In 2011, a publication used the skills of a pathologist to evaluate tissue samples from an allograft ridge augmentation and the bone was diagnosed as sclerotic:
Dr. Vanchit John in June of 2023 duplicated this study using the skills of a pathologist to evaluate tissue samples from an allograft ridge augmentation, and the bone was diagnosed as sclerotic:
“This led to the diagnosis of viable sclerotic bone at the alveolar ridge augmentation site.”
In research, when findings on a particular subject are first published, no conclusions can be drawn. However, when the same study is duplicated by a completely separate group of researchers and the same findings are produced, it becomes established scientific fact.
Dr. Vanchit John is the head of graduate periodontology at Indiana University School of Dentistry who lead the research confirming that allografts produce pathologic sclerotic bone.
There have been hundreds of publications on the histology of cadaver bone grafts over the last decades. Most of these studies were performed and evaluated by periodontists or oral surgeons. The studies amounted to counting retained particles and calculating the percent mineralization. However, because periodontists and oral surgeons do not receive formal training in bone architecture, bone biology, or bone pathology, these well-intentioned researchers thought they were looking at normal tissue, but in fact, every one of these studies was evaluating pathologic mineralization.
Our profession will continue to publish histologic studies that do not accurately describe the tissue being presented. As a service to our readers, we will go over the hallmarks of sclerotic bone so you can distinguish between normal and pathologic bone.
Sclerotic bone has very poor vascular supply. Many clinicians know this because when drilling into sclerotic bone, they often report little to no bleeding. Histologic images of sclerotic bone will have few blood vessels and they will be difficult to identify. Normal bone at the same phase of development will have a profuse vascular supply that is easy to identify.
Osteoclasts are never found in sclerotic bone. New bone is formed in a defect exclusively by osteoblasts producing woven bone. This bone is temporary. After the initial bone formation of woven bone occurs, osteoblasts never work alone. All graft resorption and all changes in bone for the rest of the life of the bone requires osteoclasts to first remove bone before osteoblasts can rebuild the bone. After initial bone formation, osteoclasts are the first cell to act in order for any change in bone to occur. Over the decades with hundreds of papers published on cadaver bone graft histology, there has never been an osteoclast found in this tissue either resorbing an allograft particle or remodeling the sclerotic bone.
The lack of osteoclasts is the primary reason why bone produced by cadaver bone grafts lead to implant loss. When bone is drilled for an implant, the bone on the surface of the osteotomy is torn up and severely damaged. Then the implant is placed, and the surface bone is crushed. This necrotic bone on the wall adjacent to the implant must be removed and replaced for integration to take place. This process is well documented in normal bone and the process of removing the damaged bone adjacent to the implant is why implants lose stability after placement. After the damaged bone is resorbed, only then can new bone grow onto the surface of the implant and stability increases as integration occurs. In sclerotic bone, there are no osteoclasts to remove the damaged bone and consequentially, implants never integrate into the sclerotic bone produced by allografts and xenografts. In sockets grafted with allografts and xenografts, implants never integrate and are supported like a screw in wood.
The second problem with the absence of osteoclasts in sclerotic bone is that the bone can never change or adapt. As stated earlier, nothing changes in bone unless an osteoclast initiates that change. Without osteoclasts, the sclerotic bone is never converted into normal lamellar bone, never adapts to changing loads, never repairs itself after you bite on that olive pit — and because it never remodels, it ages, resulting in an ongoing reduction in strength. The combination of all of this leads to sclerotic bone breaking up and the clinician misdiagnosing the lesion as periimplantitis.
Poor vascular supply, amorphous structure, no osteoclasts, and a lack of organized, oriented lamellar bone are the hallmarks of sclerotic bone and likely the biggest reason for implant loss today.
Now that cadaver bone grafts have been proven to produce pathologic sclerotic bone, we congratulate Dr. John and his team on their landmark study that confirms what we at SteinerBio have known for many years.
Cadaver bone grafts are the only bone graft material taught at many of our universities and used by most of our lecturers. It is the bone graft paradigm that cannot be questioned. History has proven that all scientific findings will be ignored if it goes against the prevailing paradigm. This was made clear by the brilliant Nobel Prize winning physicist, Max Plank:
“A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.”
We were informed in 2011 that the bone produced by cadaver bone grafts was pathologic. Over the years, all the fanciful biologic characteristics attributed to allografts have been proven wrong, but our profession still holds fast to the cadaver bone graft paradigm and continues to ignore science.
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. Every time a cadaver bone graft is placed in your patient, you are creating sclerotic bone that will scar that bone for the life of the patient. Unfortunately, many in our profession will put their career and reputation ahead of the health of our patients and continue to teach and promote cadaver bone grafts knowing these materials are permanently damaging their patients and resulting in implant loss. It is the clinician’s responsibility to their patients to challenge the profession and force recognition of the truth.
For those that have the courage to question what you have been taught, we invite you to view the following video: