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Efficacy of bioglass (HABG) grafting over non grafting on mandibular third molar extraction sites- A comparative study * Sajesh S., ** Manjunath Rai Reconstruction of complex osseous defects in craniofacial region is challenging to the modern surgeon. An osseous defect in the craniofacial region may result from minor surgeries trauma infection congenital anomalies or due to oncological ablative surgeries. Development of predictable methods to reconstruct and methods to enhance bone regeneration is a priority for dental and medical specialties. Historical records from implantation of natural minerals and gem-stones goes far back to the period 600-800 A.D, followed by ivory, inert metals, and bone products. 1 Bone grafting is used by many surgical specialists. Various materials are attempted by clinicians to replace the defects in orofacial region. Most of these bone replacement materials act as defect fillers or scaffolds and there by promotes regeneration. Autogenous bone graft has been used more frequently as it can be harvested easily and gives the best possible KDJ - Vol.34, No. 1 Supplement, March 2011 Research Abstract Objectives: the purpose of this study was 1. To assess and evaluate the effectiveness of Chithra hydroxyapatite bioglass composite granules (Chithra (HABG)) as a graft material in the healing of extraction sockets following third molar removal. 2. To analyze the effect of the material with regard to periodontal pocket depth and inflammation distal to second molar. 3. To investigate the merit of the material with respect to its impact on the incidence of post operative complications such as pain or dry socket and also to study the amount of osseous fill. Methods: In this study a total of 25 patients with bilateral mandibular 3 rd molar impactions were selected, age range at an averaging 18-30 years. Impacted tooth on the right side was denoted as site –A on which grafting of Chithra hydroxyapatite bioglass composite granules (Chithra HABG) was performed following removal of that tooth, where as the left side was chosen as site B and it was allowed to heal without interposition of any graft material following surgery. All patients were evaluated on the 3 rd and 7 th post operative day, they were evaluated for the presence of any inflammation, periodontal pockets distal to mandibular second molars, pain; dry sockets or any other pathologies respectively. Radiographic assessment was made at intervals of 3 months, 6 months and 9 months using panoramic study to evaluate the amount of osseous fill at both the grafted and non grafted sites. Results: Periodontal pocket distal to second molar and inflammation was significantly less in the grafted site when compared to that of the non grafted site. Incidence of postoperative pain was less in grafted site when compared to the non grafted site. There was no dry socket at both grafted as well as on the non grafted site. Radiographic evaluation showed good osseous fill in both grafted as well as on the non grafted site. The tests used in this study were Kruskal-Wallis test, Mann Whitney u test, Wilcoxon signed-rank sum test. Conclusion: This study shows the treatment of extraction site with Chithra (HABG) significantly alter the periodontal probing depth, inflammation, less incidence of pain and also shows good osseous fill distal to second molar. functional and cosmetic results. Various other materials like xenografts and allografts gave been used to overcome the disadvantages of auto grafts, such as donor site morbidity, limited availability, 3 high incidence of resorption. Allografts are becoming a more accepted form of bone grafts. The majority of large allografts assumes a near-normal / function in individuals who lack certain areas of the body that have been resected for oncologic problems or for other reasons. It is frequently possible for these areas to be replaced, and the patient can resume normal function. 2 The problems with allograft include premature resorption, delayed resorption, highly variable inductive properties and potential for disease transmission. Numerous materials have been invented and used in clinical practice which includes metals, polymers and ceramics. 127
The ideal bone replacement material should be chemically and biologically inert, surgically convenient, dimensionally stable, non carcinogenic, consistently induce bone formation, has an unlimited supply and easy to use. 3 Recently more emphasis is given on search bone replacement material which enhances bone regeneration. Bioactive bone grafting particulate, the material is the particulate form of Bioglass, which was first developed by Dr. Larry Hench in the 1970’s. The basis of the bonding property of bioactive glasses is their chemical reactivity in body fluids. Upon contact with body fluid, there is an immediate exchange of ions, which results in a physiochemical bond between bioactive glass, soft tissue and bone. The ion exchange creates an environment resulting in the formation of a hydroxy Carbonate apatite layer (HCA), a biological apatite identical to the mineral phase of bone which allows for more rapid repair and regeneration of bone than other synthetic grafting materials. Three general process leaching, dissolution and precipitation occur when a bioactive glass is exposed to body fluids. The leaching reaction occurs via ion exchange mechanism. Sodium is leached from the glass and replaced with protons from the solution. Concurrent with the leaching reaction, dissolution of the glass silica network occur. As silicic acid is released into solution, silanol groups form a hydrated layer at the glass surface. The silanol groups undergo a rearrangement via a poly condensation reaction to produce silica gel. The silica rich gel has a large surface area and a negative surface charge. This gel serves as a nucleation site to the formation of a calcium phosphate layer (CAP). The CAP phase that accumulates at the surface of the silica gel is initially amorphous, but subsequently crystallizes to hydroxycarbonate apatite structure by incorporating carbonate anions from the solution within the amorphous CAP phase. Organic species in the local environment such as collagen, chondrotin sulphate and 128 Sajesh S. Fig I: Post operative 3 months with graft Post operative 3 months with out graft glycosaminoglycans are incorporated into this bioactively forming layer. Osteoblasts are attracted to the hydroxy carbonate apatite and release organic constituents, followed by mineralization. The end result is a strong, bonded interface consisting of a series of layers: glasssilica gel- hydroxycarbonate apatite-bone. The Bioglass initiated HCA layer is biologically equivalent to the mineral phase of human bone, and is therefore recognized by the body as being something natural, not synthetic. This is followed by collagen deposition and cellular differentiation resulting in chemical bonding and enhanced healing of the defect. This bonding is theorized to prevent the fibrous encapsulation from occurring at the material surface. Studies have shown greater new cementum and alveolar bone formation with bioglass than other materials. 