Type Of Bone Graft Research Articles

Immediate Placement and Provisionalization With Buccal Plate Preservation: A Case Report of a New Technique

Abstract Abstract Post-extraction resorption of the alveolar ridge is known particularly to affect the buccal plate, increasing the risk of facial soft-tissue recession and other adverse clinical effects. The authors have developed a simple technique for buccal plate preservation that involves surgically creating a pouch facial to the buccal plate that is filled with xenograft material. This technique can also be utilized in cases for which immediate implant placement and provisionalization are planned. A case report illustrating this approach is presented.

Maxillary alveolar ridge reconstruction with monocortical fresh-frozen bone blocks: A clinical, histological and histomorphometric study

BackgroundThis investigation is a clinical and histological assessment of fresh-frozen bone use in the reconstruction of maxillary alveolar ridges. The study evaluates the effectiveness of this material as a bone filler prior the placement of dental implants. Patients and methodsSixteen patients with atrophic maxillary ridges underwent maxillary reconstruction with fresh-frozen tibial human block grafts prior to implant placement. Sampling procedures were carried out 4, 6 and 9months later when a bone core was removed from the grafts for histological and histomorphometric analysis. ResultsEighteen blocks were placed, and each patient received either 1 or 2 blocks. During the sampling procedures, all of the grafts were found to be firm in consistency, well-incorporated, and vascularized. A total of 34 implants were placed into the grafts with a minimum of 40-Newton-cm torque in all cases. The follow-up period ranged from 18 to 30months. No implants were lost. The histological analysis revealed vital bone with mature and compact osseous tissue surrounded by marrow spaces. ConclusionBone allografts can be used successfully as graft material for the treatment of maxillary ridge defects. This type of bone graft can be used safely in the areas of implant placement as a suitable alternative to autogenous grafts.

Jaw cysts – Filling or no filling after enucleation? A review

IntroductionJaw cysts are common lesions in the oral and maxillofacial region. Enucleation of the lesions and primary closure of the defects, the so-called “cystectomy”, has evolved as the treatment of choice. In order to reduce infections and to accelerate bone regeneration, different types of bone grafts are increasingly investigated for defect filling. Material and methodsThe present review reflects the most recent studies using autogenous, allogenic, xenogenic and alloplastic bone grafts and compares the results to current investigations about conservative cyst enucleation without using any filling materials. Relevant studies with significant patient sample sizes were electronically searched in PubMed and Medline. ResultsSimple cyst enucleation and blood clot healing show low complication rates and sufficient bone regeneration even in large defects. Prospective randomized trials comparing the additional use of filling materials to the “cystectomy” are rare. Currently available data do not indicate the superiority of additional bone grafts. ConclusionEnucleation of jaw cysts and primary closure without bone substitutes remains “state of the art” in most cases.

Custom made bioceramic implants in complex and large cranial reconstruction: A two-year follow-up

IntroductionLarge cranial defects still represent a challenge in neurosurgery. Currently different biomaterials are available for cranial reconstruction including titanium, acrylic mesh and different types of calcium phosphate-based bone grafts. The goal of surgery is a perfect fit of the implant without infection and absorption, and a good aesthetic result. This paper describes a surgical method for cranioplasty, using a customised porous hydroxyapatite (HA) prosthesis. Materials and methodsSixty patients treated surgically with a customised porous-HA prosthesis for large cranial defects, were followed retrospectively. A two-year follow-up was carried out with periodic visits and CT scans. Safety (the incidence of adverse events and fractures of the implant) and clinical performance (biological and cosmetic results) were evaluated. ResultsFifty one patients were followed-up, no rejection occurred and only one case of infection was recorded. Five patients had minor surgery-related complications, and no spontaneous implant fractures or mobilisation were reported. Three patients exhibited implant fractures as a result of trauma and all healed spontaneously. All patients showed a satisfactory clinical outcome with good cosmetic appearance in the early postoperative period and after a long-term follow-up. ConclusionsCranioplasty performed with a customised porous-HA prosthesis gave a positive outcome, showing it to be an appropriate technique for use in large and complex cranial reconstruction.

