Expert Articles:
Bone Grafting, Implantology, and Dental Techniques

We encourage you to read and reach out to us regarding any of the following posts. We welcome your thoughts and look forward to discussing these topics with you. The better informed we are as a dental community, the better we can truly serve our patients.

We’ve seen significant improvements in the Journal of Periodontology in the last year. Still, dubious research has continued to blemish the journal’s integrity. We have no interest in being dentistry’s policeman. However, when we see false information published in our journals, we have a responsibility to our profession and our patients to call it out.

An accurate diagnosis is required for a positive treatment outcome. In our last post, we discussed how periimplantitis is not possible in sites grafted with cadaver bone grafts. However actual periimplantitis is also common. For these two very different lesions we need very different treatment protocols.

Our profession is struggling with a continuing increase in implant loss. Virtually every case is diagnosed as periimplantitis. In this post, we will begin to identify the different reasons for implant loss, starting with when bone loss around a dental implant is not periimplantitis.

Prion infections are transmitted through cadaver tissue grafts and surgical instruments.

In this post, we will discuss what prions are, what human neurodegenerative diseases are caused by prions, and how the infections are transmitted.

In a previous article, “Sinus Augmentation Without Sinus Membrane Exposure”, we described a method of performing a sinus augmentation without contacting the sinus membrane. Here, we use the same technique that allows the graft material to flow through the bone and lift the sinus membrane, but with the ability to graft the sinus with any desired amount of graft material.

At age 2, ths patient suffered trauma to her lower jaw. At age 12, a significant lesion was found in her mandibular symphysis. The diagnosis was a traumatic bone cavity, previously called a traumatic bone cyst. 

When talking to dentists about what bone graft material they use, we often hear that they use Puros because it has the most scientific support. We smile and do our best to maintain our composure. The last thing we want to do is to embarrass a fellow dentist by challenging his understanding of bone graft science. So, what did in this article is look at a few papers on Puros that are often quoted in support of this material.

For pain control in dentistry, we deal with pain from periodontal therapy, endodontic therapy, and implant therapy. These surgeries deal with different tissues that are likely to respond differently to various pain medications. However, orthopedic surgeons and dental implantologists both work primarily with bone, and we can benefit from sharing information on the types of pain meds that best benefit our patients after skeletal surgery.

Sinus membrane perforation is the most common complication of sinus augmentation surgery. Dealing with the sinus membrane is also one of the most stressful parts of sinus augmentation surgery. This post describes a stress-free method of elevating the sinus membrane for predictable sinus augmentation.

Every day in the clinic we see dramatic post extraction ridge resorption. We accept this as normal because it happens for most patients. Because many patients delay implant placement, questions remain about the long term benefits of grafting. In the long term, does grafting prevent alveolar ridge resorption or do all ridges resorb irrespective if the site was grafted or not?

At SteinerBio, our posts are accompanied by cited literature to support our discussions. When we are discussing a subject that lacks solid published literature, we make an effort to be clear that we are only providing our opinion. In dentistry, a “bone cavitation” is a term often used to refer to areas of jawbone that is believed to be lacking mineralization or is very poorly mineralized, and filled with either chronically infected, necrotic (dead tissue), or otherwise pathologically affected tissue.

AlloOss Plus is sold to dentists by ACE Southern. It is the same product that killed 8 people two years ago due to tuberculosis infection. Recently, there has been one death and a number of systemic tuberculosis infections with the same product. The product claims to harvest regenerative cells from cadavers, but apparently they are also harvesting diseases that you are putting in your patients.

Even when Dr. Vanchit John, a prominent head of a graduate periodontal program, publishes confirmation that the bone produced by allografts is pathologic, don’t expect the profession to change. If new scientific findings are ignored in physics, it is only an intellectual debate. If new scientific findings are ignored in healthcare, it will have much more profound effects.

Dear Dr. Effie Ioannidou,

The future of periodontics is in your hands. Will your tenure as Editor-in-Chief at the Journal of Periodontology see no improvement in patient outcomes or will your tenure usher in a new and exciting time for our profession and the public we serve?

The one check on the publication of false information are letters to the editor, and unlike other journals, the Journal of Periodontology does not allow letters to the editor. Because of this, many thought leaders in the periodontal profession have protected themselves from scientific scrutiny. Debate is stifled because the false statements that are continually allowed to be published in Journal of Periodontology cannot be challenged.

In medicine, a “Gold standard” refers to the clinical model, method, procedure, intervention, or measurement of known validity and reliability, which is generally taken to be the best available. Objectively weighing information to determine its value as evidence is crucial to determining what may qualify as a Gold standard in medicine. Has implant dentistry become the exception?

Bone grafts are designed to modify our patients’ healing and it is therefore critical that only accurate information is disseminated to the practicing clinicians. Unfortunately, our journals often lack the guidance to screen for misinformation about bone grafts, which can lead to the use of materials that in the best case scenario only fail and in the worst case harm the patient.

A lack of a clear etiology of implant loss at any time frame has prevented our profession from changing what can be done differently to predictably reduce the incidence of implant loss. Determining what therapies have the best treatment outcomes and what variables contribute to the most failures is also a very big concern in medicine, where major heath institutions perform detailed data collection and analysis to identify what variables can be controlled to avoid failures. Fortunately for dentistry, this methodology has now been applied to dental implantology.

Our previous communications on this topic were focused on the success and predictability of the technique and we have now produced a video to help clinicians be successful with what many are calling a game changer for sinus augmentation.

With the publication of our technique of removing the sinus membrane during sinus augmentation, we experienced a flood of orders for Sinus Graft. Our previous emails were focused on the success and predictability of the technique, but were not focused on the fine points of the surgery. To help our new customers be successful with the technique, we have compiled a “How to” article to help your decision-making process for what many are calling a game changer for sinus augmentation.

The study compared a modern beta tricalcium phosphate to mineralized freeze dried bone allograft and Bio-Oss, including an ungrafted control. The results are not surprising, but the authors’ understanding of the biology of the various bone grafts studied is what sets this article apart from all others. Most previous studies equate bone quality with the amount of new bone produced because the authors lack the ability to distinguish between normal healthy vital bone that has the ability to remodel and adapt, and bone that is pathologic and lacks the ability to remodel and adapt.

Over the last 15 years, SteinerBio has been developing and improving minimally invasive sinus augmentations, though handling the sinus membrane remained a challenge. No matter what type of access, some sinus membranes are so fragile that any contact can destroy it. Over the years when a membrane was damaged, we would remove it and graft. In these cases, nothing covered the grafted material in the sinus. It was cases like these that taught us that we were able to achieve superior results with fewer complications simply by removing the sinus membrane.
Recently we presented an immediate implant case outlining what we feel is a predictable, efficient method for achieving a high success rate and excellent esthetics. Rather than cherry picking a beautiful and completed case, we have chosen to present this method as the therapy progresses so you can see what you can expect on a regular basis. Here we are reporting on the immediate implant case as it progresses through the integration period, but we are adding an early implant case for comparison.
Cadaver bone grafts produce sclerotic bone, and this area of sclerosis is not limited to just the extraction socket but also involves the bone surrounding the extraction socket. As long as sclerotic bone is present, it does not matter if you immediately replace the failed implant, allow the site to heal after removal of the implant, or place any type of bone graft in the site because the site will always be sclerotic and have a poorer implant success rate than the previous implant.
Immediate implants are a benefit to both clinician and patient. However, they are more clinically demanding than delayed implants and have a higher failure rate. One advantage to an immediate implant is if a properly designed temporary crown is placed at the time of implant placement, the process can produce ideal gingival esthetics. The drawback to immediate temporization is that they have the highest failure rate and the time required to create and place the temporary crown can take significant chair time.
Large medical institutions continually evaluate the success or failure of medications and therapy with the purpose of identifying the most effective therapy at the lowest cost. Today we will review two such studies, one performed at the Mayo Clinic, and one performed at an institution in China. Both studies were remarkably extensive looking at all medications, all diseases, and such factors as smoking to identify what factors were associated with implant failure.

