Autogenous and Allogeneic Bone Grafts in Periodontal Therapy

traction to reduce lipid content, sterilization in
propiolactone, and freeze drying. In 77 intraosseous
defects in 56 patients, Scopp et al (1966)
reported pocket depth reduction of 3 mm at 6
months and an additional millimeter after 1 year.
Older (1967) reported good results in four cases,
fair results in three, and unsuccessful results in
two, as measured by probing depth reduction and
increasing radiographic density. The widespread
clinical use that followed these reports resulted
in routine rejection and failure (Emmings, 1974).
Boplant was subsequently withdrawn from the
market (Emmings, 1974).
IV. CASE REPORTS AND CONTROLLED
CLINICAL TRIALS WITH AUTOGENOUS
AND ALLOGENEIC BONE GRAFTS
Case reports document the clinical success
or failure of a therapeutic procedure, provide information
on technique sensitivity, and may stimulate
research into the validity of the procedure.
They have scientific value only when a large
number of cases are reported and become anecdotal
when published as isolated procedures. In
addition, the repeatability of results, as reported
by a significant number of investigators, lends
credence to clinical predictability. Because early
bone graft literature was concerned mainly with
clinical feasibility and technique, comparisons
with procedures that have the same or similar
objectives were not accomplished. It was only
later that controlled clinical trials were felt to be
necessary, as several authors speculated that an
equivalent amount of bone fill could be achieved
irrespective of whether the procedure included a
bone graft (Rosling et al., 1976; Ellegaard et al.,
1971; Poison and Heijle, 1978). In addition, as
judged by present-day standards, many of the
early controlled studies were inadequately designed
because the patient did not serve as the
unit of control (Hujoel et al., 1990). Yet a critical
analysis of these studies revealed that in no instance
was the control procedure (open flap debridement)
to be superior to the bone graft (Table
1).
A. Autogenous Bone Grafts
There are several types of autogenous bone
grafts that have been or are being used clinically.
They include cortical bone chips, osseous coagulum,
bone blend, intraoral and extraoral cancellous
bone, and marrow.
1. Cortical Bone Chips
The impetus for the modern-day use of periodontal
bone grafts can be traced to the work of
Nabers and O'Leary (1965). They reported that
shavings of cortical bone removed by hand chisels
during osteoplasty and ostectomy from sites
within the surgical area could be used successfully
to effect a coronal increase in bone height.
The intraosseous defects so treated were primarily
one- and two-walled and not felt by the authors
to be amenable to other methods of treatment.
Subsequently, Nabers reported long-term
success with 18- to 24-month posttreatment clinical
documentation for six cases (Nabers, 1984).
Although there is a paucity of information with
respect to cortical bone chips, a more recent publication
suggests that this type of graft is still in
use and may result in bone fill with decreased
probing depth (Langer et al, 1986). Cortical
chips, due to their relatively large particle size
— 1,559.6 x 183 fxm (Zayer and Yukna, 1983)
— and potential for sequestration, were replaced
by autogenous osseous coagulum and bone blend.
2. Osseous Coagulum and Bone Blend
Intra-oral bone, when obtained with high- or
low-speed round burs and mixed with blood, becomes
a coagulum (Robinson, 1969; Jacobs and
Rosenberg, 1984). The rationale for the use of
osseous coagulum is the belief that the smaller
the particle size of the donor bone, the more
certain its resorption and replacement with host
bone (Robinson, 1969). It was subsequently
demonstrated in monkeys that small bone particles
of 100 |xm could provide for earlier and
greater osteogenic activity than particles ten times
as large (Rivault et al, 1971).
The bone blend technique was designed to
overcome some of the disadvantages of osseous
coagulum, including inability to aspirate during
the collection process, unknown quantity and
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