Autogenous and Allogeneic Bone Grafts in Periodontal Therapy

Critical Reviews in Oral Biology and Medicine, 3(4):333-352 (1992)
Autogenous and Allogeneic Bone Grafts in
Periodontal Therapy
James T. Mellonig, D.D.S., M.S.
Department of Periodontics, The University of Texas, Health Science Center, San Antonio, TX 78284
ABSTRACT: This article is limited to a review of bone autografts and allografts, as used in periodontal therapy.
The various graft materials are discussed with respect to case reports, controlled clinical trials, and human
histology. Other reviewed areas are wound healing with periodontal bone grafts, tissue banking and freeze-dried
bone allografts, and the use of bone grafts in guided tissue regeneration.
KEY WORDS: Periodontal, bone autograft, bone allograft, tissue banking, guided tissue regeneration.
I. INTRODUCTION
Bacterially induced periodontitis leads to the
destruction of tooth-supporting tissues, culminating
in tooth loss. Disease reversal with regeneration
of new bone, cementum, and periodontal
ligament about a root surface previously
contaminated by bacterial plaque is the ultimate
goal of periodontal therapy.
Bone grafts, both autogenous and allogeneic,
are felt by some to be essential if restoration of
lost bone accompanied by a functional attachment
apparatus is to be achieved. "Bone grafting
materials will enhance regeneration of a new attachment
apparatus" (Bowers et aL, 1989c).
"Osseous grafting therapy has been shown to be
clinically successful for time intervals exceeding
20 years when encompassed in a comprehensive
care program based on effective daily plaque control
by the patient and a professionally supervised
periodontal maintenance program" (Schallhorn,
1980).
Others believe that the use of bone grafts to
enhance regeneration of the periodontium is unacceptable.
' 'Not one of the human implant studies
has provided the type of experimental model
that clearly demonstrates new attachment for-
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© 1992 by CRC Press, Inc.
mation. Many of the investigators have failed to
provide controls, and none have provided the
unequivocal histologic evidence of new attachment
to previously diseased roots" (Gara and
Adams, 1981). "From the standpoint of scientific
documentation, the value (of regenerative
procedures) is not clear. Spectacular results of
"bone fill" in intrabony pockets have been reported
with or without bone implantation"
(Ramfjord, 1984).
Still others are convinced that bone grafts are
detrimental. "Ignorance of the contribution of
the various tissue components in periodontal
wound healing may explain the widespread use
of bone transplants in the treatment of intrabony
pockets" (Karing et aL, 1984). "Since granulation
tissue derived from bone has the potential
to induce root resorption and ankylosis, the rationale
of favoring bone growth with the use of
bone transplants is highly questionable" (Karring
etaL, 1980).
Clinical case reports, controlled clinical trials,
and human histology documenting the results with
bone grafts have been reviewed previously (Pfeifer,
1969; Groff, 1976a and b; Ellegaard, 1976;
Schallhorn, 1977; Schallhorn, 1980; Mellonig,
1980; Wirthlin, 1981; Gara and Adams, 1981;
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