We aim to provide useful information and pass on knowledge that we believe will ultimately help provide the best for our patients. However, there are moments where we are bound to address an issue and present criticism when our profession lacks the ability to understand what they are saying. Today we will look at an in vitro bone regeneration study and assess the value of their findings.

It is known that the sinus membrane does not contribute to bone production during sinus augmentation procedures. However, it is assumed that the sinus membrane is required to contain the sinus graft material for successful sinus augmentation procedures. Like so many of our assumptions about bone, this is another false assumption. The sinus membrane is not needed for predictable successful sinus augmentation with same day implant placement.
There are no clinical studies that discuss gingival regeneration during extraction socket healing. However, there is continuous discussion of the management of gingival recession and how to repair it. This article will outline the principals and procedures for gingival regeneration during extraction socket healing.
Intact extraction sockets that are not treated experience 1.4 mm reduction in buccal wall height and approximately 50% reduction in horizontal ridge width within the first 3 months of healing. 53% of all post-extraction sockets have dehiscences or fenestrations, however we know very little about how to repair these lesions. A well done meta analysis was published in 2020 and found only 6 studies that qualify as evidence based evaluations of the repair of buccal wall dehiscences.

Two recent studies confirm some of the points we have made about how to regenerate bone in an extraction socket: (A) Never pack graft material into a socket as it kills the regenerative cells and delays regeneration; (B) Bovine collagen is not biocompatible and causes significant inflammation; (C) Never remove the PDL or disturb the bone in the socket; and (D) Never place any chemicals that can modify the pH and kill regenerative cells.

Both histological analysis and micro-CT analysis have strengths and limitations when evaluating bone regeneration. However, when combined, the findings can not only be validated by comparing the two methods but additional insight into the regenerative process can be gained. The purpose of the study was to gain FDA clearance for SteinerBio dental bone grafts for use in the skeleton.
When a new surgical modality is rolled out, it is always followed by a period of refinement. The following cases display the results of our recent refinements. Vertical gingival incisions for membrane placement are not required to achieve gingival hypertrophy necessary for ideal gingival architecture and esthetics. The most ideal esthetics and gingival architecture are achieved when the gingiva and membrane are secured by a tissue adhesive.

The following is our Early Implant Protocol for improved esthetics, reduced post operative pain, and shorter time from extraction to restoration. This time period of implant placement also allows for no flap implant placement, which reduces the time of surgery and post-operative discomfort to the patient because there are no incisions, flaps, or sutures.

Bone cells live in the most protected environment in the body. Bone cells are encased in thick cortical bone that is never exposed to the surrounding environment. If this protected environment is breached, the regenerative cells that we work with are easily killed. Today we will discuss how dentists routinely compromise the health of bone and how to avoid killing regeneration.

Here at SteinerBio, we do not portend to know anything about endodontic therapy. However, many of our customers do know a great deal about endodontic therapy and here we will be sharing one of those cases with you as we discuss the rationale of using SteinerBio bone graft for endodontic lesions.
For the body to regenerate itself, it must duplicate the biological processes that formed the tissue in the first place and inflammation is never a component of normal tissue growth. If a drug or device produces any inflammation, you will not produce normal healthy tissue. While inflammation is a blocker for tissue regeneration, the concept of biocompatibility encompasses an even greater array of biological processes other than just the inflammatory response.

SteinerBio bone grafts were developed to boost implant success rates.. The goal was to stimulate mineralization, not just allow it to happen. The unique qualities built into our grafts have given us a pathway to achieving significant clinical advancements. Therefore, it is important to understand the do’s and don’ts of our bone graft products in order to achieve successful bone regeneration.