Arthrodèse isolée de la sous-astragalienne par voie arthroscopique postérieure : dix cas revus à un an de suivi

Background Isolated subtalar arthrodesis is the treatment of choice for several conditions – mostly subtalar arthritis, tarsal coalition and posterior tibial tendon dysfunction – unresponsive to conservative treatment. Arthroscopic procedures are an interesting recent alternative, less invasive than conventional open techniques. Posterior arthroscopy, in prone position, could be more advantageous than the conventional lateral and/or anterior approach. Materials and methods Ten cases, from 20 to 59 years old, were prospectively followed up for minimum of one year (range 12 to 31 months). Arthritis and tarsal coalition were the most common indications. Results Fusion was observed in all cases at a maximum of 9 weeks. Mean average AOFAS score improved from 47 to 78. No complications were noted related to the technique. Only two patients, operated for a symptomatic subtalar coalition, complained of some residual pain due to a lateral submalleolar impingement. Interest of preservation of vascular talar supply and bone grafting are discussed. Conclusion The good results using this innovative technique are encouraging. Long term randomised studies remain necessary to confirm the reliability of the procedure in these different indications, and the type of bone graft to favor, if really needed. Level of evidence Level IV Therapeutic study.

Posterior arthroscopic subtalar arthrodesis: Ten cases at one-year follow-up

Isolated subtalar arthrodesis is the treatment of choice for several conditions-mostly subtalar arthritis, tarsal coalition and posterior tibial tendon dysfunction-unresponsive to conservative treatment. Arthroscopic procedures are an interesting recent alternative, less invasive than conventional open techniques. Posterior arthroscopy, in prone position, could be more advantageous than the conventional lateral and/or anterior approach. Ten cases, from 20 to 59-years-old, were prospectively followed up for minimum of one-year (range 12 to 31 months). Arthritis and tarsal coalition were the most common indications. Fusion was observed in all cases at a maximum of nine weeks. Mean average AOFAS score improved from 47 to 78. No complications were noted related to the technique. Only two patients, operated for a symptomatic subtalar coalition, complained of some residual pain due to a lateral submalleolar impingement. Interest of preservation of vascular talar supply and bone grafting are discussed. The good results using this innovative technique are encouraging. Long-term randomized studies remain necessary to confirm the reliability of the procedure in these different indications, and the type of bone graft to favour, if really needed. Level IV therapeutic study.

Radiographic alveolar bone changes following ridge preservation with two different biomaterials

The aim of this randomized controlled trial was to evaluate radiographical bone changes following alveolar ridge preservation with a synthetic bone substitute or a bovine xenograft. Alveolar ridge preservation was performed in 27 patients randomized in two groups. In the test group (n=14), the extraction socket was treated with Straumann bone ceramic(®) (SBC) and a collagen barrier membrane (Bio-Gide(®)), whereas in the control group (n=13) with deproteinized bovine bone mineral and the same barrier. Standardized periapical X-rays were taken at 4 time points, BL: after tooth extraction, GR: immediately after socket grafting, 4M: 16 weeks, 8M: 32 weeks post-operatively. The levels of the alveolar bone crest at the mesial (Mh), and distal (Dh) and central aspects of the socket were measured at all time points. All the radiographs obtained were subtracted from the follow-up images. The gain, loss and unchanged areas in terms of grey values were tested for significant difference between the two groups. In the test group, the Mh and Dh showed a mean difference (± standard deviation) of 0.9 ± 1.2 and 0.7 ± 1.8 mm, respectively, among BL-8M. In the control group, the Mh and Dh showed a mean difference of 0.4 ± 1.3 and 0.7 ± 1.3 mm, respectively (P>0.05). Both treatments presented similar gain in grey values between BL-GR, BL-4M and BL-8M. The SBC presented less loss in grey values between BL-4M and BL-8M (P<0.05). Radiographic assessment underestimated the intrasurgical measurements (mesial and distal) of an average 0.3 mm (95% CI, 0.02-0.6). Both types of bone grafts presented similar radiographic alveolar bone changes when used for alveolar ridge preservation.

