A Comparative Evaluation Of Decalcified Freeze Dried Bone Allograft And Its Combination With Hydroxyapatite In Osseous Defects Of Maxillofacial Surgery

Abstract

Background: The development of bone graft material to replace bone remains a formidable challenge in maxillofacial surgery. Although autogenous bone is the best material, however, the advantage of an autograft is offset by the limited supply of such bone and morbidity associated with surgery to harvest the graft. The thesis aims to study and compare the efficacy of two such bone substitutes in the healing of osseous defects of the maxillofacial surgery.

Method: 20 patients reporting to DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY, AL-AMEEN DENTAL COLLEGE AND HOSPITAL, BIJAPUR, requirin

Treatment for osseous defects were selected for the study. They were categorized in two groups of 10 each. GROUP A were treated by DFDBA and GROUP B were using DFDBA and HYDROXYAPATITE in combination. Treatment outcome was evaluated using many parameters like pain, swelling clinically and bone density radiographically pre operative, 1^st day ,1^st week, 4^th week and 12^th week post operative. Results: Analysis of the two groups did not reveal high statistically significant differences at any of the follow up periods except for radiological evidence at four weeks.

All the patients had mild to moderate pain on GROUP A on first post-operative day. Pain was maximum on 2^nd post-operative day and decreased gradually and almost nil by the end of 4^th post-operative day. In case of GROUP B, all patients had moderate to severe pain on first post- operative day. Pain was maximum from 2^nd to 4^th post operative day and then gradually decreased but slight pain was there at the end of first post-operative week All the patients had mild to moderate swelling in GROUP A on first post-operative day. Swelling decreased gradually towards normal. By the end of first week post-operative, swelling was nil.

In case of GROUP B, all patients had moderate to severe swelling on first post-operative day. Swelling was maximum from 1^st post-operative week and then started decreasing towards normal. By the end of first week post-operative, slight swelling was still present. GROUP A No signs of infection (persistent post operative swelling, pain or pus discharge) were seen in any patient of GROUP A. No signs of implant (graft material) rejection (discharge, extrusion, tissue dehiscence) were seen in any patient of GROUP A. In GROUP B, however, all these three signs of implant (graft material) rejection were seen in one patient at fourth week. The graft material was surgically removed at fourth week. Radiological evidence of calcification, bone formation and bridging of the gap with new bone as evident by formation of irregular trabeculae of bone and appearance of radio-opaque areas in the defect was evident from fourth week onwards. It was seen 70 % cases of GROUP A, in 30% cases of GROUP B. The difference between GROUP A and GROUP B was statistically significant (P\0.01) at this point of time. Bone density was assessed by grey scale histogram.

Conclusion: DFDBA when used for the obliteration of osseous defects bypasses the phase of obligatory resorption and shows early evidence of new bone formation. HA when used for Obliteration of osseous defects shows delayed first evidence of bone formation as compared to the decalcified freeze-dried bone matrix allograft and it undergoes resorption but takes a long period to resorbed completely and be replaced by bone. The radiograph assessment score over grey scale histogram indicates early bone formation with DFDB and the combination of DFDBA and HA.