Previously, we presented the following ridge augmentation with a brief description of the surgical procedure. When a dramatic increase in the alveolar ridge is required, it is difficult to create volume without the incision lines opening. Here we discuss a method that allows us to use the periosteum to predictably maintain surgical wound closure…

In tissue engineering and regeneration, most everything of interest happens in the first 4 weeks. This post will discuss the clinical application of 3D-printed bone grafts for ridge augmentation and evaluate what is happening in the graft as it is converted into vital bone. We will discuss the surgical application of 3D-printed beta tricalcium phosphate ridges and assess what is happening in the graft material from day of surgery through 4 weeks…

We have been teaching early implant placement as a superior implant methodology for about 2 years and it gives us great pleasure to find our customers refining and expanding the technology. Here we present a case performed by Dr. Matt Bickel, a general dentist in New Jersey who has been using our products for many years…
With the realization that implant complications and implant failures are more common in augmented sites, dentistry is trying to understand why this is the case. Eventually, the profession will understand that implant complications and failures are not caused by augmentation, but by a specific type of graft material…
To augment something is simply to make it larger. To regenerate something is to grow healthy vital tissue equal to the original. We can easily distinguish between the two terms. Bone can be augmented with metal, plastic, or any graft material that does not resorb. To regenerate bone, materials must be biocompatible and fully resorbable, resulting in bone equal to what was lost…
Traditional tooth extraction uses lateral forces to expand the alveolus until the irregularly shaped root can be removed. This expansion causes widespread fracturing of the bone on a microscopic level and creates inflammation which leads to significant bone resorption. The following atraumatic extraction method allows removal of a tooth without damaging the alveolus of the extraction socket…

This is the continuation of a previous article, “Alveolar Bone as the Surgical Guide for Early Implant Placement“. In that post, we demonstrated the case of doing an osteotomy at the time of extraction to facilitate early implant placement. Click the link below to see the rest of the case…

A recent study published in the Journal of Periodontology compared the gingival response to sockets grafted with cadaver bone grafts and non-grafted sites. While the gingiva over cadaver bone grafts was found to be ischemic and inflamed, the gingiva over non-grafted sites resulted in the gingiva returning to normal pre-treatment physiology…

Early implant placement with regenerative grafting materials that stimulate osteoblast formation and proliferation provides us with many advances over delayed implant placement. In our experience, early implant placement provides a superior level of osseointegration and implant stability. The following case demonstrates early implant placement…

Since vitamin D is associated with bone health, bone science is a primary repository of all things vitamin D. This quick summary will cover some of the knowledge we have of vitamin D regarding various diseases and will end with a discussion of vitamin D, bone health, and dental implant integration…
The ability to 3D print exact replacement parts that regenerate into normal functional skeletal tissue has been a goal of academic and industrial research for many years with no products achieving the goal to date. Our team at SteinerBio has been in pursuit of this goal for many years and we are pleased to announce a major breakthrough…
Allografts and Bio-Oss have no long-term studies that support placing implants in sockets grafted with these materials. However, we now have studies that have evaluated bone loss and implant failure for implants in sockets grafted with cadaver bone grafts and the results are damning…
Most clinicians know that a critical size defect study is when defects are created in bone that will not heal without treatment. This type of study allows us to compare the performance of a bone graft material to a site that has had no treatment. However, few clinicians know what a non-clinical GLP study entails…
Immediate implants are a terrific service to the patient. However, achieving ideal esthetics and 100% bone integration to the surface of the implant has been challenging. Immediate implant placement with temporization can produce ideal esthetics, but the production of an esthetic temporary is time-consuming and the incidence of failure to integrate is much higher…
Recent studies have increased our understanding of the etiology of osteonecrosis of the jaw (ONJ) and its prevention. The bisphosphonates are known to precipitate ONJ and because these medications are known to be toxic to osteoclasts, it was assumed that ONJ was a disease of bone. New knowledge now questions that assumption…
Loss of maxillary posterior alveolar bone resulting in the need for sinus augmentation is common and it often occurs rapidly after extraction. To better understand the problem and find a solution, we will look at the factors that contribute to maxillary posterior alveolar bone resorption…
As bone graft technology improves, clinical therapy improves. Quicker completion of treatment, both from a perspective of length of time to complete therapy and length of chair time, benefit both dentist and patient. Elimination of invasive surgical therapy again benefits both dentist and patient…
Our complete skeleton grows and changes throughout life with no physiologic interaction with inflammation. Normal bone formation and remodeling does not share metabolic pathways with inflammation. Acute inflammation is involved in fracture healing…
The following ridge augmentation case is interesting in its own light, but what is more interesting is what it can teach us about bone resorption. We will discuss why buccal resorption occurs and propose treatment that might limit the loss of buccal bone after tooth extraction…
The following patient was referred for implant replacement of his first molar (#3). During the examination, a visible mass was noted on the left sternocleidomastoid muscle. The mass was examined and appeared to be a swollen lymph node…
Sclerotic bone is a common pathological finding in routine radiographs. While there are many different causes of sclerotic bone and each of them have differing clinical characteristics, the most common cause of sclerotic lesions in dentistry are condensing osteitis and cadaver bone grafts…
A subject that has been discussed lately is the high failure rate of reimplantation after an implant is removed. In our clinic, if an implant needs to be removed, we do not experience a high failure rate. The case below showcases how advanced technology can solve many of our most challenging problems…
Dentists want to know how fast a graft material is resorbed. They often think that when they open a graft site and find bone graft granules the graft material has not performed well or has even failed. All of the grafts in this article will be fully resorbed within a few months of loading and only normal healthy bone with the ability to remodel and adapt with changing loads will be the result…
A commonly prescribed medication after implant surgery are one of the non-steroidal anti-inflammatory drugs (NSAIDs). When the mechanism of action of these drugs are evaluated, it is obvious they have an impact on the metabolic pathways responsible for bone formation and resorption…
Gut microflora is important for bone health and bone formation. If the gut microflora is disrupted, skeletal bone loss occurs. Antibiotic therapy has been found to cause long term disruption in the gut microflora in humans. In addition, disruption of gut microflora has been linked to an increase in the risk of developing inflammatory bowel disease, obesity, and diabetes…

