Bone is a hard connective tissue. The entire framework of bone and their cartilage constitute the skeletal system.

Bone is composed of

• Hydroxyapatite
• Collagen
• Water (H2O)

There are four types of cell in bone tissue:

• Osteogenic cells: They are precursor of connective tissue.
• Osteoblast: They are responsible for bone formation.
• Osteocyte: Maintain the cellular activities in bone tissue.
• Osteoclast: Found on bone surface and function in resorption.

• Autograft: Bone taken from our own body.
• Allograft: Bone taken from another person (cadaver) or bone donated during hip replacement surgery.
• Xenograft: Bone taken from an animal (bovine).
• Alloplast or Synthetic Bone Graft: prepared chemically e.g. ceramic, polymer, calcium sulfate.

Despite the fact that natural bone grafts are the gold standard for bone grafting procedure, they are associated with several problems like need of second surgical site, disease transfer risk, procurement morbidity, immunogenic, limited availability.

Synthetic bone graft substitute eliminates the need for autogenous and allogeneic bone graft along with the complications associated with them.

Synthetic bone grafts offer following advantages over natural bone graft:

• Non Immunogenic
• No risk of disease transfer
• No need of second surgical site
• Lack of procurement morbidity
• Limitless supply
• Easily fabricated in to various form, size and shape

• Bone and joint T.B
• Fracture repair
• To fill a cavity
• Bone tumor
• Patella Reconstruction
• Pubic Symphysis Reconstruction
• Scoliosis correction
• Occiptalcervical fusion
• Degenerative spine disease
• Craniotomy
• Craniomaxillofacial surgery

• Osteoconductive, Osteostimulative
• Biodegradable
• As it is from synthetic origin so free from risk of infection transfer
• Enough supply is ensured
• Available in wide range of size and shape

Yes Beta Tricalcium Phosphate is a Bioresorbable Ceramic chemically broken down by the body and resorbed. Basic thumb rule is that the chemicals produced as the ceramic is resorbed must be able to be processed through the normal metabolic pathways of the body without evoking any deleterious effects and control dissolution rate by composition and surface area (density). B-TCP has applications including for bone repair such as maxillofacial and periodontal defects, temporary scaffold or space – filler material which is gradually replaced by tissue. Reference may be made to TA Lange, JE Zerwekh, R D Peek, V Mooney and BH Harrison, “Granular tricalcium phosphate in large cancellous defects”, Annals of Clinical and Laboratory Science, Vol 16, Issue 6, 467-472 (1986). B-TCP integrally combines with bone and then dissolve and absorb to substitute for bone.

Yes. BioGraft Synthetic Hydroxyapatite material has the property of ingrowth of fibrovascular tissue and osteo conductivity and thus can be used for correction of facial skeletal and soft tissue defects. BioGraft Synthetic Hydroxyapatite materials are bio-compatible, non-allegenic, non-toxic and qualitatively superior to the imported Hydroxyapatite.

Due to increased awareness, more and more surgeries for correction of facial abnormalities are being done. In India incidence of live birth with craniofacial clefts alone is in several thousands per year. Patients with facial skeletal and soft tissue defects due to acquired factors are much more. Synthetic Hydroxyapatite Bone Graft material is a useful alternative where the donor area is limited and/or donor area morbidity is unwanted. This material is affordable and within the reach of poor patients also.

BioGraft Synthetic Hydroxyapatite material, available both in Granules and Pre-forms, can be used for treatment of following facial deformities.

• Congenital facial and craniofacial clefts.
• Hemefacial microsomia
• Post traumatic facial skeletal defect.
• Benign facial skeletal neoplasm.
• Aesthetically unacceptable facial skeletal defect like midface retrussion, microgenia, micrgnathia.
• Correction of soft tissue defect.
  