Results of Operative Treatment for a Bone Cyst in the Proximal Femur

� Purpose: We retrospectively evaluated performing curettage and bone grafting for the treatment of simple bone cyst in 21 patients with cysts in the proximal femur. The purpose of this study was to review the results with a minimum follow up of 24 months. Materials and Methods: We treated 21 cases of simple bone cysts with curettage and a bone graft from June 1995 to July 2008. 4 male and 17 female patients (age range: 14~62 years (mean age: 39.8 years) volunteered for this study. The range of the follow-up period was from 24 months to 6 years (mean follow-up: 63.7 months). We evaluated the effect of treatment by examining the simple follow-up radiographs according to Oppenheim's classification. We retrospectively reviewed the site of the cysts, the patients' ages at the time of the diagnosis, the incidence of pathologic fracture, the association with femoro-acetabular impingement (FAI) and the type of bone graft. Results: The investigation revealed that 20 out of 21 patients had better than improved results. 14 patients of the 15 patients who were treated with an autogenous bone graft had better than improved results and all 6 patients who received an autogenous and allergenic bone graft had better than improved results. Two patients had associated FAI. These cases were managed with arthroscopic labral trimming and curettage. There were no specific complications related to the bone cyst and the operative procedure. Conclusion: We believe curettage and bone grafting and stabilization with compression hip screws is a reasonable treatment for simple bone cysts in the proximal femur. The bone cyst in the femoral head neck junction in patients older than 50 years old is related with femoroacetabular impingement.

Factors affecting changes in sinus graft height between and above the placed implants

The aim of this study was to compare the radiographic dimensional changes of sinus graft height above and between placed implants, and evaluate the factors effecting these changes with 2 different grafting materials and both combination. The study group comprised 42 patients (50 sinus augmentation procedures). Four consecutive panoramic radiographs were evaluated for changes in sinus graft height between and above the placed implants. Factors that may influence graft height reduction were evaluated. The mean percentage of autogenous bone height reduction was 23% between implants and 13% above the implants. Bovine xenograft showed a mean of 6.5% graft height reduction between implants and 0% above implants. The only 2 parameters that correlated with reduction of graft height above and between the implants were time elapsed from surgery and the type of bone graft. Autogenous bone graft presented significantly more reduction (P = .022), whereas anorganic bovine bone graft had only minor or no changes in height. The most important factor influencing reduction in vertical bone height on the time axis, following sinus augmentation is the grafting material, followed by the presence of a functional implant. Anorganic bovine bone was found superior in graft height maintenance in an up to 10 years of follow-up.

Rehabilitation of Atrophic Maxilla Using the Combination of Autogenous and Allogeneic Bone Grafts Followed by Protocol-Type Prosthesis

Currently, there are several techniques for the rehabilitation of atrophic maxillary ridges in literature. The grafting procedure using autogenous bone is considered ideal by many researchers, as it shows osteogenic capability and causes no antigenic reaction. However, this type of bone graft has some shortcomings, mainly the restricted availability of donor sites. In recent years, several alternatives have been investigated to supply the disadvantages of autogenous bone grafts. In such studies, allogeneic bone grafts, which are obtained from individuals with different genetic load, but from the same species, have been extensively used. They can be indicated in cases of arthroplasty, surgical knee reconstruction, large bone defects, and in oral and maxillofacial reconstruction. Besides showing great applicability and biocompatibility, this type of bone is available in unlimited quantities. On the other hand, allogeneic bone may have the disadvantage of transmitting infectious diseases. Atrophic maxillae can be treated with bone grafts followed by osseointegrated implants to obtain aesthetic and functional oral rehabilitation. This study aimed to show the viability of allogeneic bone grafting in an atrophic maxilla, followed by oral rehabilitation with dental implant and protocol-type prosthesis within a 3-year follow-up period by means of a clinical case report.

