindeficientalveolarbone.
Limitedmaxillarydefectsarecommonlygraftedwithbone blocks harvested from the symphysis or the ramus;
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Disadvantages:Compactboneisavailable.
Disadvantages:Patientgoing under coronoidectomy needs to be hospitalized. 2.1.3 Technique Theosteotomycanbeperformedviaintraoralapproachwith the help of rotary instruments, piezoelectric devices, or reciprocatingsaw.
2.3.2 Advantages and disadvantages AdvantagesAccess:iseasytoachieve. Bothcorticalandcancellousboneisavailable. Prevalenceofcomplicationisless.
2.1.4
Disadvantages:Ocularcomplicationcanoccur. Amountofboneharvestedisless. 2.3.3 Technique Actualsiteforthegraftharvestingusedtobe5mminferior tolowerorbitalrimand3mmabovetheinferiorborderof zygomatic bone. The bone is harvested with the help of trephine with the blade angled 45 degrees to the occlusal planeanditshouldbeparalleltothelateralwallofmaxillary sinus,thecutshouldnotexceedbeyond12 14mm.
2.2.3 Technique Theupperlimitofthemaxillarysinusisapproximately5mm bellowtheinfraorbitalforamen.Osteotomycanbecarried out with the help of rotary instruments or piezoelectric device, to better avoid complications like schneiderian membrane perforation the use of piezoelectric devices is encouraged. 2.2.4 Complications schneiderianmembraneperforation. 2.3 Zygomatic body[16] Itisapreferreddonorsiteforreconstructionofbonedefect 1or2implantsites,coveringexposedsurfacesofimplants. Using the local anesthetic agent graft can be harvested intraorally.Itisintramembranousinorigin,totalamountof boneharvestedinthisprocedureisaround0.5mlto1ml.
2.4 Zygomatic alveolar buttress[16]
2.5 Incisive fossa[17] 2.5.1 Indications Itismainlyusedfortherepairofsmallbonedefects.Bone graftharvestedfromtheincisivefossacanbeusedasbone blockorasaparticulate.
Advantages:itisaverysimpleprocedure, in whichcortico cancellous graftcanbeharvested. ithashighquantityofosteoprogenitorcells. ithaslesscomplicationsascomparedtoothersites.
2.4.2
harvestingasecondsurgicalsiteinthemandibleincreases bothoperativetimeandpatient’spostoperativemorbidity. To overcome these disadvantages, the zygomatic buttress was suggested as an alternative maxillary source of autogenous bone. This intraoral donor site has a natural convexshapeandcanbeaccessedalongwiththerecipient sitethroughthesameflapdesign.Itisintramembranousin origin in which approximately 1.5cm * 2cm bone can be harvested. 2.4.1 Indication itcanbeusedforthereconstructionofbonedefectsand guidedboneregeneration. itcanbeusedasblockorparticulatebonegraft.
2.5.2 Advantages and Disadvantages
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2.6 Anterior nasal spine[4][18] Bone graft from the anterior nasal spine is harvested frequently to correct peri implant bone defects, specially duringimplantplacementintheanteriormaxillaryregion.It isintramembranous inorigin,averageamountofbonethat canbeharvestedisinbetween0.25to 0.5ml. 2.6.1 Indication usedtorepairsmallbonedefects. usedtocoverfenestrations. usedtorepairperi implantbonedefects. 2.6.2 Advantages and disadvantages
Disadvantages:Bonegraftsharvestedfromincisivefossaareoftype IVbone. 2.5.3 Techniques Bonegraftisharvested3mmapical fromtheroot tip of the central incisor, and its upper limit is anterior nasal aperture. Trephine drill or piezoelectric device can be used to obtain bone graft.
2.5.4 Complication toothinjury basalmembraneperforation.
Advantages and disadvantages
Advantages:Itiseasilyaccessible,withlowmorbidity.
Anteriorregionofthepalatecanbereliablyselectedasthe donor site in the oral and maxillofacial reconstructive, implantology,andperiodontalregenerationprocedure.Itis intramembranousinorigin.
Disadvantages:Boneharvested is limited in quantity and are too compact. 2.6.3 Technique Anotchismadeinthebaseoftheanteriornasalspine,and andthenthespineisdetachedwiththehelpofchisel. 2.6.4 Complications Aestheticsmaybehampered. 2.7 Palate[10][17][18]
Advantages:Accessandvisibilityinthisprocedureisverygood. itisadjacenttotherecipientsite. resorptionrateislow. 2.4.3 Technique Rotaryinstrumentsortrephineorpiezoelectric devicecan beusedtoharvestthebonegraftinwhichthepiezoelectric deviceisconsidered. 2.4.4 Complications theremaybechangesinsensationintheareasuppliedby infraorbitalnerve. if not done with experienced hands there may be probabilityofmaxillarysinusmembraneperforation.
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2.7.4 Complications excessbleeding injurytotheadjacenttoothstructure communicationwithnasalcavity.
