WHAT ARE THE DENTAL BONE GRAFTING OPTIONS?
Bone graft helps heal bone by creating new bone (called de novo bone). There are many bone graft technologies that can help achieve this — and substantial differences among them. They work differently, and they are made from different materials.
Common options for bone grafting include:
Xenograft Tissue
Xenograft is bone taken from an animal source and transplanted into your body.
Benefits:
- Commonly used in surgery
- Not human derived
- Readily available
- Well documented success
- May heal small defects by itself
- Portions of the graft may turn into your own bone
Drawbacks:
- Low risk of disease transmission
- Does not stimulate your body's cells to form bone
- Portions of the graft may remain in your body for years to come
- Limited in its ability to heal large defects by itself
Alloplast Bone Graft
Alloplast is synthetically made material to be used in your body as a bone graft alternative.
Benefits:
- Commonly used in surgery
- Not human derived
- Readily available
- Well documented success
- May heal small defects by itself
- Portions of the graft may turn into your own bone
- No risk for disease transmission
Drawbacks:
- Does not stimulate your body's cells to form bone
- Portions of the graft may remain in your body for years to come
- Limited in its ability to heal large defects by itself
Autograft Tissue
Autograft is bone taken surgically from one part of your body and transplanted to another part.
Benefits:
- No potential for immune reaction or disease transmission
- Commonly used in surgery
- Well documented success
- May heal large or small defects by itself
- Transplanting your own bone forming cells to help heal the defect
Drawbacks:
- Risk of pain and/or infection at harvest site which may last for a long time
- Additional surgery and anesthesia are required
- May not be an option for some patients
Allograft Tissue
Allograft tissue is generously donated by the family of a deceased loved one to enhance the life of another individual. Grafton™ Demineralized Bone Matrix (DBM) is an allograft tissue option from Medtronic.
Benefits:
- Commonly used in surgery
- Well documented success
- May heal small defects by itself
- Portions of the graft may turn into your own bone
Drawbacks:
- Minimal risk for disease transmission
- Does not stimulate your body’s cells to form bone
- Portions of the graft may remain in your body for years to come
- Limited in its ability to heal large defects by itself
Growth factors
Growth factors are a synthetic version of a protein found naturally in your body which regulates bone healing and growth. Infuse™ Bone Graft is a growth factor option from Medtronic. Infuse Bone Graft consists of two parts:
- rhBMP-2 (recombinant human bone morphogenetic protein-2)
- An absorbable collagen sponge
Benefits:
- You don't need a second surgery to harvest bone from another place in your body.
- Bone grows where Infuse Bone Graft is placed.
- It has proven, predictable, bone growth results.
- Infuse Bone Graft directs your body to grow your own bone. There is no residual graft material after bone is formed.
- It is proven clinically safe and effective for bone formation.
Drawbacks:
- You may experience short term mild to severe facial swelling (edema) after the surgery.
- It has not been studied for use in patients under 18 years of age.
- It cannot be used in patients with an active infection at the defect site.
- It should not be used in pregnant women, women who plan to become pregnant in the next 12 months, or women who are nursing.
- It should not be used in people with immune deficiencies due to other treatments, such as radiation therapy, chemotherapy, or steroid therapy.
BONE GRAFT SELECTION
The type of graft used will depend on a number of factors including, but not limited to, the type of surgery being performed, your age, medical history, and bone quantity/quality. A prescription is required, and you should always consult your surgeon to understand which bone graft is right for you, as well as for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information.
▪In an experimental rabbit study, rhBMP-2 has been shown to elicit antibodies that are capable of crossing the placenta. Reduced ossification of the frontal and parietal bones of the skull was noted infrequently (<3%) in fetuses of rabbit dams immunized to rhBMP-2; however, there was no effect noted in limb bud development. There are no adequate and well-controlled studies in human pregnant women. Women of child bearing potential should be warned by their surgeon of potential risk to a fetus and informed of other possible orthopedic treatments.