Posterior iliac crest pain after posterolateral fusion with or without iliac crest graft harvest

Background context Considerable debate exists regarding the incidence of persistent pain from the iliac crest bone graft (ICBG) harvest site. Different study designs have led to a variety of reported rates. Purpose The purpose of this study was to determine the incidence and severity of bone graft site pain after iliac crest harvest. Study design Cross-sectional. Patient sample One hundred and twelve patients, who had a posterior lumbar fusion, seen at a tertiary spine center for a routine postoperative visit. Outcome measures Numeric rating scales (0–10) for pain over lower back, right, and left posterior iliac crests. Methods An independent investigator, not directly involved in the care of the patient and unaware of the type of bone graft used in the fusion, examined the patient for tenderness over the surgical site as well as the left and right posterior iliac crest. After the examination, data on the source of grafting material, complications during harvest, and backfilling of the graft site defect were collected from the medical records. The patients were then classified as to whether ICBG was harvested or not. Chi-square test was used to determine any difference in the proportion of iliac crest pain between the bone graft group and no bone graft group. Correlations between body mass index (BMI), time since surgery, and the incidence and severity of bone graft site pain were also determined. Results There were 72 women and 40 men with a mean age of 56.6 years (range, 16–84). Mean follow-up was 41 months (range, 6–211 months) with a median of 25 months. Iliac crest bone graft was harvested in 53 (47.3%) patients through the midline incision used for lumbar fusion. In 59 patients (52.7%), recombinant human bone morphogenetic protein-2 was used with no graft harvest. There was no statistically significant difference in the proportion of patients complaining of tenderness over both or either iliac crest between the two groups. Only 10 patients had pain over the same crest from which the graft was harvested. No correlations between number of levels fused, levels fused, BMI, length of follow-up, and the incidence and severity of bone graft site pain were seen. Conclusions The results of this study highlight the difficulty in differentiating pain originating from the graft site versus residual low back pain. The incidence of pain over the iliac crest was similar in patients in which iliac crest was harvested and those in which no graft was harvested.

부산지역 치과환자의 임플란트 유형 및 분포 경향

본 연구는 부산지역 S치과에 내원한 임플란트 시술을 받은 299명이 식립한 871개의 임플라트를 대상으로 임플란트의 종류, 골 이식 종류, 치주상태, 임플란트 분포를 조사하여 임플란트 구강위생관리 및 환자관리에 기초 자료를 마련하고자 하였다. 임플란트의 종류는 국산 임플란트 83.6%, 수입 임플란트 16.4%로 나타났다. 골 이식에서는 혼합 뼈로 골 이식을 한 환자가 17.1%로 가장 많았으며, 질병이 없는 환자는 있는 환자보다 자가 뼈로 골 이식을 많이 하였다(<TEX>$X^2$</TEX>=14.66, p<.01). 치주상태는 남자보다는 여자가 좋았으며(t=-2.73, p<.01), 연령별에서는 연령이 적을수록(F=14.20, p<.001), 질병 유 무에서는 질병이 없는 환자(t=-4.67, p<.001)에서 치주상태가 좋았다. 치아별 임플란트 분포에서 하악에 많았고, 하악 좌측 임플란트가 2개 있는 환자가 16.1%로 가장 많았다(<TEX>$X^2$</TEX>=33.14, p<.01). 총 치아의 임플란트 유 무에서 연령별로는 20대의 경우 1개, 60대 이상은 2개 로 나타나 연령이 증가할수록 개수가 많아짐을 보였다(<TEX>$X^2$</TEX>=74.09, p<.001). 또한 치주상태에 따라서도 양호한 경우 1개를 식립한 경우가 많았고 불량할수록 2개 가 많았다(<TEX>$X^2$</TEX>=38.28, p<.01). 이상의 결과에서 임플란트의 식립 상태 및 치주 상태를 정확히 파악하여 환자 상태에 맞는 1:1 맞춤 구강위생관리 프로그램 개발이 조속히 마련되어야 할 것이다. The purpose of this study was to examine the types of implant, the type of bone graft, periodontal status and the distribution of implant among patients in a region. The subjects in this study were 299 patients who received implant treatment Busan area. The number of their implants was 871 in total. The findings of the study were as follows: As for the type of implant, home-made implants accounted for 83.6 percent, and imported ones represented 16.4 percent. Regarding bone graft, The presence or absence of disease made a significant difference to that(<TEX>$x^2$</TEX>=14.66, p<.01). As to periodontal status by gender, age and disease, the periodontal state was better among those who were female(y=-2.73, p<.01), who were younger(F=14.20, p<.001) and who had no disease(t=-4.67, p<.001). The intergroup gaps were statistically significant. Concerning the distribution of implant, The distribution of implant was statistically significantly different(<TEX>$x^2$</TEX>=33.14, p<.01). Age made a statistically significant difference to that(<TEX>$x^2$</TEX>=74.09, p<.001). As to links between periodontal status and the number of implant, The intergroup gaps were statistically significant(<TEX>$x^2$</TEX>=38.28, p<.01).