2.8.3 Technique Theboneharvestingcanbedonewiththehelpof rotary/trephineorpiezoelectricunit,graftwillbe harvested distal to the second molar with schneiderianmembraneasupperlimit.
2.8.4 Complication maxillarysinusmembraneperforation. 2.9. Mandibular torus[7][20]
Mandibulartoriareusuallysymmetricalandbilateral,but can also be unilateral, located on the lingual side of the mandible, above the mylohyoid line, and at the level of premolars,butitmayextenddistallytothethirdmolarand mesially to the lateral incisor. It is intramembranous in origin. 2.9.1 Indication itcanbeusedasaparticulateorboneblocktorepairsmall bonedefectsaswellasforotherminorprocedureslikesinus lift. 2.9.2 Advantages and Disadvantages
Advantages:Itis a simple procedure with low incidence of Disadvantages:complications.Boneharvested
2.8 Tuberosity[3][19] Bone graft either in form of particulate or block can be harvested from the maxillary tuberosity to repair or reconstruct the bone defects in the oral cavity. It is intramembranousinorigin. 2.8.1 Indication itcanbeusedinperiodontaldefects. itcanbeusedintheprocedureofsinusliftsurgeries. itcanbeusedtorepairsmallbonedefects.
Torus palatinus are the exostoses present mostly in the midlineofhardpalate,itcanbeusedasabonegraftdonor sitetoreconstructtheminorbonedefectintra orally.Itis intramembranousinorigin.
Disadvantages:Boneharvestedisofpoorquality(typeIV)
istoocompactaswellasitdepends onthesizeofthetoruspresent. 2.9.3 Technique It can be harvested with the help of piezoelectric unit or chiselandmallet. 2.9.4 Complications excessive alternationbleedinginthesensitivityofthelingualnerve.
Disadvantages:Accesstothedonorsiteisdifficult. Boneiscompactandamountofgraftharvestedis alsolow. 2.7.3 Technique Graftisharvestedwiththehelpoftrephineorpiezoelectric units,nasalfloorusetobeitsupperlimit.
2.10 Torus Palatinus[14][21]
2.7.2
2.7.1 Indication Itcanbeusedasparticulateorboneblocktorepair smallbonedefects. itcanbeusedinmaxillarysinusliftproceduresin casesofdeficientboneforimplantplacement.
Advantages:ithashighacceptanceratewithlessmorbidity.
Advantages and Disadvantages
Advantages:Highquantityofosteoprogenitorcellsarepresentin theharvestedgraft. Procedureissimpletoexecute. Itiscortico cancellousinnature. Complicationrateislowascomparedtootherintra oralbonegraftdonorsites.
2.8.2 Advantages and Disadvantages
[3]JensenSS,TerheydenH.Boneaugmentationprocedures inlocalizeddefectsinthealveolarridge:clinicalresultswith differentbonegraftsandbone substitutematerials.IntJOral MaxillofacImplants2009;24:218 236.
2.11.3 Technique Rotaryinstrumentorbonesaworpiezoelectricunit may be used after giving intraoral vestibular incisionandboneisharvestedfromthesymphysis region. 2.11.4 Complication excessivebleeding. facialdisfigurementmayoccur.
[8]BeitlitumI,ArtziZ,NemcovskyCE.Clinicalevaluationof particulate allogeneic with and without autogenous bone grafts and resorbable collagen membranes for bone augmentationofatrophicalveolarridges.ClinOralImplants Res2010;21:1242 1250.
2.10.3 Technique The procedure to harvest bone graft from torus palatinus is similar to the process involved in the graftharvestingfromthemandibulartorus. 2.10.4 Complications excessivebleeding oro nasalcommunication 2.11 Mandibular symphysis[11][13][14] Mandibularsymphysisregionactasapotentialbonegraft donorsitewhichisintramembranousinorigin. 2.11.1 Indications itcanbeusedasboneblockorparticulateform. usedtoreconstruct/repairsmalltomediumsized bonedefects. 2.11.2 Advantages and Disadvantages
[4] Cho YS, Hwang KG, Park CJ. Postoperative effects of anteriornasalspineboneharvestingonoverallnasalshape. ClinOralImplantsRes.2013;24:618 622.
2.10.1 Indications itcanbeusedasaparticulateorboneblocktorepairsmall bonedefectsaswellasforotherminorprocedureslikesinus lift. 2.10.2 Advantages and Disadvantages
Advantages:Simpleprocedure Lowincidenceofcomplication
[2] Urist MR, “Bone: formation by autoinduction.” Science 1965;12;150:893 899.
[7] Barker D, Walls W, Meechan JG. Ridge augmentation usingmandibulartori.BrDentJ.2001;190:474 476.
