A Review of Bone Substitutes

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The use of bone grafts in the repair of defects has a long history of success, primarily with the use of autologous bone. With increasing technologic advances, researchers have been able to broaden the spectrum of grafting materials to allografts, xenografts, and synthetic materials, which provide the surgeon and patient with options, each with unique advantages. It is with the knowledge of each material that the clinician can present and suggest the best material and tailor treatment plans to fit each individual. In this article, we present an overview of the principles of bone grafting, the types of graft materials available, and an outlook to what the future holds in this area of medicine and dentistry.

Section snippets

Overview

Many factors are involved in the successful incorporation of a grafted material, including graft type, preparation site, vascularity, mechanical strength, and pore size of the material. These parameters make the use of bone substitutes challenging in terms of reliability and predictability. Selecting the graft material is based on many factors. One such factor deals with the morbidity of the harvest site, which occurs in autograft harvesting. Another important area to consider is whether the

Allograft

Although autografts are the gold standard, allografts are much more accepted by patients as the bone grafting material of choice. Allogeneic bone is a graft that is taken from a member of the same species as the host but is genetically dissimilar. Approximately one third of the bone grafts in the United States currently are allografts [2]. The grafts are prepared as fresh, frozen, freeze-dried, mineralized, and demineralized, and each preparation may be purchased as cortical chips, cortical

Xenograft

Xenografts are derived from a genetically different species than the host. One of the most used xenografts is bovine bone. The best known example of this is Bio-Oss (Osteohealth, Shirley, NY). Bio-Oss, deproteinized bovine bone mineral, has been treated by having all of its organic material removed. This treatment leaves a crystal structure that practically matches human cancellous bone in structure. The particle size of this material is 0.25 to 1 mm. Pores with these dimensions have been shown

Synthetic materials

Synthetic grafting materials have been shown to possess two of the four characteristics of an ideal graft: osteoconduction and osteointegration. The ideal synthetic graft material should be biocompatible and elicit minimal fibrotic changes. The graft should support new bone growth and undergo remodeling. Other features include similar toughness, modulus of elasticity, and compressive strength compared with host cortical or cancellous bone [21]. Many synthetic materials are available to

Summary

The allograft is the most popular graft used currently. This graft type can be purchased in multiple structures depending on the clinical need for defect repair. Synthetic substitutes create a new avenue for clinicians to explore as adjuncts in surgical procedures. These materials may not necessarily be used solely for reconstructive procedures, but when used in the right situations in combination with autologous, allograft, or other synthetics, the results have the potential for more desirable

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