The accepted dogma of the day is that pluripotent stem cells that can make many different tissues can be induced to form bone. This process is called osteoinduction. As the dogma goes, mesenchymal stem cells (MSCs) that have the ability to form bone, muscle, fat, etc. can be directed by molecules such as BMP-2 to form bone. However, mesenchymal stem cells are not stem cells, they are not pluripotent, and they do not form any type of tissue…

The periosteum is a remarkable tissue — very thin, yet remarkably strong in addition to being packed with regenerative cells. The periosteum is responsible for healing all bone fractures, yet periodontics makes no use of this remarkable tissue for healing periodontal lesions…
As we resolve the major reasons for implant failure, we need to look for the less frequent causes of implant failure in order to approach 100% success over time. Residual cement is one of those less frequent but very real causes for implant failure. Any bone loss around an implant is diagnosed as peri-implantitis which is grossly inaccurate, and this routine misdiagnosis leads to ineffective treatment and increased reimplantation failures…
Bone graft breakdown has nothing to do with bacteria. It is simply a mechanical failure of the structure that supports the implant. It is an extension of the process that produces marginal bone loss. The following two studies confirm: when implants are placed in cadaver bone grafts, marginal bone loss occurs…

Sinus augmentation is a complex but predictable surgery. When implant placement is added, they can become very interesting procedures with multiple moving parts. With science-based regenerative bone graft materials, areas with minimal bone and lost membranes can be successfully treated…

Calcium phosphate in its elemental state is known to stimulate bone formation and Socket Graft is the only bone graft on the market that contains calcium phosphate in elemental form which contributes to the bone formation shown in the series of radiographs shown in this article…

The performance of a tissue is solely dependent on the health of that tissue. Bone is one of the most complex tissues in the body and is intimately affected by disease and lack of use or overuse. The maxilla and mandible are subjected to extremes of disease…
We previously presented Simple Ridge Augmentation to show the predictability of ridge augmentation using science-based regenerative materials. The cases were presented not as a step by step surgical procedure, but merely to illustrate the effectiveness of the procedure…
The immune system plays a critical role in determining the success or failure of bone regeneration. Trauma, infection, thermal, or chemical injury results in an immediate, non-antigen specific immune response. This response is controlled by cells of the innate immune system and is called acute inflammation…
Bisphosphonates produce osteonecrosis of the jaw by killing osteoclasts that are required for the bone resorption phase of bone remodeling. When damaged bone cannot be removed by osteoclasts, necrosis persists. TNFα is intricately involved in osteoclast differentiation and function as well as in bone destruction through osteoclast activation…