Operations are performed under general anesthesia. Target bone is exposes property and its surface is made raw with the help of periostium elevator on which BioGraft Synthetic Hydroxyapatite material is applied. After irrigation with normal saline, the soft tissue pocket is closed meticulously. Post operatively the patients are kept under antibiotic coverage for 5 to 7 days. The common complications are hematoma and facial edema which subside during next 5 to 7 days. In some cases, edema last for about 3 weeks. It depends on the amount of soft tissue dissection. Infection may occur at the graft site from time to time, which subside with systemic application of antibiotics and dressing. As the graft becomes vascularised, the infection passes away. Average use of analgesics is much less as there is no donor site morbidity.

Post operatively nearly upto 3-4 weeks, grafted site remain tender and there are palpable crepitus. Thereafter, grafted area become firm in consistency and gradually tenderness passes away. At about 6 to 7 months the area becomes hard and clinical evidence of bone formation may be appreciated by radiograph but best by 3D CT.

Dental implant placement in the posterior maxillary region is frequently hampered by atrophic ridges resulting from bone resorption which could either be following tooth removal or from the effects of periodontal disease. Tooth loss occurring in the maxilla, generally result in bone resorption both apically and palatally. Problem of compromised alveolar ridge may be in addition to maxillary sinus varying in size and shape and thus requiring surgical intervention for implant placement. Unless cavity following tooth extraction is filled in to maintain alveolar ridge, maxillary sinuses pneumatize after tooth loss and expand in such a way thereby compromising or preventing implant placement without an augmentation procedure.

Following are the most common requirements for sinus lift procedure.

• Resorbed alveolar crest under the maxillary sinus must be of a minimum height say about 5mm for placement of implant.
• Following sinus augmentation procedure, implant may surgically be placed after a minimum healing period of 6 to 12 months varying from patient to patient.
• Development of maxillary posterior for the atrophic ridge either through sinus graft or ridge augmentation procedure require bone graft material which could either be autugraft, allograft, xenograft or synthetic material and many a times accompanied by the use of GTR membrane.

Bone Graft materials can be categorized in following four types.

• Autograft or autogenous bone graft i.e. patients own bone.
• Allograft or allogenic bone graft i.e. of same species.
• Xenograft or xenogenic bone graft i.e. of two different species (bone of bovine origin).
• Alloplast or alloplastic i.e. Synthetically derived, which could either be hydroxyapatite, ß-TCP or any formulation thereof, bone graft.

Ideal bone graft/replacement material should exhibit four characteristics namely

• Osteointegsation, the ability to chemically bond to the surface of bone without an intervening layer of fibrous tissue
• Osteoconduction, the ability to support the growth of bone over its surface
• Osteoinduction, the ability to induce differentiation of pluripotential stem cells from surrounding tissue to an osteoblastic pleno type and
• Osteogenesis, the formation of new bone by osteoblastic cells present within the graft material.

Some of the applications of BioGraft Bone Regenerative/Substitute materials are the following.

• For socket preservation following extraction of a tooth or to augment an atrophied or resorbed site.
• For sinus lifting preceding placement of dental implants.
• For ridge expansion.
• For treatment of Periodontitis.

Periodontal diseases are highly prevalent and can affect upto 90% of the population worldwide. Gingivitis, the mildest form of periodontal disease, is caused by the bacterial biofilm that accumulates on teeth adjacent to the gingiva. However, gingivitis does not affect the underlying supporting structures of the teeth and is reversible. Periodontitis results in loss of connective tissue and bone support and is a major cause of tooth loss in adults. In addition pathogenic microorganisms in the biofilm, genetic and environmental factors, especially tobacco use, contribute to the cause of these diseases. Dermatological, hematological, granulomatous, immunosuppressive and neoplastic disorders can also have periodontal manifestations. Common forms of periodontal disease have been associated with adverse pregnancy outcomes, cardiovascular disease, stroke, pulmonary disease and diabetes, but the casual relations have not been established. Prevention and treatment are aimed at controlling the bacterial biofilm and other risk factors, arresting progressive disease and restoring lost tooth support.

