I've done a lot of research into bone grafting the past few weeks and it's way more interesting that I expected. There's a lot to them, how it's processed, where it's being applied, how big the defect is, etc. There is no perfect bone graft. PBHA is FDA approved for jaw surgery as an interpositional graft and is the most widely used material today. It has been studied over 15 years after application and the complication rate is very low. It has been used in other applications for 3 decades now and does cause problems on occasion.
Demineralized bone is just cadaver bone that's had all the minerals removed so you're left with cartilage and growth factors. The latter is what's significant since it integrates so quickly with surrounding bone taking only 6 weeks to heal vs 4mo for PBHA. That's because DBX is mildly osseoinductive. It may be resorbable, honestly I think these surgeons know less about this s**t than they think they do. Most of them don't sit around nights reading papers obsessively like we (or maybe just I) do. The guys most familiar with this stuff or those who specialize in implants and sinus lifts actually. The other reason PBHA is so popular is that it's extremely stable. HA is normally resorbable but PBHA is sintered (heated to high temperatures) which eliminates that property, resorbing only 2-5% per year. On the flip side, it's similar to cancellous bone so soft tissues grow through it more readily, which is why you rarely hear of someone losing feeling in their palate or teeth when used. Actually most of the time the graft isn't needed, as bony gaps up to 3-4mm should heal on their own and the plates provide most of the structure. b-TCP is promising but again is not new. It's resorption is much of the problem, as an interpositional graft it's not great because it resorbs too quickly. For cheekbones may be ok because incomplete augmentation only results in a small cosmetic defect. Xilloc is claiming it's their technique for shaping it that makes it better. I don't know what this "bone fluid" is that they're referring to. Bone marrow maybe?
Bio-OSS looks ok to me. Has similar issues to cadaver and DBX, foreign proteins can cause an immune reaction. I believe it's resorbable, not sure. Personally, the fewer complicated materials I have in me the better. Some surgeons say HA was abandoned because of the problems, other say because the results were terrible. Infection and rejection can happen at any time, decades later even. I know that with all these materials, once bone grows into it then it can be hard if not impossible to remove. The maxillary grafts should be easy to swap out but then all the tissue that grew through it will go with it, likes the nerves feeding the teeth and palate. Ugh.
What I was told about DBX as an interpositional graft is that the surgeon who uses it has been using it for 10-15 years and hasn't had any problems. He used to use PBHA but scoffed when I suggested it like it was old technology. He thinks HA grafts will cause problems down the line and that's why he switched. He's done like 5000 surgeries, comparable or more than most of the other big names we see here so he has the data to back up his position. I do know some of the surgeons who use PBHA have a tendency to downplay their negative results.
I've come across a bunch of other interesting materials and techniques, so many you can't possibly research them all and no way a surgeon can evaluate them. Surgeons find something that works and tend to stick with it.
Honestly, we're better off not knowing this s**t and just enjoying life lol.
