Bone Graft

drg. Ericka Winda Setiawaty

Periodontics Resident FKG UGM
 GRAFT

• Graft adalah suatu bagian jaringan yang diambil dari satu tempat dan
ditransplantasikan ke tempat lain, baik pada individu yang sama maupun yang
berlainan.
• Tujuan : memperbaiki cacat yang disebabkan oleh penyakit, kecelakaan, atau
anomali pertumbuhan dan perkembangan

(Horowitz, et al., 2014)

 BONE GRAFT

• Prosedur bedah yang menggantikan tulang yang hilang dengan bahan dari
tubuh pasien sendiri, pengganti buatan, sintetis, atau alami
• Kerusakan Tulang Periodontal

(Horowitz, et al., 2014)

 TUJUAN BONE GRAFTING

Mengurangi kedalaman Peningkatan

poket periodontal perlekatan secara
klinis
A B
Pengisian tulang di
daerah defek
C D Regenerasi tulang
baru, semen dan
ligamen periodontal
FUNGSI BONE GRAFTING
Mendorong terjadinya osteogenesis
(pembentukan tulang)

Memberi dukungan mekanis

pada kerangka resipien
(mechanical support)
JENIS BONE GRAFT ALAMI

AUTOGRAFT

ALLOGRAFT

XENOGRAFT
 JENIS GRAFT SUBSTITUSI
MATERIAL

Subsitusi graft tulang dengan dasar allograft

Subsitusi graft tulang dengan dasar faktor  faktor pertumbuhan alami dan
recombinant
Subsitusi graft tulang dengan dasar sel  Stemcell
Subsitusi graft tulang dengan dasar keramik: kalsium fosfat, kalsium sulfat, dan
biolgas (Haurencin et al. (2006)
 Extraction Site Preservation Using an
In-Situ Hardening Alloplastic Bone
Graft Subtitute

CASE REPORT

drg. Ericka Winda Setiawaty

Periodontics Resident FKG UGM
CASE REPORT
COMPENDIUM

(Lewentis, et al., 2014)

 INTRODUCTION
STUDI KLINIS &
EKSPERIMENTAL
Pencabutan gigi Immediate socket grafting

Mempertahankan Dimensi, kontur,

• Resorpsi tulang
• Atrofi ridge tulang alveolar
• Mempersulit penempatan
implant.
Immediate socket grafting
dan arsitektur kerangka alveolar dan
residu ridge.
Bone graft biologis maupun sintetis 
Socket Preservation & Regeneration for
Implant Placement
 INTRODUCTION

Fig 1. initial clinical

situation. Mandibular
right lateral incisor
was fractured.
 INTRODUCTION

Fig 2. atraumatic extraction

without flap raising. The
socket was grafted with the
in-situ hardening alloplastic
material. No primary closure
was necessary. vertical
cross-mattress sutures were
placed to stabilize the
adjacent papillae.
INTRODUCTION
MATERIAL BONE
GRAFT
• Bervariasi komposisi
• Karakteristik mekanik
• Mekanisme fungsi biologis:
resorpsi pembentukan tulang baru

Alloplasts osteokonduktif sintetis

• Biocompatible
• Non-iritatif
• Ketersediaan mudah didapat

Alloplastic bone substitutes  calcium

phosphate ceramics
 CASE
REPORT
 CASE REPORT
USIA PENCABUTAN
65 • Anestesi lokal
GIGI
• Atraumatic extraction with periotom 
GENDER No Flap
• Tulang Buccal utuh
Male
Bukan perokok
Tidak ada kontra indikasi POST EXO
• Debridement
implant 42
• Irigasi NaCl steril
• In-Situ Hardening Alloplastic Bone Graft
Subtitute

BONE GRAFT
• In-Situ Hardening Alloplastic Bone Graft
Subtitute
• Butiran β-TCp, dilapisi dengan pLGA
• dicampur di jarum suntik dengan
larutan BioLinker
 CASE REPORT
GRAFT GRANULES
• Graft granules  kontak darah/saliva  menempel
--> sticky, easy to handle, mudah dibentuk, mudah
mengeras
• Kasa basah untuk memadatkan 
• Mempercepat proses hard, oseokonduktif, porous
scaffold  host osseus regeneration

PROVISIONAL BRIDGE
• Soket terbuka  Secondary healing
• Penempatan provisional bridge

PENYEMBUHAN POST
• Biomekanik grafting material 
GRAFTING
proliferasi epitel bertahap
• Follow up 4 bulan:
- ditutupi epitel keratin baru
- volume & bentuk ridge adekuat
• Tulang baru, butir tertanam,
kontinuitas jaringan
 CASE REPORT

Fig 3. the biomechanical

stability of the graft, provided
by the Plga coating of the β-
tcP granules, permitted
the gradual proliferation of
newly formed soft tissues
over the grafted
site. clinical view 4 days
postoperatively.
 CASE REPORT

Fig 4. clinical view 2 weeks

postoperatively.
 CASE REPORT

Fig 5. clinical situation after 4

months.
 CASE REPORT

Fig 6. re-entry at 4 months.

the site was filled with newly
formed bone.
 CASE REPORT

Fig 7. implant
placement; good initial
stability was achieved.
 CASE REPORT

Fig 8. provisional restoration

 CASE REPORT

Fig 9. final restoration

after 3 months showing
successful esthetic outcome
 CASE REPORT

Fig 10. radiographic examination:a. initial situation; b. immediately after socket

grafting; c.bone modeling after 4 months; d. implant placement; e. peri-implant
bone remodeling after 3 months of non-occlusal loading. the maturation of
the surrounding bone can already be radiologically observed.
DISCUSSION

• Minimal invasive
• Flapless
• No membrane use to cover
the grafted
• Bio mekanis material 
stabilitas mekanik
• Heal by secondary invation
FLAPLESS
DISCUSSION
• Patients generally experience more • β-TCp as a resorbable socket
discomfort grafting material
• The mucogingival junction is • Peri-implan bone  adaptasi
significantly more coronally displaced, sesuai hukum Wolff
• Esthetic problems
• Negatively influence peri-implant soft-
tissue health and long-term stability.
FLAP GRAFTING
MATERIAL
 CONCLUSION

In-situ hardening alloplastic Hard- and soft-tissue

bone grafting substitute was preservation and
used in a minimally invasive, regeneration have been
successful, and predictable utilized in achieving an
way for socket preservation A B optimal soft-tissue profile

The in-situ hardening property

of this material may enable C D Both esthetically and
clinicians to utilize a flapless functionally allowing for
procedure without primary improved long-term
wound implant stability.
THANKS
Do you have any questions?

erickawinda@yahoo.co.id
+6282243361340

drg. Ericka Winda Setiawaty

Periodontics Resident FKG UGM