Chronic Periodontitis is considered to be most occuring disease worldwide after common cold.

Periodontitis is chronic inflammatory response over the periodontium due to accumulation of dental plaque (which is an organised form of disease forming bacterial colony over the tooth surface). Eventually this dental plaque become mineralised with incroporation of salivary inorganic ions, which makes softmass intohard deposits, commonly known as dental tartar (calculus). This is responsible for inflamation of gum, which is known as gingivitis, if not controlled progresses to form periodontitis.

Periodontitis is a chronic inflammatory disease of the periodontium occurring in response to bacterial plaque on the adjacent teeth, characterized by gingivitis, destruction of alveolar bone and periodontal ligament, apical migration of the epithelial attachment resulting in the formation of periodontal pockets and ultimately loosening and exfoliation of the teeth.

Bacteria in our mouth along with mucus and other particles, constantly form a sticky, colorless 'plaque' on teeth. Unless such plaque is removed by brushing and flossing, the same hardens and form bacterial harboring 'tartar'. Plaque and tartar on teeth, cause inflammation of gums called 'gingivitis' and unless treated advance to 'periodontitis'. Factors like Smoking, Diabetes, Stress etc are found to accelerate periodontitis.

Some of the symptoms may be the following:

• Sensitive teeth.
• Mobile teeth
• Pain during chewing
• Red swollen gums
• Tender or bleeding gums
• Bad breath
  

Periodontitis is generally treated either by scaling and root planing or medications or surgery. Type of treatment vary from patient to patient and objective is to control the infection. Surgery include Flap Surgery and Bone Graft Surgery. Grafting in addition to flap surgery, is done to replace or encourage new growth of bone or gum tissue destroyed by periodontitis and BioGraft bone regenerative materials in this regard are useful.

Why Synthetic Bone Grafts are preferred for filling bony defects?

Because they have desired consistency, particle size, porosity and strength with availability in abundance in sterile condition. These features totally eliminate donor site morbidity and risk of viral transmission associated with Autogenous grafts and Xenografts respectively.

What are 'Bio Ceramic' materials?

Ceramics are oldest man made material consisting of non-metallic inorganic substances. Bio Ceramics are those ceramics which are used to repair and reconstruct diseased or damaged parts of the body.

What are the types of Bio Ceramics?

Calcium Phosphate based Ceramics are being used in various disciplines of medicine i.e. Orthopaedics, maxillofacial surgery, spinal surgery, dentistry for augmentation of alveolar ridge etc..

Two forms of Calcium Phosphate Ceramics receiving most attention are the following:

• Synthetic Hydroxyapatite (HA) and
• Beta Tri-calcium Phosphate (TCP)

This is because these two forms have mineral composition similar to that of natural bone, bio-compatible and bond well with natural bone. Their bio-compatibility makes them successful bone substitutes. These have been found to be safe and effective for a variety of clinical applications.

Composition both Synthetic Hydroxyapatite and Beta Tri-calcium Phosphate are called Biphasic Calcium Phosphate Ceramic material.

HA is the natural mineral component of vertebrate hard tissue, comprising 60-70% of bone and 98% of of dental enamel. HA in appropriate synthetic form is generally found to be bio-active and non-bio-resorbable. HA has osteoconductive potential.

TCP is clinically similar to HA but is not a natural component of bone. It is partially resorbable and is often considered desirable for repair of non-pathological site. This act as temporary space filler or scaffolds for new tissue to develop. Natural tissue reconstruction occurs simultaneously with resorption of the ceramic.

Calcium phosphate bio-materials are devoid of local or systemic toxicity, do not elicit inflammatory or foreign body response, can become functionally integrated with natural bone with no fibrous tissue encapsulation and cause no alteration of normal bone minerlization process. Also they become bonded to bone by apparently natural bone cementing mechanism.

