**Hard Tissue Regeneration**

**Chapter 9**

**Provisional chapter**

**Hard Tissue Regeneration Treatment Protocols in**

**Hard Tissue Regeneration Treatment Protocols in** 

DOI: 10.5772/intechopen.74944

Dental implant placement is one of the most reliable and predictable treatment choices in modern oral surgery. It requires available bone volume to resist the force during loading. There are many ways to regenerate the bone to place the implants with the desired dimensions. Guided bone regeneration, socket grafting, allograft bone block grafting, and intra- and extraoral autogenous bone block grafting are the most popular treatment approaches to reconstruct hard tissues. Autogenous bone graft is still considered the gold standard for the reconstruction of hard tissues. In addition, there are many scaffold biomaterials available that are used as templates for new bone formation. These biomaterials are helpful to not only eliminate the usage of autogenous bone grafts but also decrease patient morbidity. Another advantage of biomaterial usage in tissue regeneration is to reduce the learning curve of treatments by facilitating operative approaches. The aim of this chapter is to evaluate contemporary biomaterials that are used to reconstruct hard

**Keywords:** hard tissue engineering, bone defect, biomaterials, scaffold, dental implant

The main reasons for tooth defects include periodontal diseases, decay, trauma, failed endodontic treatments, congenital anomalies, oncologic diseases, oral infections, and orthodontic treatment [1]. Functional and esthetic treatment for tooth loss is important but time-consuming. Dental implant applications are among the many methods developed to treat this problem [2]. Since the definition of osseointegration, dental implants have been a proven and

frequently used method in the treatment of total and partial tooth loss [3, 4].

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

**Contemporary Oral Surgery**

**Contemporary Oral Surgery**

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

Bahattin Alper Gultekin and Gamze Zeynep Adem Siyli

Bahattin Alper Gultekin and Gamze Zeynep Adem Siyli

**Abstract**

**1. Introduction**

http://dx.doi.org/10.5772/intechopen.74944

tissue defects in oral surgery.

#### **Hard Tissue Regeneration Treatment Protocols in Contemporary Oral Surgery Hard Tissue Regeneration Treatment Protocols in Contemporary Oral Surgery**

DOI: 10.5772/intechopen.74944

Bahattin Alper Gultekin and Gamze Zeynep Adem Siyli Bahattin Alper Gultekin and Gamze Zeynep Adem Siyli

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.74944

#### **Abstract**

Dental implant placement is one of the most reliable and predictable treatment choices in modern oral surgery. It requires available bone volume to resist the force during loading. There are many ways to regenerate the bone to place the implants with the desired dimensions. Guided bone regeneration, socket grafting, allograft bone block grafting, and intra- and extraoral autogenous bone block grafting are the most popular treatment approaches to reconstruct hard tissues. Autogenous bone graft is still considered the gold standard for the reconstruction of hard tissues. In addition, there are many scaffold biomaterials available that are used as templates for new bone formation. These biomaterials are helpful to not only eliminate the usage of autogenous bone grafts but also decrease patient morbidity. Another advantage of biomaterial usage in tissue regeneration is to reduce the learning curve of treatments by facilitating operative approaches. The aim of this chapter is to evaluate contemporary biomaterials that are used to reconstruct hard tissue defects in oral surgery.

**Keywords:** hard tissue engineering, bone defect, biomaterials, scaffold, dental implant

#### **1. Introduction**

The main reasons for tooth defects include periodontal diseases, decay, trauma, failed endodontic treatments, congenital anomalies, oncologic diseases, oral infections, and orthodontic treatment [1]. Functional and esthetic treatment for tooth loss is important but time-consuming. Dental implant applications are among the many methods developed to treat this problem [2]. Since the definition of osseointegration, dental implants have been a proven and frequently used method in the treatment of total and partial tooth loss [3, 4].

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The success of dental implants is assessed by criteria such as implant survival, stability of prosthetic treatment, radiological bone loss, and presence of peri-implant infection [5]. The accepted general consensus for the success of dental implants in recent years is that both functional and esthetic results are satisfactory [6]. There are risk factors that should be considered for the success of an accomplished outcome. Some of these factors include age, sex, general health status, habits, the region where the implant is placed, the number of implants, and the condition of the bone [7].

Major factors:

Minor factors:

• Flap design

• Graft placing method • Epithelial retardation

osteoinductive mechanisms.

**3.1. Osteogenesis**

• Patient selection, patients without medical problems

• Graft types: autografts are preferred for allografts and allografts are preferred for alloplasts

Hard Tissue Regeneration Treatment Protocols in Contemporary Oral Surgery

http://dx.doi.org/10.5772/intechopen.74944

143

The main component of bone healing is the selection of the materials for the bone graft. Bone grafts have different bone-forming capacities; therefore, we need to understand the mechanisms of bone regeneration for the grafts used at the recipient regions. The requirement of the region can be determined in advance and the graft is chosen accordingly. Bone healing in the region where the graft is placed is supported through osteogenic, osteoconductive, and/or

Osteogenesis is defined as the formation of bone in the region where osteoblasts and osteoblast precursors do not have bone tissue. New bone formation occurs when osteoblasts and osteoblast precursors are produced by cancellous bone and bone marrow. Osteogenesis (bone formation) is characterized by the presence of living osteoblast cells in the graft material. The only bone graft with osteogenesis is the autogenous bone [20]. Autogenous bone grafts, also called autografts, are grafts transplanted from one site to another. The most effective type in terms of osteogenesis is cancellous bones, due to the migration of bone cells at high concentrations. Autografts have been observed to have bone formation capacity even when bone tissue is placed underneath the skin [21]. Vascularization of the graft site is necessary for continued osteogenesis. Some studies have reported loss of osteogenic properties of free autogenous grafts without vascular support within 5 days and that they continued osteoinductive and osteoconductive effects at the end of the study [20, 21]. Therefore, free autogenous bone grafts show osteogenic characteristics only for a few days. We should pay attention to the viability of the cells when placing the autogenous graft in the recipient region. Once the autogenous bone has been obtained, it should not be left in the dry area, and if possible, it should be used

• Defect morphology: multiwalled bone defects

• Healing capacity of the patient

**3. Bone graft healing mechanism**

as soon as possible with saline in a sterile environment [22].

For dental implant indications, the presence of adequate bone and the relationship between both jaws are important. Studies have reported that a non-ideal three-dimensional implant placement may cause peri-implantitis, esthetic and functional failure, and may even result in removal of the implant [8]. To achieve optimal esthetics and function, the position of implant in the alveolar crest has to be in a biologically correct and prosthetically driven location [9]. When the implant is placed in an inappropriate position, for example, a bone-directed position, the use of pink porcelain and/or angulated abutments would be inevitable. Besides, nonaxial masticatory forces will increase the risk of complications, such as screw loosening or fracture and chipping on implant-supported restoration [10]. Insufficient alveolar ridges may require bone augmentation procedures to achieve optimal bone volume before implant placement. These applications ensure that the implant is placed in the correct position and that an appropriate restoration can be performed [11].

The amount and location of bone resorption are important factors in the selection of the augmentation technique. In addition, the relationship between the jaws in radiological and clinical evaluations should be considered in the sagittal, frontal, and transverse planes [12]. Alveolar bone augmentation procedures include applications for increasing residual crest width and/ or height using grafts and/or biomaterials or for optimizing bone contours with repair of bone defects [13]. In an attempt to correct bone defects, many techniques have been extensively described for bone augmentation and grafting materials. Although autografts remain the "gold standard," the use of biomaterials in orthopedics and dentistry is increasing [14].
