The American Dental Association Principles of Ethics and Code of Professional Conduct establishes the ethical expectations from dental providers that obligate a moral commitment toward the welfare of their patients and oral health care team.1American Dental AssociationAmerican Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to November 2020. Accessed February 25, 2021.https://www.ada.org/en/about-the-ada/principles-of-ethics-code-of-professional-conductGoogle Scholar One such expectation that requires careful navigation is patient autonomy—patients’ ability to be involved in and self-determine their treatment on the basis of their views, beliefs, desires, and choices independent of the treating dentist’s will.1American Dental AssociationAmerican Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to November 2020. Accessed February 25, 2021.https://www.ada.org/en/about-the-ada/principles-of-ethics-code-of-professional-conductGoogle Scholar Patient autonomy is a pressing concern when a recommended treatment conflicts with a patient’s spiritual or religious beliefs. One of the fastest growing and ethically undervalued treatments is bone grafting in preparation for the placement of endosseous dental implants or other restorative dental therapy.2Sallent I. Capella-Monsonís H. Procter P. et al.The few who made it: commercially and clinically successful innovative bone grafts.Front Bioeng Biotechnol. 2020; 8: 952Crossref PubMed Scopus (22) Google Scholar Bone grafts are natural or synthetic bone substitutes that are used to create a scaffold for bone formation and to facilitate optimum wound healing.2Sallent I. Capella-Monsonís H. Procter P. et al.The few who made it: commercially and clinically successful innovative bone grafts.Front Bioeng Biotechnol. 2020; 8: 952Crossref PubMed Scopus (22) Google Scholar In dentistry, bone grafts are used commonly in conjunction with dental implants to enhance the regenerative capacity of bone after tooth loss, along with other periodontal procedures. On the basis of the origin of the donor tissue, bone grafts can be classified into 6 categories: autografts or autogenous grafts, allografts, xenografts, alloplasts or alloplastic materials, composite grafts, and synthetic regenerative bone grafts.3Misch C.E. Dietsh F. Bone-grafting materials in implant dentistry.Implant Dent. 1993; 2: 158-167Crossref PubMed Scopus (239) Google Scholar, 4Hench L.L. Polak J.M. Third-generation biomedical materials.Science. 2002; 295: 1014-1017Crossref PubMed Scopus (2176) Google Scholar, 5Offner D. de Grado G.F. Meisels I. et al.Bone grafts, bone substitutes and regenerative medicine acceptance for the management of bone defects among French population: issues about ethics, religion or fear?.Cell Med. 2019; 11: 1-10Crossref Google Scholar An overview of the types of bone grafts and their sources and biological mechanisms are provided in the table.4Hench L.L. Polak J.M. Third-generation biomedical materials.Science. 2002; 295: 1014-1017Crossref PubMed Scopus (2176) Google Scholar, 5Offner D. de Grado G.F. Meisels I. et al.Bone grafts, bone substitutes and regenerative medicine acceptance for the management of bone defects among French population: issues about ethics, religion or fear?.Cell Med. 2019; 11: 1-10Crossref Google Scholar, 6Giannoudis P.V. Dinopoulos H. Tsiridis E. Bone substitutes: an update.Injury. 2005; 36: S20-S27Abstract Full Text Full Text PDF PubMed Scopus (1441) Google Scholar, 7Moussa N.T. Dym H. Maxillofacial bone grafting materials.Dent Clin North Am. 2020; 64: 473-490Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar, 8Oryan A. Alidadi S. Moshiri A. Maffulli N. Bone regenerative medicine: classic options, novel strategies, and future directions.J Orthop Surg Res. 2014; 9: 18Crossref PubMed Scopus (595) Google ScholarTableAn overview of the different classes of bone grafts used in dentistry.BONE GRAFTTISSUE OF ORIGIN OR SOURCEHARVEST SITE OR MATERIAL USEDBIOLOGICAL MECHANISMAutograftBone tissue harvested from a different site in the same patientIliac crest, mandibular symphysis, anterior mandibular ramus, maxillary tuberosity, exostoses, implant osteotomy site debrisOsteoconduction, osteoinduction, osteogenesisAllograftBone tissue from another personCadaveric bone tissue: fresh, fresh frozen, freeze-dried bone allograft, DFDBA∗DFDBA: Demineralized