▪Women of childbearing potential should be advised that antibody formation to rhBMP-2 or its influence on fetal development has not been completely assessed. In the clinical trial supporting the safety and effectiveness of the Infuse™ Bone Graft/LT-Cage™ Lumbar Tapered Fusion Device, 2/277 (0.7%) patients treated with Infuse™ Bone Graft component and 1/127 (0.8%) patients treated with autograft bone developed antibodies to rhBMP-2. The effect of maternal antibodies to rhBMP-2, as might be present for several months following device implantation, on the unborn fetus is unknown. Additionally, it is unknown whether fetal expression of BMP-2 could re-expose mothers who were previously antibody positive. Theoretically, re-exposure may elicit a more powerful immune response to BMP-2 with possible adverse consequences for the fetus. However, pregnancy did not lead to an increase in antibodies in the rabbit study. Studies in genetically altered mice indicate that BMP-2 is critical to fetal development and that a lack of BMP-2 activity may cause neonatal death or birth defects. It is not known if anti-BMP-2 antibodies may affect fetal development or the extent to which these antibodies may reduce BMP-2 activity.
▪Infuse™ Bone Graft should not be used immediately prior to or during pregnancy. Women of childbearing potential should be advised not to become pregnant for one year following treatment with the Infuse™ Bone Graft/Medtronic Interbody Fusion Device.
▪The safety and effectiveness of the Infuse™ Bone Graft/Medtronic Interbody Fusion Device in nursing mothers has not been established. It is not known if BMP-2 is excreted in human milk.
▪Women of childbearing potential should be advised that antibody formation to rhBMP-2 or its influence on fetal development has not been completely assessed. In the clinical trial supporting the safety and effectiveness of the Infuse™ Bone Graft/LT-Cage™ Lumbar Tapered Fusion Device, 2/277 (0.7%) patients treated with Infuse™ Bone Graft component and 1/127 (0.8%) patients treated with autograft bone developed antibodies to rhBMP-2. The effect of maternal antibodies to rhBMP-2, as might be present for several months following device implantation, on the unborn fetus is unknown. Additionally, it is unknown whether fetal expression of BMP-2 could re-expose mothers who were previously antibody positive. Theoretically, re-exposure may elicit a more powerful immune response to BMP-2 with possible adverse consequences for the fetus. However, pregnancy did not lead to an increase in antibodies in the rabbit study. Studies in genetically altered mice indicate that BMP-2 is critical to fetal development and that a lack of BMP-2 activity may cause neonatal death or birth defects. It is not known if anti-BMP-2 antibodies may affect fetal development or the extent to which these antibodies may reduce BMP-2 activity.
▪Infuse™ Bone Graft should not be used immediately prior to or during pregnancy. Women of childbearing potential should be advised not to become pregnant for one year following treatment with the Infuse™ Bone Graft/Medtronic Interbody Fusion Device.
▪The safety and effectiveness of the Infuse™ Bone Graft/Medtronic Interbody Fusion Device in nursing mothers has not been established. It is not known if BMP-2 is excreted in human milk.
BRIEF SUMMARY OF INDICATIONS, CONTRAINDICATIONS, WARNINGS, AND PRECAUTION FOR INFUSE BONE GRAFT FOR CERTAIN ORAL MAXILLOFACIAL AND DENTAL REGENERATIVE USES
INFUSE® Bone Graft is indicated as an alternative to autogenous bone graft for sinus augmentations, and for localized alveolar ridge augmentations for defects associated with extraction sockets.
The INFUSE® Bone Graft consists of two components–recombinant human Bone Morphogenetic Protein-2 (rhBMP-2) placed on an absorbable collagen sponge (ACS). These components must be used as a system for the prescribed indication. The bone morphogenetic protein solution component must not be used without the carrier/scaffold component or with a carrier/scaffold component different from the one described in the package insert.
INFUSE® Bone Graft is contraindicated for consumers with a known hypersensitivity to recombinant human Bone Morphogenetic Protein-2, bovine Type I collagen or to other components of the formulation and should not be used in the vicinity of a resected or extant tumor, in consumers with any active malignancy or consumers undergoing treatment for a malignancy, in pregnant women, or consumers with an active infection at the operative site.
