Autogenous Bone Graft: Is this still Justified?

Yes, b/c autogenous bone is and will always be the gold standard. Allografts, xenografts and alloplasts does not work well with all types of osseous defects where as autografts works well in all situations. That said, it doesnt mean we have to always use autografts b/c different bonegrafts have shown to be effective at treating different defects.

Dr P, If you use an implant system like Bicon, where the slow speed and hand preparation provide you with pristine, non-washed out, auto genius bone, you'd rarely need to open a donor site. They put the patient bone on and atop the implant and cover that with a bulk of Synthograft mixed with patient blood. This covers most needs, and additional sites could just be implant prepped for additional bone with little post op disturbance to the patient. Suction strainers and devices harvesting bone cooled with saline wash out the magic juices. The Bicon preps are 30-50 rpm on the motor with no irrigation and slower, of course, for the hand readers which can be used in a manner to cut only one side of the prep when near delicate structures. Also a lot of good tactile feedback while using either prep reamer.

I have to say that NO, there is now real reason to use autografts anymore. There are materials that make grafting so much easyer, faster and predictable that there is no reason for a donnor site or second morbid zone. I would not use it in my family and so I dont do it in my patients. Also membrane exposure and or infections can happen and are a problem. Many people use also prgf or prf or other bmp´s, after: Bone Morphogenetic Protein Increases Risk of Cancer Lara C. Pullen, PhD November 10, 2011 (Chicago, Illinois) — There is a strong association between treatment with bone morphogenetic protein-2 (BMP-2) and the incidence of cancer, researchers announced here at the North American Spine Society 26th Annual Meeting. This association was seen despite strict patient exclusion criteria for current or previous malignancy. So i a nutshell NO Cheers

Autogenous bone is not the gold standard just because it comes from the patient. It does work sometimes, there are other grafting materials and other regenerative materials. What is the objective of the procedure? One size does not fit all.

Hi Alejandro , more interesting news on BMPs then I have a patient had extensive use of them in her orthopeadic rehabilitation and is having some un-desirable side effects ( maybe just bad luck ) . As you know I stopped using autogenous bone completely 8 years ago and yes some cases are very complex and yes they do work . Different plans can work with a bit of practice. I showed a case the other day where a 12mm Implant was only held by 2 threads the rest was full 360 degree graft material , I then reverse torqued the Implant to 35 NM three months later to show it can work. The body wants to heal. Patients love you as well ... Hope you are well Peter

Autogenous bone may have been the gold standard when we did not have many, if any, suitable alternatives but today, in my opinion, therer is no one product that is best, each has its place and beware those surgeons who do not realise this, medico-legally they will be found out.

The positively increasing number of 'experienced' implant clinicians, reaching out to training programmes that help them with the armamentarium and techniques to harvest autogenous bone, is only complimented by the number of publications that abound in journals of scientific substance (read significant impact factor), in re-iterating the significant role that autogenous bone plays in reconstructing alveolar defects. If there are 'graftless' solutions and solutions that circumvent the need for reconstruction of bony defricits, research today wouldn't be directed at generating tissue (both hard and soft) still. In the mindless and unscientific as well non-rationale based usage of bone substitutes, one important fact seems to have been sidelined - bone and soft tissue reconstruction should yield not only volumetric replacement, but a reconstitution of tissue architecturally, so that osteogenesis may be the result. Several slow-resorbing substitutes, with low pore percentage and delaed resorption rates mimic bone-like tissue radiographically, but one does not expect osseointegration from an area abutting the implant with resident bone-like tissue that will not generate the necesssary osteoblasts or be able to anchor the Fibrin strands across to the microsurface defects on the implant surface, needed for Osseointegration. Having said that, it is true that Autogenous bone may not not be needed in all situations to enhance bone volume or replenish bone in order to optimize implant recipient sites. Bone manipulation techniques such as Expansion, Splitting, Condsenstation do help providing more optimal implant recipient sites. Judiciously chosen modalities such as Bone Splitting (using Piezosurgery) or Bone scraping, when feasible, help avoid the need for more morbid procedures that would otherwise be indicated for Bone reconstruction/restoration. What about cantilevering loads on Crowns which resemble anatomic Crowns and are yet placed on ridges with deficient buccal volume (from resorption - pl look up Cawwod and Howell, Siebert ..et al for a more detailed classification of what happens to the alveolar ridge post edentulousness). Please read literatrure by Matteo Chiapasco, Devora Arad Schwartz, Michael Pikos, Hom Lay Wang, Arun Garg, Carl Misch, ...... all comprehensively leaning towards autogenous reconstruction in the effort to restore not just function, but also cosmesis. Finally, why would a patient deserve a 15mm (vertical height) Crown on a Central Incisor, next to a natural Crown of the opposite central incisor that is 13mm long ? If one's level of clinical acumen and the expectation of one's patients does not need more exacting work, then one doesn't to bother about volume resotration/ architecture restoration, bone histology....etc. In that case its fine to just get some volume in and get on with your next patient ! Cheers Jeevan

Jeevan things have moved on a bit with materials , three of us with over 80 years of combined implant experience do not use any autogenous anymore . As for aesthetics and the long term outcome , this is more important to us being GDPs . As I said once before I always like to speak after an autogenous speaker as my long term results prove themselves . Regards Peter

Forgot , yes Autogenous is the gold standard , just interested in the future . Peter

Peter, which is your favourite material? Does it work for vertical augmentation? Do you mix with autogenous bone or other synthetic materials, and at what ratios? Do you use membrane over your grafts?

Hi Katu I generally use Fortoss Vital and some Easygraft . Yes you can get vertical regeneration ( see my case posted here a few weeks ago ) but it takes the right situation and a llittle skill. No I have not used any autogenous in my last 1,000 grafts not even a scrapping for a number of reasons . No I do not have traditional membranes in the practice as the graft materials are their own membrane . Although I did use a collagen type membrane on the sinus lining tear about 7 years ago . Seems to work well if not better , but like golf practice helps. I will be showing many cases and some new developments at my lecture in London tomorrow. Regards Peter

Autogenous graft may be the gold standard, but it may not be the only osteogenic or osteo-inductive material in the future. The current research is focusing on using stem cells and tissue engineering to create an injectable bio-active composite of stem cells, bio-polymer carrier and growth factors. The carrier also acts as a scaffolding to maintain a stable environment conducive to rapid cell differentiation and proliferation. There will be no/ less secondary site morbidity and the quantity required can be pre-ordered ! Back to your question, Dr P. To be scientifically proven, the results must be reproducible in clinical studies. In Implant dentistry, you may find that one thing that works for someone like Peter may not work for another implant dentist. Bone augmentation is also technique and operator sensitive and these confounding factors should be taken into account in any planned (multivariate) clinical studies. What the autogenous graft offers is a head start, with the secret ingredients already present in the mix. Kung Fu Panda.