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Home Bone Morphogenetic Proteins What Is Bone Grafting? Who Will Perform My Procedure? Glossary What Are Dental Implants? Your Dental Anesthesia Options Tooth 911: What To Do When You Lose A Tooth A Primer on Teeth Osteoporosis and Tooth Loss Diabetes and Tooth Loss

What Is Bone Grafting?

There are a number of bone graft options available for patients who need to reverse jaw bone loss in preparation for dental implants.

Bone grafting is the replacement or augmentation of the portion of the jaw bone that anchors the teeth. It's a surgical procedure that's often done to reverse the loss or resorption of bone that may have occurred due to tooth loss, trauma, disease or ill-fitting dentures, and to rebuild the bone structure beneath the gums in preparation for the placement of dental implants or other tooth replacements. Learn more about the potential causes of jaw bone loss.

When bone graft is implanted in the jaw, it doesn't just simply fill a void in the bone; it may also help promote new bone growth in that location. When successful, bone grafting can restore both the height and width of your jaw bone.

There are several bone graft options, and they differ in how they help promote bone formation. They include:

Autogenous Bone Grafts. Also called autografts, these types of grafts are made from the patient's own bone, harvested from elsewhere in the body. Typical harvest sites include the chin, jaw, bone of the lower leg (tibia), hip (iliac crest) or the skull (cranium).

Autogenous bone graft has traditionally been considered the "gold standard" as a graft material because it is "live bone" complete with the living cellular elements that enhance bone growth. These include osteogenesis (bone formation from cells), osteoconduction (bone formation via migration upon a scaffold) and osteoinduction (bone formation by proteins such as BMP [bone morphogenetic proteins], which direct cells to form new bone). Learn more about BMP.

A potential downside of autogenous bone grafting, however, is that it involves a second procedure to harvest the bone, which may be painful and not in some patients' best interest, depending on their condition. It also may not be a viable option in instances where the patient's overall bone quality and/or density is poor, or when a large volume of graft material is required.

Allogeneic Bone. Allogeneic bone, also called allograft, is bone derived from a genetically unrelated member of the same species. It's typically non-vital (dead) bone harvested from a cadaver, then processed using a freeze-drying method that extracts all the water via a vacuum.

Allogeneic bone cannot produce new bone on its own – it's neither osteogenic (like autograft) nor osteoinductive (like BMP). Rather, its primary mechanism of action is that it is osteoconductive, and serves as a framework or scaffold over which bone from the surrounding bony walls can grow to fill the defect or void.

Xenogenic Bone. Similar to allogeneic bone, xenogenic bone is non-vital bone derived from another species, usually a cow. Because the potential for immune rejection and contamination by viral proteins is higher in bovine bone than in human cadaver bone, xenograft material is processed at very high temperatures (600-1,000 degrees Celsius). Xenograft's mechanism of action is similar to that of allograft – it serves as an osteoconductive framework on which bone from the surrounding area can grow to fill the void.

These grafting options are preferred by many patients and dental professionals alike because they eliminate the potentially painful second harvesting procedure. However, because allograft and xenograft lack autograft's bone forming properties, bone regeneration may take somewhat longer than it does when using the patient's own bone and the outcome may be less predictable.

Bone Graft Substitutes

Bone graft substitutes are commercially produced synthetic products that have many of the same bone forming properties as human bone, and are a safe and proven alternative to autograft and allograft.

One of the advantages of using a bone graft substitute instead of autogenous bone is that it eliminates the need to harvest the patient's own bone, thus potentially reducing the risk and pain associated with the harvest procedure.
Some bone graft alternatives include:

Demineralized Bone Matrix (DBM)/ Demineralized Freeze-Dried Bone Allograft (DFDBA) — a product of processed allograft bone, DBM/DFDBA contains collagen, proteins and growth factors that are extracted from the allograft bone. It is available in the form of a powder, crushed granules, putty, chips or as a gel that can be injected through a syringe.

Ceramics—Ceramics are also used as a substitute for bone grafts, and are available in many forms such as porous and mesh. Although ceramics may provide a framework for bone growth, they contain none of the natural proteins that influence bone growth and may be associated with inflammation in some patients.

Graft Composites—Graft composites use combinations of other bone grafting materials and/or bone growth factors to gain the benefits of a variety of substances. Typical combinations in use today include: a collagen/ceramic composite, which closely reproduces the composition of natural bone; DBM combined with bone marrow cells, which aid in the growth of new bone and a collagen/ceramic/autograft composite.

Bone Morphogenetic Proteins. Bone morphogenetic proteins (BMPs) are proteins naturally produced in the body that regulate bone formation and healing. A commercially available BMP is INFUSE® Bone Graft (rhBMP-2/ACS).
To learn more about INFUSE® Bone Graft, talk to your dental surgeon.

The materials on this Web site are for your general educational information only. Information you read on this Web site cannot replace the relationship that you have with your health care professional. We do not practice medicine or provide medical services or advice as a part of this Web site. You should always talk to your health care professional for diagnosis and treatment.

  • Published: January 23, 2007
  • Updated: April 23, 2010