Dental Bone Graft types and materials

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Types of bone grafts in dentistry

The primary aim of using a bone graft in dentistry is to improve the quality or quantity of the alveolar bone where tooth replacement is anticipated. Additionally, bone grafts can be used during surgeries where large portions of jaws are amputated during the removal of large lesions. 

Four main types of dental bone grafts, according to application, include:

  1. Ridge Augmentation Graft: When a tooth is lost, the alveolar bone in that region undergoes resorption and becomes thinner than before. Ridge augmentation increases the width and volume of the jawbone, providing a stable foundation for implants or other restorative options.
  2. Socket Preservation Graft: After tooth extraction, the remaining tooth socket consists of bone and soft tissues. Due to different healing rates of hard and soft tissue, soft tissues may fill the socket instead of bone, causing issues when tooth replacement is needed. A bone graft can be placed in the socket immediately after tooth extraction to help heal the bone properly and prevent the socket’s sides from caving in. This type of graft is also called a ridge preservation graft.
  3. Sinus Lift Graft: The maxillary sinuses are located just above the maxillary posterior teeth. When posterior teeth are lost, the sinuses may drop down and occupy the space where the roots of the maxillary teeth were. In this scenario, implant placement is not possible because they would penetrate the sinus membrane. To address this issue, a sinus lift procedure can be performed. During this procedure, the sinus is raised back to its proper position, and a dental bone graft is placed underneath the sinus, creating a solid foundation for dental implants later on.
  4. Periodontal Bone Graft: Infections from gum disease can erode the bone that supports the teeth, causing them to become loose. A periodontal bone graft is placed around an existing tooth to reduce mobility and provide additional support.

Dental bone grafts are also categorized according to the source of the graft:

  1. Autogenous graft: This type of bone graft is harvested from the patient’s own body, ensuring perfect compatibility and minimal risk of rejection.
  2. Allograft: Bone graft material is sourced from a human tissue bank, providing a safe and biocompatible option for patients.
  3. Xenograft: Derived from an animal tissue bank, this bone graft material is processed to ensure safety and compatibility with human tissues.
  4. Alloplastic graft: In some cases, synthetic bone graft materials can be used, offering a non-biological option that is biocompatible and aids in bone regeneration.

Another way to differentiate between dental bone grafts is the organ it was harvests from, and/or it’s composition. For example:

  1. Dentin graft – Derived from human (autogenous) or animal teeth (xenografts) and considered as superior grafts
  2. Osteo graft – Harvest from human or animal bones – the most common allograft and xenografts
  3. Mineral graft – Sourced from materials like corals, and typically regarded as an inferior graft

Recent research indicates that
dentin autograft (harvest from patients’ extracted teeth that are grinded with a dedicated dentin grinder) followed by dentin xenograft (harvest from porcine teeth) provide the best dental bone grafting outcomes. Dentin grafts support both osteoconduction and osteoinduction, and therefore lead to more osteogenesis (bone creation). In addition, Dentin is known to directly undergo ankylosis, fusion to the surrounding bone, thus it excels for example in Periodontic treatment.

What is a dental bone graft made of?

Dental bone grafts can be made from various materials, including natural and synthetic sources. Here are some examples of bone graft types based on their composition:

The choice of graft material depends entirely on the type of procedure involved and the clinician’s preference.

What does a dental bone graft look like?

During a dental bone graft procedure, the graft material is typically placed in the area where bone loss has occurred and may be stabilized with a dental bone graft mesh. Over time, the graft material will integrate with the patient’s natural bone tissue, resulting in a stronger, healthier jawbone.

The appearance of a dental bone graft will depend on the specific type of graft material used. Dental bone graft materials are available in various forms, such as granules, putty, and blocks.

Dental bone graft material

Bone tissue can regenerate completely if provided the space into which it has to grow. Bone grafting is a surgical procedure in which the area where the bone is missing is filled with material from the patient’s own body, an artificial, synthetic, or natural substitute. After the graft is placed, the natural bone grows, generally replacing the graft material completely, resulting in a fully integrated region of new bone.

The following classification of bone grafts is based on material groups:

What is the best dental bone graft material?

