Cadaver Bone for Grafting?
Posted in Bone Grafting
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Subscribe to this PostDr. S, from Los Angeles, asks us:
As I’m sure everyone is aware there has been alot of controversy surrounding grafts made from cadaver bone, following the recent stolen body parts scandal. As such, I wanted to get a consensus view from OsseoNews readers about the current state of affairs.
How much danger is there really in using cadaver bone for bone grafting? Many
of my patients are concerned they may contract a communicable disease.
But what are the chances of this? Are most of you just switching to synthetic materials because of this bad PR? But, are the synthetic grafting materials a good and predictable alternative? What are the pros and cons? What are the alternatives and where is your practice headed? Thanks.
Dr Pratt
I would like to challenge you to ask a Periolase owner if the claims made by Millennium are false? Except for seamentum of course, who I doubt is an owner. If he were he would not have to hide behind anonymity.
Or you can look it up in the CRA evaluation where 100% of the respondents said the marketing claims made by MDT are true, 100% of the respondents would buy again, 100% of the respondents said the ethics of the company was good and they gave it a 9.7 out of 10 No other dental product has EVER gotten a 9.7 out of 10 in the history of CRA.
As far as the best interest of the patient, I know that LANAP is the best treatment modality and soon to be the standard of care in the fight against periodontitis.
Dr Pratt wrote
“Watch Doctors who make claims on these products most people have finacial interests in thier claims. The problem is one day patients will wake up and realize that they are not being treated with thier best interest in mind and thats when they contact a lawyer.”
JohnDDS You either work for Millenium or you are trying to justify ways to not refer to a specialist because you want to milk your patient for all hes worth. You shouldnt be talking about anonymity your not using your full name either.
First off LANAP is just a fancy name for ENAP which yukna study in the 80′s now hes doing it again with a LASER.
EXCISIONAL NEW ATTACHMENT PROCEDURE ENAP Yukna, et al. 1980:
The ENAP is essentially subgingival curettage performed with a knife. The scalloped, internally beveled incision extends from the free gingival margin to the base of the pocket. Debridement, root preparation and primary wound closure with sutures and dressing follow The modified ENAP essentially involves the following modifications: 1) The initial incision is directed at the alveolar crest. 2) The complete removal of all the healthy connective tissue, granulation tissue and epithelium coronal to the bone. The modified ENAP is easier to perform, affords better access and more effectively utilizes the healing potential of the periodontal ligament. A disadvantage is the removal of intact connective tissue fibers with potential for attachment loss.
Indications The ENAP and modified ENAP are limited to treatment of suprabony pockets with firm, fibrous pocket walls within a zone of adequate keratinized gingiva and areas of convex root anatomy which facilitate good soft tissue adaptation
Clinical Studies: Examined the clinical results of the ENAP after 5 years in 56 surgical sites in human subjects, reporting an overall mean PD decrease of 1.8mm for the ENAP at 5 years. This was the same as that reported for the MWF and 0.5mm better than that following curettage of lesions of similar severity at 5 years postoperativerly. The mean amount of new attachment retained at the 5 year period was 1.5mm, comparing favorably to the 0.4 mm and 0.5 mm gains accompanying curettage and the MWF respectively (Yukna, et al., 1980).
These studys where later refuted by
Lindhe and Nyman published 5-year results of an evaluation of 1620 teeth in 75 patients who had advanced periodontal disease and were treated with surgical pocket elimination (OSSEOUS SURGERY). Prior to surgery 113 of 247 teeth with furcation invasion (45%) were extracted. The remaining 134 teeth with furcation invasion were treated aggressively; i.e., 41% had scaling/root planing or furcation odontoplasty, 51% had root resections and 7% had tunneling procedures. All patients had excellent oral hygiene and were recalled every 3 to 6 months for 5 years. At 5 years:
1. plaque and gingival index scores were decreased;
2. pocket depths decreased from a mean of 5.7 mm to less than 3 mm;
3. radiographic bone scores indicated no further bone loss;
4. mobile teeth decreased from 57% to 26%; and,
5. no teeth were lost.
and
Kaldahl et al. reported on the 7-year results of a longitudinal study comparing coronal scaling, root planing, ENAP, modified Widman flap and flap with osseous resective surgery in 82 patients. The results were as follows:
1. all therapies reduced probing depth;
2. osseous resection was the most effective in reducing probing depth;
3. probing depths were reduced in direct proportion to the depth of the pocket;
4. osseous resection produced loss of clinical attachment in the 1-4 mm pocket;
5. modified Widman flap and root planing produced the greatest gain of clinical attachment in 5-6 mm pockets; and,
6. osseous resection resulted in the most recession.
