BONE GRAFT AND BONE

GRAFT SUBSTTUTES

Presented By
DR. G.O. EYICHUKWU
 OUTLINE
Introduction
General principles of bone grafting.
Physiology of bone grafting.
Indications of bone grafting.
Goals of bone grafting
Complications of bone grafting.
BONE GRAFT SUBSTITUTES

Need for Graft Substitutes

Qualities of Ideal graft Substitutes
Classification of Bone Grafts Substitute
Types of bone Substitutes
Recent Advances
Conclusion
 INTRODUCTION
A graft is a term applied to a
piece of tissue removed from one
organism (person) and implanted
in another organism or at a
different site in the same
organism in other to remedy some
defects.
GENERAL PRINCIPLES OF BONE GRAFTING .
Terminology
Autograft (Autologous)
Alograft (Allogeneic)
Xenograft (Xenogeneic)
Isograft (Isogeneic/Syngeneic)
 CLASSIFICATION OF GRAFTS
Based on source
Grafts
Fresh
Preserved
Preservation can be by
Freezing
Freeze Drying
Irradiation
Chemical
Graft placement
Orthotopic
Anatomically appropriate
Hetrotopic
Anatomically inappropriate
 SOURCES OF BONE GRAFTS
Autologous / Autografts
Allografts

GRAFTS FUNCTIONS
Mechanical
Biologic

Osteogenesis
Osteoinduction and

Osteoconduction
 GRAFT INCORPORATION
A successful graft incorporation can be
defined as the ability of the transplanted
tissue to function as well as the original
tissue in maintaining the mechanical
integrity and functions
It is a complex multifaceted process; and
multiple variables influence its rate,
pattern and completeness.
 PHYSIOLOGY OF BONE GRAFT
Haemorhage
Inflammation
Revascularization
Substitutes of the graft with local tissue
Remodelling / Consolidations
INDICATIONS FOR BONE GRAFTS
Reconstructing skeletal defects
Augmenting fracture healing

Joint Fusion

Augmenting joint reconstruction procedure

 GOALS OF BONE GRAFTING
To
restore function
provide adequate cosmesis

provide relieve from pains.

COMPLICATIONS OF BONE GRAFTS.

Donor site morbidity
Transmission of infection
 BONE GRAFT SUBSTITUTES
These are matrices / materials that attempts to
simulate the physical and chemical properties of
cancellous bone.
They serve as off the shelf alternative to
autografts.
The substitute could be used alone or in
combination with autograft as bone graft
expanders.

NEED FOR GRAFT SUBSTITUTES.

 QUALITIES OF
BONE GRAFT SUBSTITUTES.
It Must be
Biocompatible
Osteo inductive/Osteogenetic

It should be
Resorbable
Able to to provide structural support and
thus available in block and granular form.
Cost effective

Readily available and easily processed

 CLASSIFICATION OF
BONE GRAFT SUBSTITUTES

Bone Graft Substitutes

OSTEOCONDUCTIVE OSTEOINDUCTIVE OTHERS

BIOLOGIC NON-BIOLOGIC
 TYPES OF BONE GRAFT SUBSTITUTES

Osteocondutive Biologic Types

Ceramics
hydroxyapatite
Porous Coralline ceramics

Tricalcium Phosphate Implants (TCP)

Combined TCP and hydroxyapatite

Calcium Phosphate Cement

Collagens (Collagraft)
 TYPES OF BONE GRAFT SUBSTITUTES
Osteocondutive Non Biologic Types
Acid polymers
Polylactic/Polyglycolic
Porous metals
Bioactive glasses

Osteoinductive Bone Graft Substitutes

Demineralized bone matrix
Bone morphogenetic protein
rhBMP and Purified type
Gene therapy

Recombinant growth and development factor -5

rhGDF5
 OTHER BONE GRAFT SUBSTITUTES
Calcium sulphate based bone substitute
Polymethyl methacrylate bone cement.

RECENT ADVANCES
Other growth factors
FGF
TGF
PDGF
IGF
Growth Hormone
Engineered stem cell products.
CONCLUSION