freeze-dried bone allograft.Osteoconduction, weak osteoinductionXenograftBone tissue from a source of a different speciesBovine bone, porcine bone, equine bone, natural coralsOsteoconductionAlloplastSynthetic substitute or deorganified biocompatible materialsCeramics, calcium phosphate cement, HA,†HA: Hydroxyapatite. tricalcium phosphate BCS,‡BCS: Biphasic calcium sulfate. bioactive glass, glass ionomersOsteoconductionComposite GraftsCombination of ≥ 2 graft materials from various sourcesCombination: BCS and deproteinized bovine bone, BCS and alloplast, autografts and anorganic bovine bone (Bio-Oss, OsteoGraf/N), autologous cancellous bone and nonresorbable HA (Interpore 200), autografts and DFDBA, DFDBA and bovine-derived HA (OsteoGraf/N), recombinant human bone morphogenic proteinsOsteogenesis, osteoconduction, osteoinduction (≥ 1 mechanisms involved depending on combination of materials used)Synthetic: bone marrow and synthetic composites, ultraporous b-tricalcium phosphate and bone marrow aspirate, bone morphogenic protein and polyglycolic acid, polymer composites, bone marrow aspirate and bone marrow protein and polyglycolic acid polymer composite (materials combined as needed for optimum effect)Synthetic Regenerative Bone GraftsSynthetic substitute using regenerative techniquesHuman cell cultures with polymeric substitutes stimulated by growth factorsOsteoconduction, osteoinduction, osteogenesis∗ DFDBA: Demineralized freeze-dried bone allograft.† HA: Hydroxyapatite.‡ BCS: Biphasic calcium sulfate. Open table in a new tab In 2020, the global dental bone graft and substitutes market size was valued at $663.2 million and is estimated to grow at a compounding annual rate of 11.4% from 2021 through 2028.9Dental bone graft and substitutes market size, share & trends analysis report by end-use (dental clinics, hospitals), by material type (xenograft, synthetic), by application, by region, and segment forecasts, 2021-2028. Grand View Research. Accessed February 10, 2021.https://www.grandviewresearch.com/industry-analysis/dental-bone-grafts-substitutes-marketGoogle Scholar Increasing use of bone grafts in dental implant surgeries and associated high success rates are propelling the market growth, and, with the rise in the global geriatric population, an increased prevalence of periodontal diseases and edentulism is expected.9Dental bone graft and substitutes market size, share & trends analysis report by end-use (dental clinics, hospitals), by material type (xenograft, synthetic), by application, by region, and segment forecasts, 2021-2028. Grand View Research. Accessed February 10, 2021.https://www.grandviewresearch.com/industry-analysis/dental-bone-grafts-substitutes-marketGoogle Scholar Consequently, a higher demand for bone substitute materials is anticipated.9Dental bone graft and substitutes market size, share & trends analysis report by end-use (dental clinics, hospitals), by material type (xenograft, synthetic), by application, by region, and segment forecasts, 2021-2028. Grand View Research. Accessed February 10, 2021.https://www.grandviewresearch.com/industry-analysis/dental-bone-grafts-substitutes-marketGoogle Scholar As a general trend, autologous grafts and alloplasts have the highest rates of acceptance among patients, and most people prefer to harvest bone from the posterior mandible or retromolar region than from any other intraoral or extraoral site for autologous grafts.10Hof M. Tepper G. Semo B. Arnhart C. Watzek G. Pommer B. Patients' perspectives on dental implant and bone graft surgery: questionnaire-based interview survey.Clin Oral Implants Res. 2014; 25: 42-45Crossref PubMed Scopus (45) Google Scholar, 11Fernández R.F. Bucchi C. Navarro P. Beltrán V. Borie E. Bone grafts utilized in dentistry: an analysis of patients’ preferences.BMC Med Ethics. 2015; 16: 71Crossref PubMed Scopus (28) Google Scholar, 12Agrawal N. Gupta N.D. Tewari R.K. Garg A.K. Yadav P. Patients’ perception about dental implant and bone graft surgery: a questionnaire-based survey.J Indian Assoc Public Health Dent. 2017; 15: 258-262Crossref Google Scholar, 13Bucchi C. Del Fabbro M. Arias A. et al.Multicenter study of patients' preferences and concerns regarding the origin of bone grafts utilized in dentistry.Patient Prefer Adherence. 