BOTH SHOWED FLAP OSSEOUS IS MORE EFFECTIVE AT MAINTAINING TEETH LONG TERM AND THERE IS COUNTLESS OTHER STUDYS TO SUPPORT FLAP OSSEOUS OVER ENAP OR LANAP OR WHATEVER YUKNA WILL CALL IT THESE DAYS.
TRY TO REMEMBER YOU NEED TO PRACTICE EVIDENCE BASED DENTISTRY BEFORE YOU MAKE CLAIMS LIKE: JOHNdds”As far as the best interest of the patient, I know that LANAP is the best treatment modality and soon to be the standard of care in the fight against periodontitis.”
ARE YOU BASING THE YOUR ABOVE STATEMENT BASED ON ONE STUDY, DO YOU BOTHER TO LOOK AT OTHER STUDYS OR DO ANY RESEARCH ON YOUR OWN, OR YOU DO YOU BUY EVERYTHING THAT THE COMPANY CLAIMS.
I GUESS YOUR ONE OF THESE GUYS THAT TELLS HIS PATIENTS NOT TO FLOSS BECAUSE LISTERINE FOUND THAT RINSING IS JUST AS EFFECTIVE AS FLOSSING.
SAD IF YOU DO.
JOHN TRY TO REMEMBER YOUR A DOCTOR, AND TRY NOT TO BASE ALL YOUR TREATMENT BASE ON ONE STUDY THAT THE COMPANY IS PUSHING.
BUT WHAT DO I KNOW IM JUST A GENERAL DENTIST, FEEL FREE TO LOOK ME UP. I WOULD LOOK YOU UP IF YOU USED YOUR WHOLE NAME.
Seamentum
Part of the AAP emblem is Cooperation, collaboration, and advancement, I’d like to see all 3 especially the advancement of the treatment of periodontitis. The AAP has not invested $1 to LANAP research to disprove the claims by the FDA. On the contrary they sent out a hit piece against the Periolase last year. Don’t you think that if anyone should advance the treatment of Periodontitis it should be Periodontists.
My opinion is that periodontists have given up on saving teeth and are now bowing down to the Implant god. So of course it is now the obligation of GP’s to help their patients KEEP THEIR TEETH!!!!
As far as your question “Why is Dr. Yukna the only one supporting this “revolutionary” procedure.” I would recommend you ask yourself, Why you did not return your Periolase??? You had a 6 month money back guarantee. In the history of MDT only one clinician has ever exercised that option. Why have all the periodontists that have the periolase none of them have ever returned it? Did you know that over 15% of periolase users are periodontists and the ratio of GP’s to periodontists in the general population is less than 5%.
Dr Pratt
To see who I am all you need to do is click on my name it will take you to my website.
John
Impressive website. But you havent addressed the sound research I presented and the claims you are making.
You need to be careful when you list stuff like this on your website:
“Laser Gum Therapy We can now reverse gum disease Gingivitis and Periodontitis. For more information see below”
You cant reverse periodontal disease, you can maintain and prevent further and even regenerate but a patient will have periodontal disease for life unless you maintain them.
I agree with you that we as a profession our pulling teeth far to quickly in replace of implants. But you my friend our contributing to the problem, not referring you patients to a perio specialist who provide therapy backed by research. Instead you choose not to refer and provide laser treatment that is backed by little research and evidence. Look at the millenium website, most of the articles are in dentistry today. I see very few articles in perio journels, Jada, etc.
Unfortunately most periodontist I talked to have to do implants to just stay afloat, thats because to many general dentists are lasering and arestining there patients instead of referring them to get the patients proper treatment.
Once again Dr John, that piece of paper you hang on the wall should give you the knowledge and tools to look at the research and provide therapy that is evidence based. One article is not enough for you to make claims to your patients that you can reverse peridontal disease.
You owe your patients more, we all do. Dont get blinded by the dollars your making and the claims a company makes.
JOHN TRY TO REMEMBER YOUR A DOCTOR, AND TRY NOT TO BASE ALL YOUR TREATMENT BASE ON ONE STUDY THAT THE COMPANY IS PUSHING. AFTER SEEING YOUR WEBSITE I SEE THATS WHAT YOU ARE DOING.