3. Conclusions
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[6]200.BeitlitumI,ArtziZ,NemcovskyCE.Clinicalevaluationof particulate allogeneic with and without autogenous bone grafts and resorbable collagen membranes for bone augmentationofatrophicalveolarridges.ClinOralImplants Res2010;21:1242 1250.
Disadvantages:Amount of bone graft harvested is directly proportionaltothetorussize.
Autogenousbonegraftscontinuestobegoldstandardinthe fieldofreconstructionsurgery,beitinmaxillofacial,spinal areasortraumaandtreatmentofmalunions,nonunions,or tumors.Therearevariousdonorsitesavailableinthebody fromwhichwecanharvestthegraft,eachhavingtheirown advantagesanddisadvantageswhichincludetheiranatomic locationwhichmakesonesitepreferableovertheother. Maximum autogenous bone grafts donor sites options availableintra orallycanbe usedasparticulateaswell as boneblockformtorepairsmallbonedefectsinmaxillofacial region. REFERENCES [1] Al Nawas and Schiegnitz, “Augmentation procedures using bone substitute materials or autogenous bone a systematicreviewandmeta analysis”EurJOralImplantol 2014;7(Suppl):S1 S16
[5] Rodriguez Recio O, Rodriguez Recio C, Gallego L, Junquera L. Computed tomography and computer aided designforlocatingavailablepalatal boneforgrafting:two case reports. Int J Oral Maxillofac Implants. 2010;25:197
Disadvantages:Chancesofcomplicationsarehighascomparedto other Facialsites.disfigurementmayoccur.
Advantages:Goodamountofboneisharvestedfromthesite.
[12] Sakkas et al., “Autogenous bone grafts in oral implantology is it still a “gold standard”?A consecutive review of 279 patients with 456 clinical procedures” InternationalJournalofImplantDentistry(2017)3:23 [13]WidmarkG,AnderssonB,IvanoffCJ.Mandibularbone graft in the anterior maxilla for single tooth implants. Presentationofsurgicalmethod.IntJOralMaxillofacSurg. 1997;26:106 9. [14] Graft:HansChristophPape,PhilippKobbe,“AutologousBonePropertiesandTechniques,”JOrthopTrauma Volume24,Number3Supplement,March2010.
[20] Hassan KS, Al Agal A, Abdel Hady AI, Swelam WM, ElgazzarRF.,“MandibularToriasBoneGrafts:AnAlternative Treatment for Periodontal Osseous Defects Clinical, Radiographic and Histologic Morphology Evaluation.” J ContempDentPract2015;16(3):192 200.
[10] Devorah and Liran, “Multitier Technique for Bone Augmentation Using Intraoral Autogenous Bone Blocks,” implantdentistry/volume16,number12007.
[21] JuniorEFM.,Damanteetal.,“Torus Palatinus:AGraft OptionforAlveolarRidgeReconstruction”,TheInternational JournalofPeriodontics&RestorativeDentistry,Volume30, Number3,2010
[9] Schwartz Arad D, Dori S. Intraoral autogenous onlay blockbonegraftingforimplantdentistry[inHebrew].Refuat HapehVehashinayim.2002;19:35 39.
International Research Journal of Engineering and Technology (IRJET) e ISSN: 2395 0056 Volume: 09 Issue: 02 | Feb 2022 www.irjet.net p ISSN: 2395 0072 © 2022, IRJET | Impact Factor value: 7.529 | ISO 9001:2008 Certified Journal | Page266
[11] Montazem A, Valauri DV, et al., “The mandibular symphysisasadonorsiteinmaxillofacialbonegrafting:A quantitative anatomic study.” J Oral Maxillofac Surg. 2000;58:1368 1371.
[15]ChuongPH,KimSG.Thecoronoidprocessforparanasal augmentationinthecorrectionofmidfacialconcavity.Oral SurgOralMedOralPathol2001;91:28Y33
[16]Araújo filhoelal.,“Useofautogenousbonegraftofthe anterior wall of the maxillary sinus in the management of oroantralfistula”,ArchHealthInvest(2019)8(9):498 500 [16] Kainulainen V.T. et al., “Safety of zygomatic bone harvesting:aprospectivestudyof32consecutivepatients.”, theinternationaljournaloforalandmaxillofacialimplants 20(2):245 52 [17]AliHassani;ArashKhojasteh;AliNasirShamsabad,“The Anterior Palate as a Donor Site in Maxillofacial Bone Grafting: A Quantitative Anatomic Study.” , 63(8), 1196 [18]1200.Titsinides,S.;Agrogiannis,G.;Karatzas,T.(2018),“Bone grafting materials in dentoalveolar reconstruction: A comprehensivereview.”JapaneseDentalScienceReview,(), [19]S1882761618300395Khojasteh,Arash; Nazeman, Pantea; Tolstunov, Len (2016)., “Tuberosity alveolar block as a donor site for localisedaugmentationofthemaxilla:aretrospectiveclinical study.”,BritishJournalofOralandMaxillofacialSurgery,(), S0266435616301632 .