Bone grafting and bone graft materials are the most invasive things we do to our patients. At SteinerBio, we are interested in the performance of all graft materials and we evaluate all bone graft materials that come through our practice. Dr. Greg Steiner has worked as a periodontist/implantologist in the same practice of general dentists for 10 years. Before Dr. Steiner arrived at the practice, he was preceded by two other periodontists. The first periodontist began placing implants in a limited number of cases and Dr. Steiner never saw one of them fail. This periodontist did not graft extraction sites. Following that periodontist was a young, very well-trained periodontist who worked in the practice for approximately two years. After both doctors left the practice, all implant problems were sent to Dr. Steiner for care.
Be Thankful You Use Synthetic Bone Grafts
When a patient was referred to Dr. Steiner with a failing implant, his interest in bone and bone grafting lead to a surprising discovery. Every patient who presented with a failing implant came from the young, well-trained doctor. However, what was even more surprising, was that every implant failure had been grafted with some form of cadaver bone. After working in the office for two years and seeing many failures of implants in cadaver bone, he became convinced that these implants were not failing because of peri-implantitis, but because the bone was breaking down. That was 8 years ago, and since then, he has researched the type of bone cadaver materials produced and why implants are lost when placed in this material. He has cautioned dentists about the increased failure rate of implants placed in sites grafted with cadaver bone and has received a nearly unanimous hostile response.
Let’s look at a few facts. There has never been a legitimate study that has evaluated the success rates of implants placed in either Bio-Oss or allografts. So, no one knows if implants placed in cadaver bone are successful or not. An allograft is a transplant tissue and therefore, has never been evaluated by the FDA to determine if it is safe and effective for placing implants. When using a transplanted tissue, you, as the surgeon, are responsible for knowing that the transplant material is suitable for your patient. From Dr. Steiner’s studies, he has found that cadaver bone grafts produce sclerotic bone that compromises the site. Allografts have never been evaluated by the FDA and there are no studies that show that it is safe or effective.
For years, Dr. Steiner has pointed out that implants are being lost because they are placed in cadaver bone but he was the only one making this claim, until now. These findings are now being accepted at the highest level of academia. Recently, a professor at Stony Brook gave a presentation to the graduate periodontal department outlining how allografts are leading to a significant number of implant failures. Another professor who is the director of a specialty program at another elite institution has come to the same conclusion. This professor, who has spent his life studying bone, is preparing a paper for publication that outlines the entire process of cadaver bone graft failure and implant loss. Having implant failure is bad enough, but it is not going to stop there. Patients do not like the idea of having a cadaver bone graft placed into their body and it is up to the doctor to convince them otherwise. Dentists are not intentionally misleading their patients, but everything they are telling the patient about cadaver bone grafts is false. So here we have a bone graft material that has not been evaluated by the FDA and has never been proven to be safe or effective, and now we are finding that this bone graft material is resulting in implant loss on a large scale. When this becomes known, our profession will have no defense for using this bone graft material to support dental implants. 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, but we are putting materials in bone that have no scientific justification. My recommendation is to use a material that is cleared by the FDA as safe and effective, just like every other material you use in your dental office. Be thankful you use resorbable synthetic bone graft materials.
American Society for Bone and Mineral Research (ASBMR) Tissue Engineering and Regenerative Medicine International Society (TERMIS)