There have been a number of well done, head to head studies that have compared beta TCP to various types of harvested bone grafts and we are unaware of any published human clinical study where autografts, allografts, or xenografts have outperformed beta TCP. The studies listed found that beta TCP was equal to or better than autografts, allografts or xenografts…

In this case presentation, implants were placed 8 months after grafting. The surgical procedure of this case was identical to a simple ridge augmentation previously presented. The previous ridge augmentation case showed implants placed 4 months after grafting. The time difference of both of these cases will allow us to evaluate the process of bone formation and remodeling when tissue is regenerated using the principals of regenerative medicine…
Have you ever asked yourself why orthopedic groups have no interest in researching PRF and why orthopedic surgeons do not use or put PRF in bone? With their vast knowledge and research of bone and extensive study dedicated to bone, they know this subject very well and they know that using PRF will only delay the healing process and not work for bone regeneration…
Since Dr. Brånemark discovered integration of bone to titanium, the factors that guide successful implant integration have not changed. Good bone, good implant torque, and an optimized titanium surface are still the factors that are considered necessary for successful implant integration and long-term function…
Peri-implantitis is a common cause of implant loss. Unfortunately, we do not have an effective, predictable method for treating this disease. We have developed an effective and predictable way of growing bone that fills the defect and integrates to the implant surface. So why is it not possible to treat the same type of defect caused by peri-implantitis?
As clinicians, it is important to offer the best quality of care we possibly can along with using the best materials available. As technology in dentistry advances, it is critical we have a full understanding of the materials we are using and seek the latest scientifically proven materials that will continue to improve our patient’s oral health…
PTFE membranes are textured on one side to provide traction for fibroblasts in the gingiva so they will adhere to the membrane and prevent the incision line from opening. While there may be research on this, we at SteinerBio are interested to find out if that is actually the case…
This patient presented with an unrestorable #19. Follow as this patient is primed for implant placement only 4 weeks after extraction and grafting…
It is common practice to mix various bone graft materials. Using different bone graft materials in order to take advantage of their individual properties is obviously appealing. However, knowledge of the mechanism of producing mineralization is critical for success…
Many patients who receive a bone graft will delay implant placement under the assumption that the bone graft will maintain the area for whenever they choose to have the implant placed. When this happens, it gives us an opportunity to evaluate how different types on bone grafts perform over time.
The only way to fully understand how a bone graft is performing is to study various bone grafts growing under controlled conditions. In order to achieve this, the application of bone grafts must be applied to laboratory animals of a specific breed in enough numbers to obtain repeatable findings…
Most ridge augmentations are simple and well within the wheelhouse of any dentist who regularly does bone grafts. The following case illustrates a simple and predictable method of gaining ridge width…
According to new studies, an alarming percentage of patients will refuse what is otherwise a routine grafting procedure because they categorically reject cadaver bone graft materials…
In an effort to better understand single tooth implant replacement and gingival esthetics, we evaluated a number of variables that can affect gingival esthetics. The one surprising negative influencer was suturing…
Histologic studies that have evaluated extraction sockets grafted with mineralized freeze-dried bone allografts have found that the percentage of retained bone graft particles never changes across different time points, indicating that these materials are never resorbed…

Increasing the odds that your patients accept a bone graft is the first step to increasing the odds your patient returns to place an implant. When a patient invests in a bone graft, they have made the decision to have the best possible therapy and are determined to follow through with the implant. Why is it that when some patients are presented with a treatment plan that includes an extraction, bone graft, and implant, they never follow through or simply disappear?

In your practice, you would never place a filling material in a tooth that has not been cleared by the FDA as safe and effective. You would never prescribe a drug that has not been found to be safe and effective. Still, many are putting materials in patients that have no scientific justification, unlike every other material you use in your dental office…

MEMBER:

American Society for Bone and Mineral Research (ASBMR)

Tissue Engineering and Regenerative Medicine International Society (TERMIS)

American Academy of Implant Dentistry (AAID)