Im not saying you have to refer all your patients, I certainly dont, but I certainly refer the cases that are beyond my scope. Which is alot of cases, thats why the ADA and AMA created specialist.
Dr Pratt
Why should I refer for an inferior service? I have seen the results first hand the reversal of the #1 cause of tooth loss in adult Americans!! I have slashed periodontal pockets in half consistently. 12mm infected and inflamed pockets to 2mm sulci over & over & over & over again with little or NO pain, with out screwing down the patient!
Dr Pratt
I googled you & nothing.
As far as comparing ENAP to LANAP they are two different modalities.
Here is another article in the Peer reviewed General Dentistry.
Laser-assisted new attachment procedure in private practice
David M. Harris, PhD
Robert H. Gregg II, DDS
Delwin K. McCarthy, DDS
Leigh E. Colby, DDS
Lloyd V. Tilt, DDS, MS, PC
Three private dental practices conducted a retrospective analysis of patients receiving the laser-assisted new attachment procedure (LANAP). Retrospective results were compared to clinical trial data from the University of Texas Health Sciences Center in San Antonio (UTHSCSA) to determine if outcomes from a controlled clinical trial can be duplicated in private practice. Results also are compared with published results of other surgical and nonsurgical therapies for inflammatory periodontal disease.
Received: March 1, 2004
Accepted: April 19, 2004
General Dentistry, September/October 2004, Volume 52, Number 5
Pretty sad John. You obviously dont see my point. I truly wonder if you are being paid by the company, my thought is you are. No matter, this will catch up with you eventually.
I wonder how the California peer review would view your thoughts.
BTW isnt putting your patients on Utube a hippa violation?
Good luck to you.
Here is one of your statements from above posts;
“As far as compensation from MDT I have helped at their booth during the AGD I received less than a third of my daily production for my time.”
So the company is paying you.
What would your patients think if they found out that you were pushing a therapy that the company is paying you to push at a convention?
Hmmmmmm anyone else see a problem?
Dr Pratt
You said
“What would your patients think if they found out that you were pushing a therapy that the company is paying you to push at a convention?”
I think that my patients would be very proud of their dentist standing behind his beliefs.
I am sure you call what you do “Pushing” your patients into treatment, I prefer to call it educating. You imply that I am doing something wrong in helping my patients save their teeth.
You may like to push your patients into screwing them down, I do not!
Wonderful you are educating your patients to undergo a treatment that essentially has very little evidence behind it.
Im glad you can stand by that because I myself wouldnt be able to sleep at night.
BTW I place very few implants in my general setting, most I refer out to surgeons. I look to save teeth whenever possible, thats why I refer to specialist because it is in the best interest of my patients. Endo, Perio, Oral surgery, etc and even with all I refer I still do very well because my patients understand that I have thier best interest at heart.
I dont disagree with you that we move to fast to implants, however there are countless studys to support that.
Where is the evidence?
By the way, how much do you charge for this wonderful cure for perio disease that your so proud to stand behind (and get paid for by the company)?
Better yet, look into a word called ethics.
Dr Pratt said Better yet, look into a word called ethics.
I hope you have the ethics to offer your patients LANAP. According to Ed Zinman DDS MS JD this is within the standard of care since it has FDA clearance to provide “NEW CEMENTUM MEDIATED ATTACHEMENT TO THE ROOT SURFACE IN THE ABSCENCE OF LONG JUNCTIONAL EPITHELIUM”. Therefore, patients who are not told about this alternative do not have full informed consent.
As far as the investment to save peoples teeth for 32 teeth we charge $4600 about the cost of one graft, one implant, for one tooth.
Johndds said “As far as the investment to save peoples teeth for 32 teeth we charge $4600″
LOL you charge 4600 dollar for essentially a laser scaling and root planing. If you look up ethics, you will not see yourself there. By the look of your website you are proud of it.
Im done with this debate, shame we have guys like you in our profession.
Evidence based dentistry, look into it. Its not what you are practicing.
The company made a wise investment in paying you to push thier product.
“If you look up ethics, you will not see yourself there. By the look of your website you are proud of it.”
YES! I am very proud to offer this service! I recomend that the next perio case that you think is hopeless you at least inform your patient that it is available. That would be the ethical thing to do.
