70	F. D. Fragiskos

Fig. 4.72. Clinical photograph showing closure of the operative field with surgical dressing

4.30

Materials for Tissue Regeneration

Sometimes during surgical procedures (removal of cysts, extraction of impacted teeth, etc.) large bony defects are created, which cause problems associated with esthetics, function, and the healing process, or they may even affect the stability of the jaw bone. Recently, application of a variety of materials in oral surgery to the area around these bony defects aids bone regeneration and eliminates the defect or limits its size. These materials may also prove useful in the regeneration of periodontal tissues, for the filling of bone defects around an implant, or for augmentation of a deficient alveolar ridge, etc. The most commonly used such materials are membranes and bone grafts.

Membranes. These may be absorbable or nonabsorbable. Synthetic polymer and collagen membranes are absorbable (Fig. 4.73a). Nonabsorbable membranes include those reinforced with titanium, as well as metallic titanium network membranes. The main disadvantage of nonabsorbable membranes is the need to perform a second surgical procedure for their removal.

Bone Grafts. These belong to four categories:

Fig. 4.73 a, b. a Absorbable collagen membrane used for guided bone regeneration. b Clinical photograph showing stabilization of the membrane in an area of bone deficit after surgical extraction

Fig. 4.74 a, b. Heterografts of bovine bone (Bio-Oss) for the regeneration of large osseous defects; a in compact form, and b in granules

1.Autografts, which are composed of tissues from the actual patient.

2.Allografts, which are composed of tissues from an- 4. Alloplastic grafts, which are composed of synthetic

other individual.

3.Heterografts, which are composed of tissues from various animals (Fig. 4.74).

bone substitutes, e.g., hydroxylapatite (Fig. 4.75), phosphoric calcium ceramics, and oily calcium hydroxide in cream form (Fig. 4.76).

Chapter 4 Equipment, Instruments, and Materials

71

Fig. 4.75 a, b. a Synthetic bone substitute (hydroxylapatite) in granules. b Clinical photograph of transplantation of lateral incisor of the maxilla. The area of osseous defect is filled with hydroxylapatite

Fig. 4.77. Amelogenin (base and catalyst) used for tissue regeneration

Fig. 4.76 a, b. a Oily calcium hydroxide in cream form used for bone regeneration. b Postextraction socket with buccal loss of bone. The area is filled with synthetic material

Other materials that contain amelogenin as the active ingredient, amelogenin being one of the proteins associated with tooth enamel (Fig. 4.77), may also promote tissue regeneration.

Of all the grafts, bone autografts give the best results. In spite of that, their use of limited, because a second concurrent surgical procedure is required. For this reason, the aforementioned synthetic substitute materials are used today instead, and bone regeneration in areas with large bone defects is accomplished satisfactorily.

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