4 bioactive glass is a bioactive material that can be used in granular form to fill bone defects, 10 and is well tolerated by human tissues 13. It has the ability to bond to bone tissue and in addition, it enhances bone tissue growth due to its osteoconductive properties. Bioactive glass ceramics have found a wide range of application in other fields of dentistry and medicine. Bioactive glasses have also been used in the management of orbital floor fractures, 5 frontal sinus obliteration, sinus floor elevation 6 and various other osseous reconstructive procedures. They find use as liners for prosthetic applications. Bioactive glasses have also been used in bone cements and as fillers in polymer composites. The Chithra hydroxyapatite bioglass composite granules (Chithra HABG) used in this study was developed by the Biomedical Technology Wing of Sree Chithra Thirunal Institute of Medical Sciences and Technology (SCTIMST), Thiruvananthapuram. This material was developed as a part of their research on the development of bioceramics for hard tissue applications. These granules are made up of a combination of bioactive glass and hydroxyapatite, aimed at achieving better clinical results. It is a new KDJ - Vol.34, No. 1 Supplement, March 2011
Page 2 and 3: OFFICE BEARERS OF IDA KERALA STATE
Page 4 and 5: Contents Self adjusting files: the
Page 6 and 7: On publishing an article Publishing
Page 8 and 9: * Jacob John, * Tony P Mathew, **An
Page 10 and 11: DIFFERENTIAL DIAGNOSIS FOR PALATAL
Page 12 and 13: Fig 1. Swelling on buccal aspect of
Page 14 and 15: A comparative evaluation of bond st
Page 16 and 17: A comparative evaluation of bond st
Page 18 and 19: * N.S. Manikantan, ** S.C. Ahila, *
Page 20 and 21: *Ranjith M., **Rajesh Pillai, ***Ga
Page 22 and 23: Culturing of stem cells A successfu
Page 24 and 25: dentin complex 3 . Current research
Page 26 and 27: Alveolar decortication as a part of
Page 28 and 29: movement and the position of teeth
Page 30 and 31: stained, profuse or scanty. Cough:
Page 32 and 33: Fig 1. V taper files Fig 2. Parabol
Page 34 and 35: Fig 1. Schematic illustrations show
Page 36 and 37: * Roopa Prasannan, ** Rajesh Pillai
Page 38 and 39: Fig 5. PhotoActivated Disinfection
Page 42 and 43: Efficacy of bioglass (HABG) graftin
Page 48 and 49: Evaluation of antimicrobial efficac
Page 50 and 51: Introduction Biomedical Waste (BMW)
Page 52 and 53: c. Safe burial on hospital premises
Page 54 and 55: An in vitro evaluation of the effec
Page 56 and 57: An in vitro evaluation of the effec
Page 58 and 59: KDJ - Vol.34, No. 1 Supplement, Mar
Page 60 and 61: 2 of amelogenesis imperfecta, there
Page 62 and 63: Fig. 1 situations where rapid separ
Page 64 and 65: occlusal interference are the prima
Page 66 and 67: 1. Fig. 1A and Fig.1B; STEP 1: The
Page 68 and 69: implant fixtures based on the conce
Page 70 and 71: Novamin® & 5% Potassium nitrate in
Page 72 and 73: * Lakshmi Aravind Crown dilaceratio
Page 74 and 75: * Parvathy V. Lasers are devices th
Page 76 and 77: dentist can inspect the prepared wa
Page 78 and 79: and 17% EDTA. 5 The irrigating flui
Page 80 and 81: collagenase for 30 minutes. The num
Page 82 and 83: Genetic technology in the managemen
Page 84 and 85: *Sangeeth Sasidharan, **Rajesh Pill
Page 86 and 87: Fig 3: Diagram showing the imaging
Page 88 and 89: * Sameera G. Nath, ** Harikumar K.
Page 90 and 91:
curettage plus SRP it was concluded
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one. Thinning incisions and removal
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Fig 1. pre-operative photograph Fig
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* Lekshmy S. Devi Mandibular first
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Fig 4. A mandibular first molar wit
Page 100 and 101:
* Faisal M.A. Gaffoor Introduction
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VI. Simple reattachment Here no add
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Anterior middle superior alveolar i
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Of these, the phenothiazine dyes (t
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* Nandakumar V. Craniofacial distra
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orthognathic surgery18 this is usua
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original Problem and the features o
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of Mandibular Symphyseal Distractio
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Application of platelet-rich fibrin
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Application of platelet-rich fibrin
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Fig 1. Clinically, patient presente
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Fig 1. Extraoral photograph Fig 4.
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* K. Harikumar Introduction “To s
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Guided Tissue Regeneration with FEP
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Report of a case of radicular dense
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* Sapna Balakrishnan, ** Hema Sesha
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Fig 7. Preop probing depth of 7mm o
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Conclusion DMBM (Osseograft) alone
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determine how the lips and soft tis
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length also may play a role in faci
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*Ummer A., **Roshni A. Introduction
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Management of gingival recession us
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Graph-1 Comparison of CAL Between D
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Prosthetic rehabilitation of a pati
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the surgical techniques with the pr
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First visit Following scaling and r
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Evaluation of tissue dissolving pot
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