Im sure you are proud of making 4600.00 for technology that has little evidence. The ethical thing for you to do is inform patients of the long term studys that are out there, I hope you are informing you patients that the laser your using while FDA approved has very little evidence to support your 4600 dollar fee. But Im sure your more of a salesman then a professional. Dont get blinded by the FDA, a device is very easy to get approved. Remember this is the same FDA that approved drugs like Vioxx etc.
Before I condemn a tooth hopeless for perio reasons I usually send them to the specialist because thats the right thing to do. I do the same for endo. Believe me I have been corrected many times in what I feel is hopeless actually isnt in the right hands.
You sound like a know it all with a magic laser wand in his hands that will cure all, and I have failed to get you to see any reason in what evidence based dentistry is about.
Good luck to you.
I must admit I was just as or more skeptical than you, when I first looked at the Periolase. You might even have called me a doubting Thomas.
I referred a patient to my periodontist (one of the best in LA, teaches at USC) I knew this patient needed his teeth removed it was confirmed by the perio that he needed implants, and for all the training I had it was a good recommendation.
But the patient didn’t agree he searched for an alternative and found the creator of the LANAP procedure, & had the LANAP done. That was 10 years ago; those loose teeth that I knew needed to be removed are still there and firm. So every 3 months this guy would come into the office I couldn’t deny it had worked for him.
So I started to look into it, because as you know Periodontitis is the #1 cause of tooth loss in adult Americans. And I being a dentist, by definition a dentist doesn’t exist without a patient, and after asking my patients what they wanted from me, the usual response over and over again was “I WANT TO KEEP MY TEETH”, “I WANT TO KEEP MY TEETH”, “I WANT TO KEEP MY TEETH”, so for me it was a patient driven search.
So my journey took me to Dentaltown an online community where 40,000 dentists are signed up and discuss things like perio. Being a doubting Thomas I searched out “The Guy” you know the one “The guy” who always has something negative to say about every procedure or dental product you know “the guy” who always says “it didn’t work for me”. Well after many years of looking for “The Guy” I still haven’t found him. Still looking.
Fortunately the two knuckleheaded Gp’s that developed the LANAP protocol practice nearby so I would refer my hopeless cases to them every time it got harder and harder to refer, they would always try and sell me a laser, but I DIDN’T WANT A LASER!, I wanted to help my patients keep their teeth.
Then after seeing and understanding Ray Yuknas HUMAN histology, the FDA clearance that says “NEW CEMENTUM MEDIATED ATTACHEMENT IN THE ABSENCE OF LONG JUNCTIONAL EPITHELIUM” the CRA 9.7 out of 10, never finding “THE Guy” on DT to say anything negative about the procedure or the laser, not being able to refer to anyone who had the laser, seeing my anecdotal case walk in the door every 3 months, I decided, I too wanted to help people keep their teeth. The rest is history you can go on this site to see my x-rays you would be shocked at what my perio readings are 12mm bleeding suppurating pockets going to 2mm healthy sulci, again INCREDIBLE RESULTS time after time. This is why I have NO problem recommending to my colleges this procedure. So you can continue to sit around while your patients lose their teeth & waiting for more dog studies. Good luck with your wait.
John do you right your own material or does the company right your responses?
To Johndds. It seems you are not really in to the laser. Maybe you should follow some lecture and understand the principles from the lasers. There are a lot of papers about lasers, but first every wavelength have it’s own limitations and indications and even when we have for instands two er-yag or nd-yag lasers from different factories the setting will not be the same, because it is all about the output energy and the pulsedurations. So it is very difficult to compare results from different papers to each other because of all the difference there is. I use 810nm laser, nd-yag laser and er-yag laser. My patients like the treatment a lot because healing is faster and the pain afterwards is less. Even the results seems to be better then without laser, but a real explanation for this we cannot give yet. With the er-yag one can do also flapsurgery with deëpithalisation giving an advantage to become less long epithelic attachment and therefor some regeneration. It will not cure periodontics because periodontics is a multifactorial desease:bacteria, genetics, etc. So once a periodontic patient one stays a periodontic patient, but that doesn’t mean we cannot stabalise it or improve it.About lasers there is a very good book “oral laser applications”by “moritz”.
Dr Pratt
I write my own stuff.