2019; 13: 179-185Crossref PubMed Scopus (7) Google Scholar According to a survey of a French patient population, bone grafting products derived through regenerative medicine were accepted to a similar degree as autografts.5Offner D. de Grado G.F. Meisels I. et al.Bone grafts, bone substitutes and regenerative medicine acceptance for the management of bone defects among French population: issues about ethics, religion or fear?.Cell Med. 2019; 11: 1-10Crossref Google Scholar Conversely, the highest rates of refusal were seen with allografts and xenografts.10Hof M. Tepper G. Semo B. Arnhart C. Watzek G. Pommer B. Patients' perspectives on dental implant and bone graft surgery: questionnaire-based interview survey.Clin Oral Implants Res. 2014; 25: 42-45Crossref PubMed Scopus (45) Google Scholar, 11Fernández R.F. Bucchi C. Navarro P. Beltrán V. Borie E. Bone grafts utilized in dentistry: an analysis of patients’ preferences.BMC Med Ethics. 2015; 16: 71Crossref PubMed Scopus (28) Google Scholar, 12Agrawal N. Gupta N.D. Tewari R.K. Garg A.K. Yadav P. Patients’ perception about dental implant and bone graft surgery: a questionnaire-based survey.J Indian Assoc Public Health Dent. 2017; 15: 258-262Crossref Google Scholar, 13Bucchi C. Del Fabbro M. Arias A. et al.Multicenter study of patients' preferences and concerns regarding the origin of bone grafts utilized in dentistry.Patient Prefer Adherence. 2019; 13: 179-185Crossref PubMed Scopus (7) Google Scholar Common grounds for refusal included fear of disease transmission, religious beliefs, and moral conflict.13Bucchi C. Del Fabbro M. Arias A. et al.Multicenter study of patients' preferences and concerns regarding the origin of bone grafts utilized in dentistry.Patient Prefer Adherence. 2019; 13: 179-185Crossref PubMed Scopus (7) Google Scholar However, despite the high refusal rates reported in the literature, xenografts had the largest revenue share among bone grafts, accounting for more than 47% of sales in 2020.9Dental bone graft and substitutes market size, share & trends analysis report by end-use (dental clinics, hospitals), by material type (xenograft, synthetic), by application, by region, and segment forecasts, 2021-2028. Grand View Research. Accessed February 10, 2021.https://www.grandviewresearch.com/industry-analysis/dental-bone-grafts-substitutes-marketGoogle Scholar Some hypotheses to explain this discrepancy could include miscommunication between the patient and the dentist regarding the composition of xenografts or even a dentist’s lack of knowledge about bone grafts. Lastly, regarding composite graft acceptance, there is a lack of specific literature regarding this treatment. Nevertheless, it may be worth considering that the blended nature of composite grafts possibly can lead to refusal from patients who may have an objection toward any of the component materials. An ethical perspective should be considered carefully when recommending the use of various bone grafts because patients’ unique cultural, spiritual, or religious beliefs will influence their treatment preferences. Furthermore, patients’ religious beliefs historically have been undervalued in human studies evaluating bone graft effectiveness to repair osseous defects.14Romanos G.E. Romanos E.B. Alqahtani F. Alqahtani M. Javed F. "Religious belief": an undervalued ethical inclusion criterion for clinical trials on bone grafting procedures.J Relig Health. 2020; 59: 2928-2934Crossref PubMed Scopus (6) Google Scholar The views, beliefs, and customs adopted by various religious and cultural groups may differ from one another, yet one of the major conflicts reported is the use of animal-derived products or tissues from another human for medical or surgical treatment.15Eriksson A. Burcharth J. Rosenberg J. Animal derived products may conflict with religious patients' beliefs.BMC Med Ethics. 2013; 14: 48Crossref PubMed Scopus (60) Google Scholar,16Jenkins E.D. Yip M. Melman L. Frisella M.M. Matthews B.D. Informed consent: cultural and religious issues associated with the use of allogeneic and xenogeneic mesh products.J Am Coll Surg. 2010; 210: 402-410Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar Depending on the religious context, some groups view animals as sacred, thereby making it wrong to kill or consume them, whereas others consider certain animals unclean or impure. Certain religions such as Judaism and Islam, as well as Hinduism, forbid the consumption of porcine-derived products such as pork.17Zarif M.M.M. Murad A.H.A. Yusof A.F.M. The use of forbidden materials in medicinal products: an Islamic perspective.Middle East J Sci Res. 2013; 13: 5-10Google Scholar,18Paris W. Seidler R.J.H. FitzGerald K. Padela A.I. Cozzi E. Cooper D.K.C. Jewish, Christian, and Muslim theological perspectives about xenotransplantation.Xenotransplantation. 