Bone graft and bone graft substitutes: a review of current technology and applications

The morbidity associated with autogenous bone graft harvest and the recent concern regarding the transmission of live virus through use of allografts, have been the impetus for research into a variety of materials that could take the place of these standard materials for bone grafting. The positive results reported with various ceramics and/or bone derivatives suggest the possibility of a material with osteoconductive and/or osteoinductive properties for use with or in place of bone graft. This review discusses a variety of bone graft and bone graft substitute materials. Among the osteoconductive materials outlined are the hydroxyapatite and tricalcium phosphate ceramics as well as some reportedly osteoactive polymers. While osteoconduction is a favorable quality, much interest has focussed on the use of osteoinductive or osteogenic materials such as demineralized bone matrix or bone derivatives, that is, BMP, osteogenin, etc. It is increasingly apparent that these materials require a carrier vehicle for optimal expression of osteoactivity. Therefore, the review finishes with a comparison of the various materials suggested for use as carriers.