Calcium phosphate bio-material provide a physical matrix suitable for deposition of new bone and can display growth guiding properties causing bone to extend its growth into areas it would not otherwise occupy. It also has the ability to maintain bone bulk in areas where bone resorption normally takes place.

BioGraft-HA and BioGraft-HT are available in Granule size range of 0.25 mm (250 microns) to 4 mm (4000 microns). These materials can also be made in other Granule sizes requested for.

These Granules are wetted either with patient blood or PRP (Patelet Reinforced Plasma) or saline solution and placed directly on application area in conjunction with Guided Tissue Regeneration Membrane (GTP) and followed by sutures.

Yes these materials are available in different pre-formed shapes like square, rectangle, cone, triangle, circular, semi-circular etc in different standard sizes of appropriate porosity. Pre-forms of specific design and sizes can also be made available.

No but pre-forms are meant for filling of larger voids.

Many more women get osteoporosis than men. Women who have low estrogen levels are especially at risk. Women may have low estrogen levels:

• During menopause
• If had surgery to remove r female organs
• If menstrual cycles have stopped early (before age 45).

Elderly men and women who take certain medicines can also get osteoporosis.

• Old age
• Menopause before age 45
• Fair skin (white or Asian)
• Female
• Sedentary lifestyle (immobile because of illness or wheelchair-bound)
• Small frame
• Alcohol abuse
• Chronic medications
• Chronic steroid use
• Smoking history
• Hyperthyroidism (overactive thyroid)
• Kidney disease
• A family member had osteoporosis.

Treatment can keep osteoporosis from getting worse and can sometimes increase bone strength.

Getting calcium (1,500 mg daily) and vitamin D (400 IU daily) in diet or through supplements is important. Also, doctor may provide the following treatments:

• Estrogen replacement therapy
• Bisphosphonates
• Selective estrogen receptor modulators
• Fluoride.

It is best to prevent osteoporosis in the first place. It is harder to build bone than it is to keep from losing it.

• By regular weight-bearing exercise (such as walking or jogging)
• By taking calcium and vitamin D
• Keeping a healthy estrogen level (in women)
• Eating a balanced diet
• Avoid using tobacco and alcohol
• Only take steroids if  doctor prescribes them.

BioGraft-HT is a biphasic calcium phosphate consisting of hydroxyapatite and beta-tricalcium phosphate in the ratio of approximately 70:30 that is biocompatible, non-toxic, restorable, non-inflammatory and bioactive. It causes no immunological, foreign-body, or irritating response, and has excellent Osteoconductive ability. In a study carried out by Dr K T Chandrashekar and Dr Chhavi Saxena of the Department of Periodontics, Darshan Dental College, Udaipur, Rajasthan, efficacy of BioGraft-HT as a bone graft material in the treatment of vertical defects in generalized chronic periodontics patients, clinical and radiological evaluation was carried out. Twenty patients diagnosed with generalized chronic periodontics having two or more vertical defects were selected for this study. Clinical parameters like plaque index, gingival index, probing pocket depth and clinical attachment levels were recorded at different points of time over six months. Radiographic evaluation included the depth of the bone defect and the percentage of bone defect fill at three months and six months. After recording clinical parameters and administering phase - 1 therapy, the sites were randomly treated either with Biograft-HT or open flap debridement only. At the end of six months there was a significant reduction in the plaque and gingival scores in both test and control groups. There was 65% decrease in pocket depth for the test site as compared to 54.52% decrease seen for the control group. Similarly there was an 84.82% gain in clinical attachment level from the baseline to six months post operatively for the experimental group in comparison to 68.83% gain for the control group. Furthermore, 43.57% bone fill was observed for the experimental site whereas only 17.98% of bone fill was evident in the control site. BioGraft HT improves outcomes, leads to a reduction of probing depth, a resolution of osseous defects and a gain in clinical attachment, compared with open flap debridement by itself.