2018; 25e12400Crossref PubMed Scopus (19) Google Scholar According to a study conducted by Güngörmüş and Güngörmüş,19Güngörmüş Z. Güngörmüş M. Effect of religious belief on selecting of graft materials used in oral and maxillofacial surgery.J Oral Maxillofac Surg. 2017; 75: 2347-2353Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar religious affiliation predominantly impacts porcine-derived tissues. Furthermore, Hinduism and Sikhism deem it sinful to kill animals for human gain and do not approve the use of bovine or porcine materials for surgical treatment. When it comes to human-derived products or tissues such as allografts, Christianity, Hinduism, and Sikhism permit their use if prior consent was obtained from the tissue recipient.15Eriksson A. Burcharth J. Rosenberg J. Animal derived products may conflict with religious patients' beliefs.BMC Med Ethics. 2013; 14: 48Crossref PubMed Scopus (60) Google Scholar However, a large population of Hindus believe in cremation as a whole with no mutilations, and, therefore, the use of cadaver parts may be contraindicated.16Jenkins E.D. Yip M. Melman L. Frisella M.M. Matthews B.D. Informed consent: cultural and religious issues associated with the use of allogeneic and xenogeneic mesh products.J Am Coll Surg. 2010; 210: 402-410Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar Conversely, Buddhism and Islam do not have any restrictions regarding the use of allogenic or xenogeneic materials.16Jenkins E.D. Yip M. Melman L. Frisella M.M. Matthews B.D. Informed consent: cultural and religious issues associated with the use of allogeneic and xenogeneic mesh products.J Am Coll Surg. 2010; 210: 402-410Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar Although Jehovah’s Witnesses strictly forbid the use of human blood–derived products, such as in transfusions, they usually do not object to the use of human-derived tissues for treatment purposes.15Eriksson A. Burcharth J. Rosenberg J. Animal derived products may conflict with religious patients' beliefs.BMC Med Ethics. 2013; 14: 48Crossref PubMed Scopus (60) Google Scholar,16Jenkins E.D. Yip M. Melman L. Frisella M.M. Matthews B.D. Informed consent: cultural and religious issues associated with the use of allogeneic and xenogeneic mesh products.J Am Coll Surg. 2010; 210: 402-410Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar Religious leaders and regional dental licensing boards generally advocate the practice of obtaining the tissue donor’s informed consent when considering the use of human-derived tissue.16Jenkins E.D. Yip M. Melman L. Frisella M.M. Matthews B.D. Informed consent: cultural and religious issues associated with the use of allogeneic and xenogeneic mesh products.J Am Coll Surg. 2010; 210: 402-410Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar A caveat when evaluating evidence is overgeneralization because patient preferences may vary among geographic locations depending on the religious and cultural diversity of the population. Furthermore, the views of religious leaders are not universal because people of the same religion may display a spectrum of opinions regarding the use of animal and human tissues in dental treatment.15Eriksson A. Burcharth J. Rosenberg J. Animal derived products may conflict with religious patients' beliefs.BMC Med Ethics. 2013; 14: 48Crossref PubMed Scopus (60) Google Scholar Nowadays, philosophies such as ethical veganism are on the rise, and their followers do not accept the use of animal-derived products in the presence of other alternatives.16Jenkins E.D. Yip M. Melman L. Frisella M.M. Matthews B.D. Informed consent: cultural and religious issues associated with the use of allogeneic and xenogeneic mesh products.J Am Coll Surg. 2010; 210: 402-410Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar A study by Bucchi and colleagues13Bucchi C. Del Fabbro M. Arias A. et al.Multicenter study of patients' preferences and concerns regarding the origin of bone grafts utilized in dentistry.Patient Prefer Adherence. 