Bone Substitute: The Search for the “Perfect” Grafting Material

By Dr. David Rosen – from Dental Compare

With the possible exception of implant fixtures (and their prosthetic attachments), no area in periodontics has proliferated so rapidly as periodontal regeneration materials. Today commercial preparations are marketed almost as soon as the first piece of research is published. Some pan out and some are gone as fast as last week’s average movie.

Compact bone & spongy bone

Image via Wikipedia

Now, with the advent of ridge augmentation to receive implants and sinus lifts, grafting materials are being designed for specific applications. Some are engineered to maximize the space for bone ingrowth while others provide a scaffold and readily available inorganic components of bone that migrating reparative cells can utilize. Biologic modifiers are being introduced to increase the likelihood of regeneration.

In addition, some manufacturers have begun to individually test donor materials, such as allografts from tissue banks, to determine the graft’s ability to induce bone formation in lab animals in areas which would not normally form bone. This increases the likelihood that the graft will actually induce surrounding tissues to form new bone. Inconsistent induction potential in commercially available allogenic grafting materials may be partly responsible for the variability in study results on osseous grafts. Continuing refinements such as these will ultimately improve the predictability of results.

The search for the “perfect” grafting material has focused on bone and bone substitutes, and more recently had added biologic modifiers; that is,substances which influence the activity of the cells responsible for new periodontal ligament formation. Autogenous bone grafts are the “gold standard” for comparing the success of other graft materials. The table below shows the three categories of non-autogenous materials now being used in periodontics,with major examples of each within the category. It is obvious that the choice of material, or combination or materials, is becoming increasingly complex. We want to inform you of these materials so you may share the wide variety of possibilities with your patients.


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