Dr Andoni Jones BDentSc discusses his preference for allograft granules over alternative materials for bone grafting.
When it comes to bone grafting, a number of techniques and materials can be used, the most traditional being autografting. However, the need to harvest bone from other parts of the oral cavity or body and the added surgical procedure mean that patients are often reluctant to opt for this as a treatment modality. Patients are much more accepting of bone grafting when it comes in a sterile bottle, as in the case of a xenograft or allograft, which are now widely adopted.
Can you explain your preferred product for bone grafting?
I prefer to use allografts rather than xenografts if a patient requires bone augmentation as it integrates well and remodels into the patient’s own bone much more quickly and predictably than xenografts or synthetic materials, in my opinion. During my years as a dental implantologist, I’ve found that xenografts take a long time to integrate – even after six to eight months, loose granules can be found on re-entry and sometimes part of the bone would be encapsulated in the soft tissue, which means removing and re-grafting. This level of uncertainty is unsettling for both myself and the patient.
When I started using allograft granules, I found I could re-visit the area again after three to six months and the graft was well consolidated and ready for the implant to be placed. Because an allograft like botiss maxgraft® has a matrix closest to a patient’s own bone, I generally find really good quality, natural-looking, live bone when I return to the augmented site. Very rarely do I see loose particles or bone encapsulated in the soft tissue as it really integrates well.
Having completed over 150 cases using botiss maxgraft®, including a considerable number of socket repairs where the buccal bone was damaged and had to be rebuilt, the results have been excellent; it’s my material of choice, without fail.
Allograft reabsorption rates have been questioned in some of the literature; what’s your experience of this?
My experience is that botiss maxgraft®particles are resorbed gradually by the patient’s own bone without loss of volume. I usually use Jason® membrane alongside the maxgraft® to act as a barrier to protect the bone particles and I find the two products work very well together.
Are patients accepting of allografts and do they have concerns about the costs of grafting?
In my experience, perhaps one out of 100 patients wouldn’t consider an allograft, and this is usually for ethnic or religious reasons. The cost of grafting is just one factor in the whole treatment plan and I’ve found that If you give patients as much information as possible and talk to them about why a particular product is being suggested, they are very receptive. Many patients have already researched their treatment procedure online and have quite an in-depth understanding of the choices, costs, time frame and possible outcomes.
Bone defect, after tooth extraction and cleaning of the site
Pre-op CT scan
Post-op CT scan
Dr Andoni Jones is a Specialist in Oral Implantology, in practice at 3Dental, Red Cow, Dublin, www.3dental.ie
For more information about the botiss product portfolio, visit www.botiss.com