Bone substitutes and growth factors as an alternative/complement to autogenous bone for grafting in implant dentistry

• Autogenous bone, with its osteogenic, osteoinductive and osteoconductive properties, has long been considered the ideal grafting material in bone reconstructive surgery (26, 85). However, drawbacks with autogenous bone include morbidity, availability and unpredictable graft resorption (85, 93, 94, 128, 167, 174). Recent advances in biotechnology have provided the implant surgeon with access to a great variety of bone grafting materials and the possibility of easier implant treatment for the patient as well as for the surgeon. However, the perfect grafting material has yet to be identified. Current research focuses on proteins and carriers for delivering growth factors to the surgical site; however, drawbacks of high production costs and unpredictable results exist. The clinical usefulness of a great variety of materials for bone augmentation in implant dentistry has been seriously questioned (56). The use of osteconductive osteobiologics in implant dentistry remains an experimental procedure until more knowledge becomes available regarding the clinical and biologic aspects of these materials. Osteoinduction denotes a process of accelerated bone formation that provides an abbreviated healing period. Using solely an osteoconductive grafting material may prolong the healing period with 2–6 months, which may be of clinical significance. Uncontrolled case reports, which suggest a graft healing period of 3–4 months for osteoconductive deproteinized bovine bone or biphasic materials, may mislead the inexperienced dentist. Furthermore, clinical recommendations seem premature when based upon a few animal studies rather than upon comprehensive long-term investigations in humans. This review discusses clinical studies of bone substitutes, growth factors and bone graft procedures employed with the purpose of augmenting periimplant sites.

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