Distraction Arthrodesis of the Subtalar Joint Using Allogeneic Bone Graft: A Review of 15 Cases

Distraction arthrodesis of the subtalar joint is often used for the correction of neglected calcaneal fractures. Although different techniques have been advocated, there remains some debate as to the optimal type of bone graft for this purpose. This study retrospectively reviewed one surgeon's results for distraction arthrodesis of the talocalcaneal joint for 15 consecutive feet in 15 patients using 12 frozen femoral head and 3 freeze-dried iliac crest allografts. Indications for distraction arthrodesis in this series included neglected calcaneal fracture (n = 10), failed open reduction with internal fixation (n = 3), malunion after ankle fusion (n = 1), and subtalar joint arthritis with deformity (n = 1). The mean patient age was 47.5 (range 29 to 66) years, and the mean duration of follow-up was 20.6 (range 13 to 31) months. Complete union was achieved in 14 (93.33%) feet. Orthobiological agents were used in every case, including 7 (46.67%) platelet-rich plasma, 5 (33.33%) demineralized bone matrix combined with platelet-rich plasma, 2 (13.33%) platelet-rich plasma combined with an implantable electrical bone growth stimulator, and 1 (6.67%) demineralized bone matrix only. One (6.67%) patient developed a nonunion with collapse of the allogeneic graft, requiring revision with autogenous iliac crest bone graft. There were 8 (53.33%) minor complications, including 4 (26.66%) cases with inferior heel irritation, 2 (13.33%) with sural nerve paresthesia, and 2 (13.33%) with wound dehiscence. In conclusion, the use of allograft for subtalar joint distraction arthrodesis results in similar union rates as autogenous iliac crest grafting previously reported in the literature.

Autologous Bone Graft: Properties and Techniques

Bone grafting is involved in virtually every procedure in reconstructive orthopaedic surgery. Although autologous bone grafts have excellent biologic and mechanical properties, considerable donor site morbidity and the limited volume available must be taken into consideration. Currently, there are no heterologous or synthetic bone substitutes available that have superior biologic or mechanical properties. This review article summarizes the biologic and mechanical properties of autologous bone grafts, differentiates various autologous bone graft types, and compares them with other bone substitutes.

Do bone grafts or barrier membranes provide additional treatment effects for infrabony lesions treated with enamel matrix derivatives? A network meta‐analysis of randomized‐controlled trials

Network meta-analyses of randomized-controlled trials were undertaken to investigate whether enamel matrix derivatives (EMD) in conjunction with other regenerative materials yield better treatment outcomes than EMD alone in the treatment of infrabony defects > or =3 mm. A literature search was conducted using the Medline, EMBASE, LILACS and CENTRAL databases up to and including December 2008. Treatment outcomes were changes in probing pocket depth (PPD), clinical attachment level (CAL) and infrabony defect depth. Different types of bone grafts (or barrier membranes) were first treated as a group and then separately. Twenty-eight studies were included in the review. EMD plus bone grafts and EMD plus membranes attained 0.24 mm [95% high probability density (HPD) intervals: -0.38, 0.65] and 0.07 mm (95% HPD intervals: -1.26, 1.04) more PPD reduction than EMD alone, respectively. For CAL gain, EMD plus bone grafts and EMD plus membranes attained 0.46 mm (95% HPD intervals: -0.17, 0.83) and 0.15 mm (95% HPD intervals: -1.37, 0.30), respectively. When different types of bone grafts and barrier membranes were treated separately, EMD with bovine bone grafts showed greater treatment effects. There was little evidence to support the additional benefits of EMD in conjunction with other regenerative materials.

