Grafting Endodontic Lesions

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 today we will be sharing one of those cases with you as we discuss the rationale of using SteinerBio bone graft for endodontic lesions.

All SteinerBio graft materials are structurally resistant to bacterial colonization. When our graft materials are placed in a lesion, only cells that can crawl have the ability to enter the graft material. This feature of our graft material allows the entrance of regenerative cells and blood vessels, but not bacteria. The vast majority of bacterial pathogens spread by replication and are not individually able to crawl. In addition, our βTCP granules have micropores that are too small for bacterial to colonize, making them structurally resistant to bacterial infection. On the other hand, all cadaver bone grafts and many synthetic granules have macropores which not only allow bacteria to occupy the space around the granules, but also allow bacteria the ability to colonize the granule itself. SteinerBio graft materials will keep the bacteria out of the graft material and any bacteria remaining along the graft/bony junction will be susceptible to systemic antibiotics.

This case was shared with us by Dr. Charles Ruefenacht and illustrates the benefits of using SteinerBio graft materials for treating apical defects:
The patient presented for a second opinion for an option to extraction. Both bicuspids were retreated endodontically.
#5 was successfully treated. However, #4 failed to respond and apical surgery was planned.

Day of apical surgery. Clinically, a buccal fistula was present with a bony dehiscence of approximately 10mm. Granulation tissue was removed with minor instrumentation of apex of the tooth. The apical lesion was grafted with Socket Graft Plus without a membrane.

Successful treatment, 1.5 year post op.

Dr. Ruefenacht made the assumption that because the tooth had been endodontically treated twice, it was likely that the tooth was successfully obturated and that the apical lesion was now a primary lesion. In other words, the tooth was no longer infected, but the apical bony lesion was now the infection, and this was the reason why the lesion did not resolve. If that was the case, then by removing the granulation tissue and grafting with a material that is structurally designed to resist colonization, the lesion should then heal. The healing of this lesion with minimal alteration of the tooth supports his assumption.

For a more detailed discussion of this case, Dr. Ruefenacht can be reached at:

Innovative Dental Solutions
3509 School St
Lafayette, CA 94549
(925) 284-2203


American Society for Bone and Mineral Research (ASBMR)

Tissue Engineering and Regenerative Medicine International Society (TERMIS)