Where Do I Use What Material...and Why? By: Boyd J. Tomasetti, DMD

Today’s dental patients are keenly aware of their options and take a concerned interest in their treatment plan. They want products and materials proven to be safe and efficacious and are interested in the long-term prognosis of their treatment. With the introduction of bone replacement graft materials, the placement of endosseous implants need no longer be limited to the location of the patient’s natural bone. Extractions, failed endodontic treatments, and trauma all may result in alveolar ridge atrophy and prosthetic compromises. Today, there are numerous materials available that can recreate the ideal recipient site for endosseous implants. Alloplasts, allografts, and xenografts have all been used successfully in these situations. However, with the recent introduction in the United States of a natural pentacalcium phosphate harvested from porous marine algae, a more dependable and predictable material is now available.

As an oral maxillofacial surgeon, I prefer autogenous bone and consider it to be the Gold Standard of grafting materials. When sufficient autogenous bone is unavailable, the patient refuses a second surgery for the harvesting of bone, or it is not economically feasible, I have looked to the various bone substitutes as an alternative or additive to an autogenous graft. I have tried them all, and each brand of bottled bone has its own claims, features, and benefits. When comparing today’s available bone replacement products, it is important to consider several things, the first being origin of the material. Although there have been no known reports of disease transmission or immunological response in dental bone grafting, allografts and animal xenografts often concern and confuse patients. The non-animal, plant material I currently use in my practice seems to comfort patients and eliminates any fear or concerns. Secondly, the resorption rate of the material should be in harmony with the regeneration of new bone into the defect. As with any procedure, ease-of-use for the clinician and economics for the patient are always a consideration.

Alloplasts became very popular in the mid 1980s. Most synthetic materials are either totally non-resorbable and just maintain a space or they resorb too quickly and result in a significant loss of augmented dimension. Alloplasts have not proven to be favorable when grafting a defect that has been treatment planned for endosseous implants.

In theory, xenografts should be the ideal material to mimic the chemistry and structure of human bone. Bovine bone has been used successfully for many years and has, until now, been quite successful in pre-implant graft cases. However, risk of cross-species contamination requires extreme processing of the bone to minimize the possibility of immunological reaction. These processing procedures reduce the natural porosity and resorptive capability of the material. Bone formation occurs around the particulate material as well as bridging the gaps between the particles. However, minimal actual resorption/replacement of the graft material occurs with bovine-derived HA.

While traveling in Europe, I was introduced to processed marine algae that has been widely used and accepted as a bone replacement graft material. Europeans have a perception of risk utilizing bovine and human bone products for medical and dental applications and the viable alternative is the renewable plant algae marketed in Europe under the brand name Algipore. It is composed of natural pentacalcium phosphate harvested from renewable porous marine algae with an interconnecting pore structure that provides a biological framework for reliable bone regeneration. After further research, I learned there are more than 15 years of documented clinical success using this material and I was delighted to recently learn it is available in the United States carrying the brand name of C-Graft (The Clinician’s Preference, Golden, Colorado).

Bone replacement graft materials have become an intricate part of implant dentistry. With the introduction of C-Graft in the United States, we now have the opportunity to utilize a material proven by many years of clinical research and in vivo analysis to be an ideal method of resorption remodeling and vital bone replacement. This renewable plant is a non-animal, non-human material that predictably provides an economical method for pre-implant site preparation.

It is my opinion that as clinicians we are obligated to offer our patients the safest, most predictable, dependable materials available. Bone grafting is a key component of many implant practices and sometimes, like with C-Graft, it is the simple, economical solution that becomes a permanent part of our armamentarium.

Dr. Boyd Tomasetti completed his specialty training at King’s County Downstate Medical Center, following graduation from Tufts University School of Dental Medicine in Boston. He is Board Certified and is active in the Colorado Dental Association, having served as a member of the Council on Governmental Affairs. Dr. Tomasetti is past-president of the American Association of Oral and Maxillofacial Surgeons. He is past-president of the Colorado Society of Oral and Maxillofacial Surgeons. Dr. Tomasetti is an Assistant Clinical Professor at the University of Colorado School of Dentistry and a consultant to the oral surgery residency program at Denver Health Hospital. He is the liaison for the Nobel Biocare/Steri-Oss Dental Implant Company to all of the U.S. dental schools and oral surgery residency programs, lecturing on dental implant surgery nationally and internationally.