2019; 13: 179-185Crossref PubMed Scopus (7) Google Scholar reported that not only do sociodemographic variables or religious affiliation influence a patient’s decision to receive a bone graft but so does the desire to avoid harming animals for human gain. According to a study investigating religious and cultural views on soft-tissue grafts, vegans prefer to use allogeneic materials over animal-derived surgical products, despite potential higher cost and lower efficacy.16Jenkins E.D. Yip M. Melman L. Frisella M.M. Matthews B.D. Informed consent: cultural and religious issues associated with the use of allogeneic and xenogeneic mesh products.J Am Coll Surg. 2010; 210: 402-410Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar To our knowledge, there are no studies that focus on vegan perspectives on the use of bone grafts; however, greater emphasis is being placed on vegan ideals in the development of animal-free treatment options. Dentists are expected to adhere to the principles of beneficence, nonmaleficence, justice, autonomy, and veracity to treat their patients ethically.1American Dental AssociationAmerican Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to November 2020. Accessed February 25, 2021.https://www.ada.org/en/about-the-ada/principles-of-ethics-code-of-professional-conductGoogle Scholar The violation of patient autonomy in bone graft cases can have severe consequences, such as the loss of trust in the treating dentist or in the profession and potential treatment discontinuation. A case series by Sattar and colleagues20Sattar S.P. Shakeel Ahmed M. Majeed F. Petty F. Inert medication ingredients causing nonadherence due to religious beliefs.Ann Pharmacother. 2004; 38: 621-624Crossref PubMed Scopus (38) Google Scholar describes 4 distinct cases in which the use of animal-derived inert medication ingredients such as gelatin and stearic acid conflicted with patients’ faiths and led to discontinuation of these medications and nonadherence to treatment. The American Dental Association Commission on Dental Accreditation standards require that dental educational programs develop and implement educational processes encouraging a patient-centered and comprehensive approach to oral health care delivery and “ensure that patient preferences, and their social, economic, emotional, physical and cognitive circumstances are sensitively considered.”21Commission on Dental AccreditationAccreditation Standards for Dental Education Programs. American Dental Association, 1998Google Scholar To practice mindfully and with cultural competency, dental health care providers can discuss the source of bone grafts with patients and obtain proper informed consent for treatment.22Easterbrook C. Maddern G. Porcine and bovine surgical products: Jewish, Muslim, and Hindu perspectives.Arch Surg. 2008; 143: 366-370Crossref PubMed Scopus (73) Google Scholar Dentists should be encouraged to hold conversations regarding religious beliefs and values when considering the use of bone grafts to better understand patient priorities and avoid conflicts. The dentist must not make any assumptions of patient preferences based on the patient’s religious affiliations or cultural practices. A study by Enoch and colleagues23Enoch S. Shaaban H. Dunn K.W. Informed consent should be obtained from patients to use products (skin substitutes) and dressings containing biological material.J Med Ethics. 2005; 31: 2-6Crossref PubMed Scopus (60) Google Scholar undertaken in the United Kingdom found that most health care professionals lack basic awareness of the components present in many biological products used in medicine. Under these circumstances, clinicians cannot provide adequate information to patients to obtain informed consent. Therefore, it is the responsibility of a competent dental practitioner to enlighten themselves, with the assistance of hospitals and manufacturers, on the components of potential bone grafts considered for intraoral use. A potential disagreement during treatment planning with a chance for resolution would be far better than the dentist facing a predicament later. Potential predicaments faced by the dentist can be in the form of patient dissatisfaction with performed treatment after the