Selecting the Best Bone Graft Material for a Dental Implant

best bone graft material for dental implant

Selecting the Best Bone Graft Material for a Dental Implant

David Hudnall

By David Hudnall, DMD

Bone grafting is possible because natural bone has the ability to regenerate itself if provided the space and structure on which to develop and thrive. The process of bone grafting has less to do with the actual type of dental bone graft material chosen and more to do with stimulating the body’s own osteoblastic activity to form and lay down new bone growth.

The bone grafting material placed is present to act as a framework for the development of new bone, filling in voids and defects and fusing with the surrounding bone as new bone forms and matures.

Best Bone Graft Materials for Dental Implants

The choice of bone grafting material often depends on balancing the patient’s wishes with the complexity of the bone deficiency. While the end goal of every bone graft is the same, the treatment needs of each patient must be individualized and may require different types of bone grafting material to obtain the most successful results. The most important criterion of a dental bone graft material is to maintain the space while the body forms new bone.

Characteristics of the Best Bone Graft Material for a Dental Implant

Osteoconductive

  • Osteoconductive materials encourage osteoblasts produced by the body to integrate within the graft structure, using it as a scaffold for new bone formation and repair.

Osteoinductive

  • This type of graft material stimulates the migration of mesenchymal stem cells into the grafting site via blood vessels. These stem cells then further stimulate osteoblasts to form from undifferentiated osteoprogenitor cells.

Osteogenic

  • Osteogenic graft material contains living osteoblasts that promote the formation of additional osteoblasts to form on the scaffolding.

Types of Bone Grafts in Dentistry

There are four types of bone grafts used in dentistry, based upon the source of the dental bone graft material:

1. Autografts

Source and Considerations

Human bone is harvested from another part of the patient’s own body in order to fill the bony defect. In oral surgery, this typically occurs when bone is removed from one area and is transferred to another area, either from within the mouth or from a completely extraoral second surgical site. This method is always the first choice as it is the best bone graft material for a dental implant. There is almost no chance for graft rejection or disease transmission with an autograph.

Mechanism of Action

Autografts also have the synergistic advantage of stimulating osteoblastic activity from three different mechanisms of action:

  • Osteoconductive
  • Osteoinductive
  • Osteogenic

2. Allograft

Source and Considerations

An allograft involves using bone taken from a human cadaver. Because it shares many of the components of the patient’s own tissue and the body remodels it as if an allograft were living bone, a mixture of cortical and cancellous cadaver bone is the most common type of bone used as a solid foundation for socket preservation and ridge augmentation after extractions or with immediate implant placement.

Mechanism of Action

  • Osteoconductive
  • Osteoinductive
best bone graft material for dental implant

3. Xenograft

Source and Considerations

Xenografts use bone taken from an animal source, typically a cow or a pig. In cases where there is insufficient bone available for an autograft, and an allograft is declined by the patient, a xenograft may be used.

Mechanism of Action

  • Osteoconductive

4. Alloplast

Source and Considerations

Alloplasts derived from resorbable or non-resorbable synthetic materials are used in limited circumstances and are usually the last choice for grafting materials. The most well-known alloplasts are hydroxyapatite and beta-tricalcium phosphate.

Hydroxyapatite is generally considered to be only slightly resorbable, whereas beta-tricalcium phosphate is resorbed by a cellular pathway, leaving only the newly formed bone tissue. These grafts eliminate the possibility of disease transmission completely.

Mechanism of Action

  • Osteoconductive

How To Choose Dental Bone Graft Materials

The main function of bone grafting materials is to provide mechanical support and stimulate osteo-regeneration, with the ultimate goal of bone replacement. The choice of graft material used to perform any bone grafting procedure depends on a number of factors including, but not limited to, patient concerns, the type of surgical procedure, medical history, and bone quantity/quality issues.

Type of Surgery

While the best bone graft material for dental implants is simultaneously osteoconductive, osteoinductive, and osteogenic, material that has all three properties is not always practical or abundantly available. Therefore, the vast majority of bone graft procedures are performed using the second-best option.

Whether the surgery involves ridge or socket preservation, lateral ridge augmentation, a sinus lift, or stabilization of an immediately-placed implant, most surgeons will select an allograft, a mixture of cortical and cancellous bone, because it is readily available for purchase in sufficient qualities to fill most any defect and it provides predictable results.

Patient Concerns

While generally considered safe, patients sometimes decline a procedure involving the use of allografts or xenografts citing concerns that they could be a possible vector for disease transmission. This forces the surgeon to look for other treatment alternatives such as autographs or alloplasts.

Health History

It is no secret that the patient’s overall health has a tremendous effect on the success rate of bone graft placement for dental implants. After all, the success of the surgery depends on stimulating the body’s own response mechanisms.

If the patient has a suppressed immune system, altered healing (diabetes, autoimmune diseases), thyroid issues, nutritional deficiencies or malabsorption (bariatric surgery patients), or other chronic health issues, the possibility of graft or implant failure is a real concern, and bone grafting is contraindicated until such time that the health issue can be controlled or resolved.

best bone graft material for dental implant

Bone Quantity/Quality

Patients who lack sufficient bone to stabilize and support a dental implant in all dimensions can benefit from bone grafts. Even those patients with spongy bone can benefit from grafts that promote new, more dense bone growth, allowing the implant to be placed partly in solid bone in order to gain traction and stability.

Use of Membranes

When ridge augmentation is required to increase the width or height of bone for future implant placement, a membrane is often necessary to help support and stabilize the graft until a clot and new bone formation occurs. The choice to use a resorbable or non-resorbable membrane is often based on the lack of surrounding bone for framework support.

Membranes, by nature, can prove to be an irritant and one of the most frequent post-operative complications of guided regeneration therapy is an exposed membrane after a dental bone graft. In most cases, an exposed membrane in and of itself does not automatically lead to graft failure if infection can be prevented with excellent hygiene and follow-up care.

Restorative Solutions by Stomadent Dental Lab

Clearly, the goal of bone grafting is for the patient to have higher-quality treatment options and more aesthetic restorations. What better outcome than to have implant-supported restorations that look and function like natural teeth. Stomadent Dental Laboratory has a number of CAD/CAM-produced restorative solutions that make dental bone grafting and other dental implant surgery procedures worthwhile.

Whether the final restoration is a single crown, implant-supported fixed bridgework, or an implant denture, Stomadent is your go-to source for precisely-fitting dental prosthetics that enhance the beauty and self-esteem of your patient. When superior restorative solutions matter, trust Stomadent Dental Lab to deliver exceptional quality!

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  • FedEx two-day return postage shipping labels

  • Laboratory prescription slips

  • Three mailing boxes

  • Product and service inserts with price list