Effect of platelet‐rich plasma on sinus lifting: a randomized‐controlled clinical trial

The combination of anorganic bovine bone (ABB) with platelet-rich plasma (PRP) has been widely used in bone regeneration procedures although its benefits are still unclear. The purpose of this study was to evaluate whether or not PRP improves the efficacy of ABB in sinus floor augmentation. In addition, we have investigated the effect of residual bone height and tobacco on implant survival in sinus augmentation procedures. Eighty-seven patients recruited for this study underwent 144 sinus floor augmentation procedures using ABB alone or ABB plus PRP (ABB+PRP) in a randomized clinical trial. A total of 286 implants were placed in the augmented bone, and their evolution was followed up for a period of 24 months. In order to investigate on a histological level and any adjunctive effects, we performed an ancillary study in five edentulous patients with a symmetrical severely resorbed maxilla. In these patients, a bilateral sinus augmentation was randomly performed using ABB or ABB+PRP in a split-mouth design, and after 6 months, bone biopsies were taken from the implant sites for histological and histomorphometric analysis. Overall, 96.2% of ABB and 98.6% of ABB+PRP implant success were obtained during the monitoring period and differences were not found between sites grafted with and without PRP in the 87 patients studied. Densitometry assessments and graft resorption were similar in both experimental groups. However, the histological and histomorphometrical analysis in the five edentulous patients revealed that bone augmentation was significantly higher in sites treated with ABB+PRP (p <or= 0.05). Another outcome from our study is that the lack of initial bone support (p <or= 0.05) and smoking (p=0.05) appeared to have a negative effect on the treatment success, which was accentuated when both circumstances coincided. PRP is not a determining factor for implant survival in sinus lifting procedures. However, this study revealed that PRP can improve the osteoconductive properties of ABB by increasing the volume of new bone formed. Moreover, in sinus augmentation procedures the implant's survival rate appears to be more influenced by the residual bone height or by tobacco than by the type of bone graft.

Maxillary Ridge Augmentation With Fresh-Frozen Bone Allografts

The present investigation clinically and histologically evaluated the use of fresh-frozen bone in the reconstruction of maxillary alveolar ridges to confirm the effective bone fill and support for the placement of dental implants. Fifteen patients who had atrophic maxillary ridge necessitating bone block grafts prior to implant placement were submitted to maxillary reconstructions performed with human block grafts of tibia fresh-frozen chips. Nine months later the re-entry procedures were carried out and at this time a bone core was removed from the grafts for histological analysis. Thirty-four blocks were placed, and the number of blocks each patient received ranged from 1 to 4. During the re-entry procedures, all of the grafts were found to be firm in consistency, well-incorporated, and vascularized. A total of 51 implants were placed over the grafts with a minimum of 40-Newton torque in all cases. None of the implants were lost. The follow-up period ranged from 24 to 35 months. The histological analysis revealed a living bone that showed features characteristic of mature and compact osseous tissue surrounded by marrow spaces. Bone allografts can be successful as graft material for the treatment of maxillary ridge defects. If adequate surgical techniques are adopted, this type of bone graft can be safely used in regions of implant placement as a suitable alternative to autogenous grafts.

The effect of bone graft geometry on spinal fusion vertebral stresses.