DR T I agree there is a place for lasers. Soft tissue, hard tissue, and restorative aspects. But the research isnt there yet, and as you said perio disease is multi factorial, patients require many different approaches in treating the disease that is evidence based. JohnDDS has gone as far as saying he can cure perio disease with his laser based on one study. Just go to his website. Im glad someone with sense replied to this thread. Im just a gen dent so I feel that I need to do whats best for my patients and I refer whenever possible. But when you got guys like JohnDDS you make claims to his patients that he can cure perio disease and poo poo specialists it gives our profession a bad name.
Dr Pratt
Please refrence where I have said “I can Cure it”
IMHO I can reverse it. Diferent statement.
Where have I poo poo’d specialists? I don’t do CTG’s and most of my implants are done by OMFS.
Oh, and I don’t do Ortho and will throw a bone to the Endo, not that he needs it he’s always so busy
JohnDDS says
“I referred a patient to my periodontist (one of the best in LA, teaches at USC)”
“Why should I refer for an inferior service? I have seen the results first hand the reversal of the #1 cause of tooth loss in adult Americans!! I have slashed periodontal pockets in half consistently.”
Im sure you buddy at USC would like to know that he provides an inferior service for you.
He doesn’t use the Periolase so in my opinion YES it is an inferior service.
Though he does a GREAT implant service.
John – I’m just a mini implant guy, not a periolase guy yet, but I find it fascinating that you have the same problems on this forem that I have on the mini implant forems. Some doctors just want to wait for 10 or 20 years for “evidence based” dentistry. In the meantime someone has to do the work so they will have some evidence to look at someday. I think it’s genetic – some of us want to move forward, some want to look backward. Dentistry needs all of us, in my opinion. Best of luck to you, and I’m looking into LANAP. Sounds like the lack of trauma to the bone might make the Biolase unit just the thing to make the starter holes for the min implants, and give me quicker healing around the gingiva as well.
Ken
I also have a mini thread going on DT you might want to check it out it’s called “Anyone really using mini implants?” On that thread I combine Mini’s & Lanap together. If you think they were rough on me here this was nothing I had at least 3 perios a prostho and several GP’s dog pilling on me over there.
Ken
Before you go out and get a Biolase make sure you do your due diligence. Look on Ebay you’ll find many on the resale market. I have never seen a periolase in any dental clasified section.
Seamentum
Have you considered remedial training since you have not had good results?
JohnDDS,
remedial training for what? Periolase? or my periodontal training? I’m an instructor at a university and hopefully I don’t need remedial periodontal training. jk
Seriously, john it is hard to discuss this with you since you are not objective. You keep accusing me of not owning the laser and not knowing how to use it. You have basically stated that periodontists don’t know anything about periodontal treatment because we don’t use your machine. You have thrown out peer reviewed statements and opinion papers. I realized that you repeat the same argument no matter the point being made…and you have already stated you have a conflict of interest.
Yukna tried to point out the laser needs to contact the whole root surface to work…he mentioned that lasers are advantageous to work with when reaching micro-crevices on the root. I buy that, but in my hands I can scale away much of the diseased cementum…like most periodontists and GPs. Plus, $4,600 is more than I charge for full mouth OFD.
Ken Clifford,
The argument “it works in my hands” is not a scientific one. If you feel you are doing what is best for your patient then more power to you. However, predictable treatment in the hands of the masses NEEDS to be evidenced-based. My suggestion is follow your patients with an objective eye and publish your finding in a few years. I don’t think anyone is against mini implants. We have an ongoing study at the U looking at immediate load mini implants. The patients are informed that this is not a standard of care and will be (have been) treated free of charge during complications.
The cavalier dentists (incl specialists) always think they are ahead of everyone and the whole world is against them. Experimenting on your patients without their knowledge is not ethical.
Ken,
One more thing…John is a PERIOLASE guy…Biolase doesn’t work.
Seamentum
You seem to think that $4,600 is a lot of money.
I beg to differ. I think it is a bargain.
Do you know that the average American drives around in a $20,000 piece of sheet metal and rubber that will be obsolete in 5 years?
I’m sure you have seen the devastation of a patient in dentures. When a person gets older what joy do they have? Usually it is sitting around the table with their friends and family enjoying a good meal. This measly $4600 allows my patients that future JOY.
Not to mention what Aetna medical insurance found that they will save about 16% on future medical bills.
Thank you all for the insightful comments. This thread is now being closed to further comments.