irreversible use of a material that the patient is not comfortable receiving, which may lead to loss of trust in the dentist, can damage the dentist-patient relationship and in some cases, even bear legal ramifications. Practitioners should tend to rely mainly on scientific evidence, along with the aid of their experience and personal philosophies, to make clinical diagnostic and treatment decisions. In efforts to provide evidence-based care, providers inadvertently may overlook conflicting factors that are not aligned with a patient’s values. In a survey of dental patients Chapple and colleagues24Chapple H. Shah S. Caress A.L. Kay E.J. Exploring dental patients' preferred roles in treatment decision-making: a novel approach.Br Dent J. 2003; 194: 321-327Crossref PubMed Scopus (78) Google Scholar conducted in the United Kingdom to understand patients’ preferred role in deciding the course of their treatment, most patients expressed their desire to be involved in a collaborative treatment planning decision-making process along with their dentists. The same study reported that most dental patients surveyed in both general dental practices and hospitals had perceived their roles in treatment decision making to be passive, with most of them considering that they had little to no involvement in the treatment decisions being made. Some of the patient-reported factors that disempowered them from participating actively in the decision-making process included an increased trust in the dentist, a lack of knowledge in the field, time constraints during the appointment, or even situation-related factors associated with emergency conditions or comorbidities.24Chapple H. Shah S. Caress A.L. Kay E.J. Exploring dental patients' preferred roles in treatment decision-making: a novel approach.Br Dent J. 2003; 194: 321-327Crossref PubMed Scopus (78) Google Scholar Patients who expressed an intent to participate in treatment decisions either assumed a consumerist stance with increased treatment awareness or distrusted their provider.24Chapple H. Shah S. Caress A.L. Kay E.J. Exploring dental patients' preferred roles in treatment decision-making: a novel approach.Br Dent J. 2003; 194: 321-327Crossref PubMed Scopus (78) Google Scholar Dentists must share evidence and explain rationales behind selecting a bone graft material for a given clinical scenario as the superior or best choice. Through a mindfulness approach, providers can not only understand the patient’s perspectives but also underscore scientific reasoning behind their recommendations. In some cases, a bone graft material that may be rejected by the patient could have, in fact, a better potential treatment outcome. For instance, a 2020 study by Wychowanski and colleagues25Wychowanski P. Woliński J. Morawiec T. et al.Preliminary clinical data and the comparison of the safety and efficacy of autogenous bone grafts versus xenograft implantations in vertical bone deficiencies before dental implant installation.Transplant Proc. 2020; 52: 2248-2251Crossref PubMed Scopus (5) Google Scholar revealed that xenografts may provide greater benefits to patients receiving chronic immunosuppression therapy, with lower complication rates than autogenous bone blocks for vertical bone augmentations before implant placement. According to a Cochrane systematic review, Cerabone (Botiss), a bovine bone xenograft, is comparable with autografts in treating severe maxillary alveolar atrophy.26Esposito M. Grusovin M.G. Rees J. et al.Effectiveness of sinus lift procedures for dental implant rehabilitation: a Cochrane systematic review.Eur J Oral Implantol. 2010; 3: 7-26PubMed Google Scholar In the maxillary alveolar reconstruction of unilateral cleft lip and palate conditions, the alloplastic material recombinant human bone morphogenic protein-2 showed equal effectiveness as traditional autografts.27Scalzone A. Flores-Mir C. Carozza D. d'Apuzzo F. Grassia V. Perillo L. Secondary alveolar bone grafting using autologous versus alloplastic material in the treatment of cleft lip and palate patients: systematic review and meta-analysis.Prog Orthod. 