Optimized bone grafting

Abstract

Bone grafting is routinely performed in periodontology and oral surgery to fill bone voids. While autogenous bone is considered the gold standard because of its regenerative properties, allografts and xenografts have more commonly been utilized owing to their availability as well as their differential regenerative/biomechanical properties. In particular, xenografts are sintered at high temperatures, which allows for their slower degradation and resorption rates and/or nonresorbable features. As a result, clinicians have combined xenografts with other classes of bone grafts (most notably allografts and autografts in various ratios) for procedures requiring better long‐term stability, such as contour grafting, sinus elevation procedures, and vertical bone augmentations. This review addresses the regenerative properties of each class of bone grafts and then highlights the importance of understanding each of their biomechanical and regenerative properties for clinical applications, including extraction site management, contour augmentation, sinus grafting, and horizontal and vertical augmentation procedures. Thereafter, an introduction toward the novel production of nonresorbable bone allografts (NRBAs) via high‐temperature sintering is presented. These NRBAs not only pose the advantage of being more biocompatible than xenografts owing to their origin (human vs. animal bone) but also display nonresorbable properties similar to those of xenografts. Thus, while packaging allografts with xenografts in premixtures specific to various clinical indications has never been permitted owing to cross‐species contamination and FDA/CE requirements, the discovery and production of NRBAs allows premixing with standard allografts in various ratios without regulatory restrictions. Therefore, premixtures of allografts with NRBAs can be produced in various ratios for specific indications (e.g., a 1:1 ratio similar to an allograft/xenograft mixture for sinus grafting) without the need for purchasing separate classes of bone grafts. This optimized form of bone grafting could theoretically provide clinicians more precise ratios without the need to purchase separate bone grafts. This review highlights the future potential for simplified and optimized bone grafting in periodontology and implant dentistry.

The development of non‐resorbable bone allografts: Biological background and clinical perspectives

“…Extraction sockets were randomly filled with the following grafting materials (i.e., 6 teeth/group): (1) DBBM, (2) FDBA, (3) FDBA sintered at 700°C for 4 h, (4) FDBA sintered at 900°C for 1 h, ( 5) FDBA sintered at 900°C for 4 h, ( 6) FDBA sintered at 1300°C for 1 h, (7) FDBA sintered at 1300°C for 4 h, or (8) blood clot alone. The extraction sockets were covered by a resorbable collagen membrane (Bio-Gide®; Geistlich Pharma AG, Wolhusen, Switzerland).…”

“…6 Each of these classes of bone grafts offers various advantages and disadvantages based on their respective handling properties, biocompatibility, surface geometry and chemistry, mechanical properties, and degradation properties. While autogenous bone is considered the gold standard combining the features of osteoconduction, osteoinduction and osteogenesis, as highlighted in the previous article titled "Optimized bone grafting", 7 alternative bone grafting materials available in higher supply with less patient morbidity have always been a desired end goal for clinicians.…”

A parathyroid hormone related supramolecular peptide for multi-functionalized osteoregeneration

“…While bone tissue shows self-healing properties after injuries, critical bone defects caused by severe trauma or surgical excision generally fail to obtain absolute union, resulting in nonunion or delayed union [ 1 , 2 ]. Autologous bone transplantation is currently the gold standard to treat this troublesome disease, but it may cause various complications, such as bleeding, infection and chronic pain [ 3 ]. Allogenic or xenogeneic bone transplantation are also indispensable strategies in the clinic, but they are normally correlated with detrimental inflammation and pathogen transmission, ultimately causing graft failure [ 4 ].…”

Bone Allograft Acid Lysates Change the Genetic Signature of Gingival Fibroblasts

“…However, the harvesting of autologous bone, particularly for mandibular reconstructions [8] but also mandibular symphysis, retromolar regions, and ramus [9,10], is an invasive procedure associated with morbidity and the volume to be harvested is limited. Moreover, the original volume achieved upon augmentation with autologous bone shrinks [11], thus resorption of the grafts requires over-augmentation and combination with slow-resorbing biomaterials [12]. Thus, and because only a limited amount of autologous bone grafts can be harvested from the same patient to be treated, allogenic bone grafts prepared from the femoral head of a patient undergoing hip replacement, multi-organ donors, or even post-mortem donors are more accessible [13].…”