Author: Kate Scheer
Bone grafting is widely used to treat a range of bone defects in oral and maxillofacial surgery. The choice of grafting material, source and treatment methods depend on factors such as tissue viability, size, shape and defect volume. Among the options available, autogenic bone block grafts, harvested from the patient’s own body, are considered the gold standard for predictable repair of bone defects. [i]
Autografts are most commonly used to increase bone volume in the jaw before placing dental implants, but are also widely used in the repair of congenital or acquired jaw defects, in cases of trauma or tumour-related bone loss, and for a number of other oral health conditions.[ii]
Autologous bone used for grafting in craniofacial surgery can be sourced from various sites in the body depending on the clinical requirement and patient-specific factors. Free non-vascularised bone grafts are often taken from sites such as the iliac crest, ribs, cranial vault, clavicle, or tibia.[iii] Within the oral cavity, commonly used intraoral donor sites include the zygomatic bone, mandibular ramus, and mandibular symphysis.i
The palatal bone is increasingly accepted as a predictable donor site, especially for maxillary bone augmentation in cases of atrophic defects. Several studies have indicated that harvesting from the palate carries fewer risks compared to other intraoral sites, making it a favourable option in selected cases.[iv] Autogenous tooth grafts have recently shown some promising results in both block and powdered form.[v]
Some of the pros and cons of different grafting techniques
Bone grafts are commonly required in various dental procedures such as dental implants, ridge augmentation, sinus lifts, socket preservation, and periodontal surgeries. A wide variety of materials are used for these procedures, all of which come with associated risks and benefits.
Synthetic options, including calcium phosphate-based ceramics such as hydroxyapatite, are frequently used because their composition closely resembles that of natural bone. However, these materials are limited in their ability to stimulate new bone growth.ii
Allografts are carefully selected, and although these can be advantageous in regenerative treatments, there is a high processing cost, and concerns still exist about the risk of disease transmission.ii Xenografts are widely used in dentistry, and can be effective in combination with other materials, including autologous bone. These products are highly processed to remove any risk of contamination. However, where organic components are completely removed for safety, their efficacy has been called into question.ii
Autografts offer a number of advantages over alternatives, such as xenografts, allografts and synthetic substitutes. The material is inherently biocompatible, and provides living cells that more predictably promote new bone formation.ii
Autografts: risks and possible complications
Despite their benefits, autologous grafts are not without drawbacks. The procedure requires a second surgical site, increasing the complexity of the operation and extending recovery time.ii Additionally, the quantity and quality of the donor’s bone may be insufficient, particularly in older patients or those with metabolic conditions such as osteoporosis or diabetes.ii
Complications associated with the mandibular ramus harvesting include nerve damage, pain, swelling, and postoperative bleeding. Harvesting cortical bone while avoiding exposure of the bone marrow can significantly reduce complications. However, due to the complex curvature of the mandible, achieving this precision can be technically challenging.[vi]
Piezosurgery revolutionising bone surgery
Recent advancements in surgical technology have significantly improved the safety and precision of autologous bone harvesting. Because of its unique ability to efficiently and precisely cut bone while not affecting surrounding soft tissue, piezosurgery is widely used to harvest autologous intraoral block bone for grafting. This technique reduces surgical trauma, minimises postoperative discomfort, and promotes faster healing. In addition, the cavitation effect generated during piezosurgery contributes to improved visibility by reducing intraoperative bleeding.[vii]
An example of this innovation is the Piezomed system from W&H. This advanced surgical motor harnesses the power of ultrasonic technology, automatically recognising instruments and adjusting to the appropriate power level for optimal performance. Designed for seamless integration and flexibility, Piezomed allows clinicians to control all essential functions with a single foot pedal, ensuring efficient and precise surgical execution. The system remains digitally up to date, reflecting W&H’s commitment to continually evolving surgical solutions.
Despite the availability of alternative graft materials, autografts remain the gold standard for treating bone defects due to their superior osteogenic potential. By minimising trauma to the donor site, piezosurgery significantly reduces many of the traditional risks associated with autologous grafting, reinforcing its role as a valuable tool in contemporary oral and maxillofacial surgery.
To find out more about the full range from W&H, visit www.wh.com/en_uk, call 01727 874990 or email office.uk@wh.com
[i] Sakkas A, Wilde F, Heufelder M, Winter K, Schramm A. Autogenous bone grafts in oral implantology-is it still a “gold standard”? A consecutive review of 279 patients with 456 clinical procedures. Int J Implant Dent. 2017 Dec;3(1):23. doi: 10.1186/s40729-017-0084-4. Epub 2017 Jun 1. PMID: 28573552; PMCID: PMC5453915.
[ii] Ferraz MP. Bone Grafts in Dental Medicine: An Overview of Autografts, Allografts and Synthetic Materials. Materials (Basel). 2023 May 31;16(11):4117. doi: 10.3390/ma16114117. PMID: 37297251; PMCID: PMC10254799.
[iii] Elsalanty ME, Genecov DG. Bone grafts in craniofacial surgery. Craniomaxillofac Trauma Reconstr. 2009 Oct;2(3):125-34. doi: 10.1055/s-0029-1215875. PMID: 22110806; PMCID: PMC3052656.
[iv] Durrani F, Vishnu JP, Taslim A, Imran F, Kumari E, Pandey A. Palatal bone block: A predictable bone augmentation technique for restricted maxillary defect. J Indian Soc Periodontol. 2023 Sep-Oct;27(5):530-535. doi: 10.4103/jisp.jisp_409_22. Epub 2023 Sep 1. PMID: 37781323; PMCID: PMC10538504.
[v] Janjua OS, Qureshi SM, Shaikh MS, Alnazzawi A, Rodriguez-Lozano FJ, Pecci-Lloret MP, Zafar MS. Autogenous Tooth Bone Grafts for Repair and Regeneration of Maxillofacial Defects: A Narrative Review. Int J Environ Res Public Health. 2022 Mar 20;19(6):3690. doi: 10.3390/ijerph19063690. PMID: 35329377; PMCID: PMC8955500.
[vi] Ku JK, Ghim MS, Park JH, Leem DH. A ramus cortical bone harvesting technique without bone marrow invasion. J Korean Assoc Oral Maxillofac Surg. 2023 Apr 30;49(2):100-104. doi: 10.5125/jkaoms.2023.49.2.100. PMID: 37114449; PMCID: PMC10151694.
[vii] Lakshmiganthan M, Gokulanathan S, Shanmugasundaram N, Daniel R, Ramesh SB. Piezosurgical osteotomy for harvesting intraoral block bone graft. J Pharm Bioallied Sci. 2012 Aug;4(Suppl 2):S165-8. doi: 10.4103/0975-7406.100260. PMID: 23066242; PMCID: PMC3467932.
