S213: A Decision Tree for Bone Graft Success

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Successful bone grafts to the maxillo-mandibular complex depend upon an understanding of basic bone biology, appropriate surgical technique, evaluation of recipient and donor sites and knowledge of bone graft materials.

This lecture presents the protocol for bone graft success and discusses the reasons that affect success and/or failure. Particular attention is directed to evaluation of the recipient site and specifically the quality and quantity of cancellous and cortical bone. This evaluation combined with an understanding of basic surgical principles aids the clinician to decide not only on appropriate surgical procedure, but upon the use of autogenous bone versus allogeneic or alloplastic grafts. This lecture guides the clinician to answer specific questions of when to use an on-lay bone graft, a split cortical graft, the sandwich graft, the sinus graft, ridge preservation, socket grafts, particulate grafts with titanium or membrane stabilization.

Autogenous bone has been considered the “gold standard” as the most predictable graft. However, harvesting autogenous bone requires a second surgical site, increased surgical and healing time, and increased morbidity. Is there an alternative to autogenous grafts?

This lecture also discusses when autogenous grafts are absolutely indicated and when alternative graft materials are successful as well as when they fail to produce predictable success.

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References 

1. Roberts E, et al. Bone physiology and metabolism. In: California Dental Association Journal. 1987;p. 54–67October
2. Reddi AM, Wientroub S, Muthukumaran N. Biological principle of bone induction. Orthop Clin No Amer. 1987;18:207–212
3. Wittbjer J, Palmer B. Osteogenetic activity in composite grafts of demineralized compact bone and marrow. Clin Orthop. 1983;173:229–238