Spinal fusion is a frequent surgical technique in which the success is uncertain due to post-operative changes in the biomechanics of the spine. Bone grafts are good candidates for disc and vertebra substitutes due to their similar bone properties and their good osteogenic properties. However, the effect of the anatomic harvest location of the bone graft on the load transfer is unknown. A physiologic three-dimensional (3D) finite element model of a lumbar spine was modified to model spinal fusion with a fixator and a bone graft. Bone grafts were taken either from the femur, the tibia, or from the fibula in a configuration of three or six fragments. The configurations were submitted to physiological loadings, and strain and stress distributions were calculated within the vertebrae, the fixator and the bone grafts. Quantitative differences were found from one type of bone graft to another. It was found that fibula bone grafts provided better stability by carrying a large part of the load. However, femoral and tibial bone grafts provided a more similar strain distribution within the vertebrae compared to the physiologic model. For tibial bone grafts, load transfer was found to be sensitive to the orientation used during the surgery. The use of a femoral bone graft to replace one vertebra and two intervertebral discs was found to give a better biomechanical function than using a tibial or fibula bone graft. This surgical technique is proposed to be beneficial in the case of severe spinal trauma providing good interface is obtained between the bone graft and the vertebrae.

Brazilian Research Academy and Scientific Evidence on Calcium Phosphate Bone Grafts

Different types of bone grafts are available in Brazil due to the increase of use of biomaterials for hard tissue replacement. This study was designed to evaluate the scientific production of Brazilian research groups on safety and efficacy of calcium phosphate bone grafts of commercial use in Brazil. The calcium phosphate bone grafts approved for commercial use in Brazil were searched at the National Health Regulatory Agency’s database (ANVISA). The main leaders’ names of the Brazilian Research Groups on these health technologies were obtained by applying the search strategies to the National Council of Technological and Scientific Development’s database (CNPq). Afterwards, it was performed a systematic search of studies conducted by these leaders on calcium phosphate bone grafts and published from 2000 to May 2008 at the following databases: Medline, Lilacs and Scielo. Twenty-nine bone grafts composed by calcium phosphates were registered at Anvisa in May 2008. From those products, 17 and 12 were from imported and national origin respectively. There were twenty-four Brazilian research groups on calcium phosphate bone grafts whose scientific production consisted of 5 studies on bone grafts registered at Anvisa: 3 experiments conducted in animals on the Brazilian bovine bone graft Gen-Ox®, one prospective comparative study and one case report both evaluating the clinical performance of a national biomaterial composed by BMP, demineralized bovine bone, inorganic bovine bone and bovine collagen with the commercial name Gen-Tech® for dentistry applications and 6 months of follow-up. However, all the included studies had poor methodological quality and could not be used for further recommendations despite their good results. The scientific evidence produced by the Brazilian research groups on safety and efficacy of calcium phosphate bone grafts of commercial use in Brazil is still scant. Additional studies are necessary to evaluate these technologies.

The Incorporation of Allogeneic and Autogenous Bone Graft in Healing of Lateral Column Lengthening of the Calcaneus

Lateral column calcaneal lengthening as described by Mosca is a widely accepted technique for the correction of hindfoot valgus and pes planus. It is performed with both allogeneic and autogenous bone graft. The purpose of this study was to evaluate the incorporation of these 2 types of bone graft in this procedure. A retrospective review of all lateral calcaneal lengthenings performed by 4 pediatric orthopaedic surgeons over a 10-year period was conducted. Radiographs at the last follow-up visit were independently examined by 3 reviewers. Incorporation of the bone graft was determined by 2 criteria: (1) presence of continuity of trabecular lines between graft and native bone, and (2) inability to distinguish the boundary between bone graft and native bone. A consensus or majority opinion (2 out of 3 reviewers) was considered positive for graft incorporation. Thirty-five lateral column lengthenings in 26 patients were reviewed, 30 of which used allograft bone and 5 autograft. Ninety-seven percent of the allograft cases and 80% of the autograft cases were incorporated at final follow-up. There was 1 case of graft failure in each of the 2 groups. Follow-up in the allograft failure was 6 weeks; the autogenous failure 7.2 years. Interrater reliability was good (kappa=0.61, P < .0001). No adverse events or complications were noted with the use of allograft bone in this series. Allogeneic bone graft is rapidly integrated into native bone and is a desirable substitute to autogenous bone for use in lateral column lengthenings, avoiding any patient morbidity from graft harvesting.