Endodontic Grafts: A Comprehensive Guide for Dental Practitioners

Abstract

Bone defects of the jaws are frequently ascribed to accidents, congenital anomalies, tooth abscesses, jaw atrophy with ageing, or general disease are frequently implicated in bone deformities of the jaws. Although less known, endodontic surgery uses bone grafting materials more and more frequently these days for bone defects due to large periapical lesions. Bone grafting and guided tissue regeneration are two modern methods that have been developed to treat certain bone abnormalities. This article reviews the most common graft materials and regenerative materials used in endodontics and explain the outcomes of these grafts.

Introduction

Numerous studies in the past have demonstrated a better outcome with regards to tissue healing following periapical surgery with the aid of regenerative technique using bone graft compared to the same lesions without regenerative techniques.(1) The concept of regenerative therapy entails utilization of periosteal grafts with the potential to stimulate bone formation. It allows cellular regrowth of defects caused by pathosis or surgical trauma and has resulted in development of grafts, membrane or barrier. (2) Bone graft may maintain space for new bone formation, provide vital osteogenic cells (osteogenic effect), induce host cells to reconstruct lost bone (osteoinductive effect) and act as scaffolds on which host osteogenic cells might grow (osteoconductive effect) (3) Bone grafting materials are classified as autograft (derived from same individual), allograft (derived from a different individual from the same species), xenograft (derived from a different species) and alloplasts (derived from synthetic sources). (4) Autograft: Autografts are obtained from the host and are the gold standard bone replacement grafts because they are osteogenic and induce minimal immune responses.(3) Allograft: Allograft is is harvested from an individual other than the one receiving the graft.There are three types of bone allograft available. (5)

1. Fresh or Fresh frozen bone
2. FDBA
3. DFDBA

Xenograft: Xenografts are derived from bovine, porcine and coral sources. (4) Alloplastic grafts: Alloplastic grafts may be made from hydroxyapetite,a natural occurring mineral, made from bioactive glass.(5) Some synthetic bonegraft are made of calcium carbonate.(5)The most commonly used bone grafting materials in endodontic surgery are calcium phosphate, hydroxyapatite and demineralized, freeze-dried bone allograft (DFDBA) material. (3) This article briefly describes different graft materials which are used in Endodontics.

Bone grafts used in Endodontics

Autograft: Due to their osteogenic qualities, autografts are regarded as the "best quality level" among the several available unifying materials. Since a number of developmental factors contribute to the separation of mesenchymal undifferentiated cells into osteoblasts, reasonable cells from the benefactor to the beneficiary site as well as osteoinductive characteristics are also desirable. The risk of an impervious response is zero, with a success rate of >95% because they share the same natural birthplace as the existing life form desirable. Allograft: Allografts are typically obtained from human cadavers and require to be processed before being used. (4) The most commonly used forms of allograft are freeze-dried bone allograft and decalcified freeze-dried bone allograft (DFDBA). (7) FDBA has osteoconductive potential only whereas DFDBA has both osteoconductive and osteoinductive properties. (8)

Endodontic regeneration has been demonstrated with both FDBA and DFDBA. When used in periapical defects after root end surgery, one endodontic study demonstrated that FDBA results in histological regeneration with no adverse reaction. Many studies showed that healing and new bone formation with FDBA is more rapid. (7)

Alloplastic material: A heterogeneous group of materials including calcium phosphate, calcium sulphate, calcium carbonate, bioactive glasses and polymers is represented in this category. (8) Alloplastic bone substitutes are available in a wide range of sizes and shapes for use in bone replacement or soft tissue support applications. These biomimetic materials aim to act as a three-dimensional framework for bone growth and arrangement, increasing cell adhesion and expansion, without osteoinductive, osteogenetor, or osteogenic components. (6)

Hydroxyapatite is found to be very effective alloplastic material in large bone destruction caused by periradicular lesion. Hydroxyapatite offers the potential of an unlimited supply of bone substance, absence of donor site morbidity, and decreased operative time. Hydroxyapatite is biocompatible, not immunogenic nor antigenic.