There are no adequate and well-controlled studies in human pregnant women. In an experimental rabbit study, rhBMP-2 has been shown to elicit antibodies that are capable of crossing the placenta. Women of childbearing potential should be warned by their surgeon of potential risk to a fetus and informed of other possible dental treatments. The safety and effectiveness of this device has not been established in nursing mothers. Women of childbearing potential should be advised to not become pregnant for one year following treatment with this device.
INFUSE® Bone Graft has not been studied in consumers who are skeletally immature (<18 years of age or no radiographic evidence of epiphyseal closure).
Please see the package insert for the complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information.
INDICATIONS FOR USE: GRAFTON dBM AND GRAFTON PLUS DBM
GRAFTON™ DBM and GRAFTON PLUS™ DBM are intended for use as a bone graft extender, bone graft substitute, and bone void filler in bony voids or gaps of the skeletal system (i.e., spine, pelvis, and extremities) not intrinsic to the stability of the bony structure. The voids or gaps may be surgically created defects or defects created by traumatic injury to the bone. GRAFTON™ DBM (excluding the Orthoblend form) and GRAFTON PLUS™ DBM are also intended to be packed into bony voids or gaps to fill and/or augment dental intraosseous, oral, and cranio-/maxillofacial defects. These defects may be surgically created osseous defects or osseous defects created from traumatic injury to the bone, including periodontal/infrabony defects; alveolar ridge augmentation (sinusotomy, osteotomy, cystectomy); dental extraction sites (ridge maintenance, implant preparation/placement); sinus lifts; cystic defects; craniofacial augmentation. GRAFTON™ DBM and GRAFTON PLUS™ DBM may be used alone in a manner comparable to autogenous bone chips or allograft bone particulate (demineralized freeze dried bone), or they may be mixed with either allograft or autograft bone or bone marrow as a bone graft extender. GRAFTON™ DBM and GRAFTON PLUS™ DBM are indicated only for bony voids or gaps that are not intrinsic to the stability of the bony structure. GRAFTON™ DBM and GRAFTON PLUS™ DBM are absorbed/remodeled and replaced by host bone during the healing process. Note: The user should consider the fact that GRAFTON™ DBM CRUNCH contains demineralized bone chips approximately 3 mm (±1 mm) in determining the appropriateness of this allograft for use in small defects.
CAUTION
This allograft may contain trace amounts of antibiotics (gentamicin), surfactant, and other processing solutions. Caution should be exercised if the patient is allergic to these antibiotics or chemicals. GRAFTON PLUS™ DBM Paste contains starch. Therefore, caution should be exercised in using GRAFTON PLUS™ DBM Paste in a patient with a starch allergy and/or amylase deficiency.
PRECAUTIONS
Extensive donor blood serum testing, medical and social history screening procedures, and tissue microbiological testing have been used in the qualification of all tissue donors. Despite the viral inactivation and extensive tissue donor selection and qualification processes used in providing this tissue graft, transmission of an infectious disease through the use of this tissue graft is still possible. Bacterial infection at the graft site may also occur. Any adverse outcomes potentially attributable to GRAFTON™ DBM or GRAFTON PLUS™ DBM must be reported promptly to Medtronic. Adequate fixation should be used to stabilize the implant site during bone formation and healing in bony voids or gaps of the skeletal system (i.e., spine, pelvis, and extremities). If injecting GRAFTON™ DBM or GRAFTON PLUS™ DBM into the defect site, precaution should be taken not to: • over-pressurize the delivery device, as this may lead to extrusion of the device beyond the site of its intended application and damage to the surrounding tissues. • over-pressurize the defect site, as this may lead to fat embolization or embolization of the device material into the bloodstream. When used as a bone graft extender in bony voids or gaps of the skeletal system (i.e., spine, pelvis, and extremities), GRAFTON PLUS™ DBM Paste is intended for use only with autograft, not other allograft. Recommended ratios of GRAFTON PLUS™ DBM Paste to autograft as a bone graft extender are 1:1 or 2:1.
CONTRAINDICATIONS
The following are contraindications for the use of GRAFTON™ DBM and GRAFTON PLUS™ DBM:
- The presence of infection at the transplantation site.
- Treatment of spinal insufficiency fractures.