The best dental bone graft material for a patient depends on their individual needs and circumstances, as each type of bone graft material has its unique advantages and disadvantages.

By evaluating various factors, including the extent of bone loss, the location of the graft site, the patient’s overall health and the available budget, the best-suited material for grafting can be determined.

Dental bone graft granules

Dental bone graft granules are small particles typically made from materials such as hydroxyapatite, tricalcium phosphate, or a combination of both. Different types of calcium phosphates, including tricalcium phosphate, synthetic hydroxyapatite, and coralline hydroxyapatite, are available in various forms, such as pastes, putties, solid matrices, and granules.

These biocompatible materials are used in dental procedures to help regenerate or rebuild bone tissue. Various types of dental bone graft granules are available, each with unique characteristics and benefits. Most bone grafts involve ceramics, either alone or in combination with another material (e.g., calcium sulfate, bioactive glass, and calcium phosphate).

Calcium phosphate products include Bio-Oss and OsteoGraft, which both use hydroxyapatite as either a particulate (Bio-Oss) or as blocks and particulates (OsteoGraft). When combined, such as calcium hydroxyapatite, they work as osteoconductive, osseointegration, and in some cases, osteoinductive materials. High temperatures are required for scaffold formation.

OsteoSet is a calcium sulfate tablet used for bone defect sites, while Allomatrix combines calcium sulfate and demineralized bone matrix (DBM) to form an injectable paste or pliable putty.

Bioactive glass (bioglass) is a biologically active silicate-based glass with a high modulus and brittle nature. It is used in combination with polymethylmethacrylate to form bioactive bone cement. Pro-Osteon, a unique product based on sea coral, is converted from calcium carbonate to calcium hydroxyapatite. The advantage of this material is its structure, similar to that of trabecular bone.

During a dental bone graft procedure, the granules are placed in the area where bone loss has occurred. Over time, the granules will fuse with the patient’s existing bone tissue, promoting the growth of new bone cells and ultimately resulting in a stronger, healthier jawbone. The surgeon can decide the type of graft granules needed based on the procedure and the extent of bone loss that has occurred.

Dental bone graft mesh

In dentistry, a dental bone graft mesh is typically a small, mesh-like sheet used to contour the area where bone loss has occurred, providing support for bone grafting materials. During the bone grafting procedure, the mesh is placed over the bone graft material, acting as a barrier to keep the graft in place, promoting better healing. Additionally, the mesh offers a scaffold for new bone growth, encouraging osteo-regeneration and osteo-integration of the graft.

Made of biocompatible materials such as titanium or other metal alloys, dental bone graft meshes are commonly used in procedures where precision is of the utmost concern. Examples of such procedures include ridge augmentation, where minimal bone is left to work with; sinus lifts, where positioning is critical and requires precise control; and guided bone regeneration. Dental bone graft meshes can also be used in combination with other dental implants, such as dental crowns or bridges, to provide additional support and stability.

Dental bone graft companies

Numerous companies manufacture dental bone graft materials for use in dental procedures. Here are a few examples:

These companies, among others, provide various bone graft products available in the market. The selection of bone graft material depends on the type of procedure being performed and the clinician’s preference.

Dental bone graft codes

Dental bone grafts are typically assigned codes within the Current Dental Terminology (CDT) coding system. The specific code used depends on the type of bone graft procedure being performed. 

Here are a few examples:

It is important to note that dental codes may vary by location and insurance carrier. Therefore, it’s always best to consult with your dental provider and insurance carrier to confirm the appropriate code for your particular situation.

Where does dental bone graft come from?

Dental bone grafts can be divided into the following types based on their sources:

Are dental bone grafts from cadavers?

Dental bone grafts can be obtained from cadavers in the form of allograft bone. Allograft bone is a common source of bone graft material used in dental procedures, and it is acquired from donors who have agreed to donate their bone tissue for medical use after death.

Allograft bone is a popular choice for bone graft material because it is readily available, eliminating the need for a second surgical site to harvest bone tissue from the patient’s own body. It is also less expensive than some other types of bone graft materials, such as autogenous bone grafts, which require a separate surgical procedure to harvest bone tissue from the patient’s body.