2019; 20: 6Crossref PubMed Scopus (19) Google Scholar A systematic review by Alyahya and Swennen28Alyahya A. Swennen G.R.J. Bone grafting in orthognathic surgery: a systematic review.Int J Oral Maxillofac Surg. 2019; 48: 322-331Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar concluded that all classes of bone grafts had comparable performance in orthognathic surgeries; however, calcium phosphate and hydroxyapatite alloplastic materials had increased postsurgical infection rates. Dentists must judge appropriately and streamline the available evidence in an unbiased manner before presenting it to the patient. Educating patients about the risks and benefits of graft materials will encourage a shared decision-making process between the dentist and patient. For patients who are opposed to using xenografts or allografts, alternatives such as autografts or alloplasts may be presented, provided that dentists explain the advantages and disadvantages of each specific graft type. However, practitioners must consider carefully factors such as evidence-based clinical performance, feasibility (specifically for autografts), anticipated treatment outcome, operator expertise, and cost of the graft material before recommending the bone graft options. Although dentistry is not entirely devoid of animal-based products, efforts to be inclusive of the vegan community are underway, and with advancements in technology and innovation, vegan-friendly dentistry might not be far off. Synthetic polyester membranes can be suggested as alternatives to the traditional bovine- or porcine-derived collagen membranes in patients who do not want animal-derived materials. These synthetic membranes usually contain medical grade aliphatic polyesters like polylactic acid, polyglycolide acid, polycaprolactone, and their copolymers, such as polylactic glycolic acid (PLGA), and are free of animal derivatives.29Aprile P. Letourneur D. Simon-Yarza T. Membranes for guided bone regeneration: a road from bench to bedside.Adv Healthc Mater. 2020; 9e2000707Crossref PubMed Scopus (28) Google Scholar Newer bioabsorbable and biodegradable synthetic PLGA membranes such as Tisseos (Biomedical Tissues SAS), Biomesh-S (Samyang Holdings), and Gore Resolute Adapt (W.L. Gore and Associates), have been introduced commercially as alternatives to traditional collagen membranes.29Aprile P. Letourneur D. Simon-Yarza T. Membranes for guided bone regeneration: a road from bench to bedside.Adv Healthc Mater. 2020; 9e2000707Crossref PubMed Scopus (28) Google Scholar Polyester membranes degrade in vivo through the process of hydrolysis, and, therefore, the resorption rate of these membranes can be controlled via altering the hydrophobicity of the polymer, making them good candidates for guided bone regeneration.29Aprile P. Letourneur D. Simon-Yarza T. Membranes for guided bone regeneration: a road from bench to bedside.Adv Healthc Mater. 2020; 9e2000707Crossref PubMed Scopus (28) Google Scholar For instance, the bilayered PLGA Tisseos membrane takes a longer time (up to 26 weeks) to hydrolyze in vivo, with a persistent barrier effect lasting up to 16 weeks compared with collagen membranes that typically last up to 8 weeks in vivo.30Hoornaert A. d'Arros C. Heymann M.F. Layrolle P. Biocompatibility, resorption and biofunctionality of a new synthetic biodegradable membrane for guided bone regeneration.Biomed Mater. 2016; 11045012Crossref PubMed Scopus (40) Google Scholar They are considered clinically safe and predictable for use in guided bone regeneration, with a greater controlled resorption rate and performance comparable with that of traditional animal-derived collagen membranes.30Hoornaert A. d'Arros C. Heymann M.F. Layrolle P. Biocompatibility, resorption and biofunctionality of a new synthetic biodegradable membrane for guided bone regeneration.Biomed Mater. 2016; 11045012Crossref PubMed Scopus (40) Google Scholar,31Martin-Thomé H. Bourdin D. Strube N. et al.Clinical safety of a new synthetic resorbable dental membrane: a case series study.J Oral Implantol. 2018; 44: 138-145Crossref PubMed Scopus (6) Google Scholar Before using bone grafts in patients, dentists should consider patients’ religious, humanitarian, and personal values to ensure that dentists do not neglect patients’ opinions. Furthermore, dentists need to inform patients about the bone graft composition and rationale for use. To advance our profession and enhance dental patient experience, we should be adaptive to the patient’s needs and desires, but the selection should be on a scientific basis without any bias.