Bone substitutes in oral surgery

Osseous defects pose a clinical challenge the operator can meet with the aid of techniques that promote bone tissue regeneration. The current gold standard is autologous bone harvested from intra- and extraoral donor sites; however, autologous bone grafting requires two surgical sites (donor and recipient), resulting in greater morbidity and prolonged operating times, particularly for extraoral sites, with greater discomfort for the patient. Such disadvantages can be overcome with the use of bone substitute materials. There is a notable variety of so-called intelligent biomaterials that can modulate bone response in regeneration. Based on origin, bone substitute materials are classified as allogenic, heterologous and alloplastic materials. The first refer to bone from same-species donors, the second are obtained through processing of bone from different species, while alloplastic materials are synthetic composites. Besides different resorption rates, they possess different chemical and structural characteristics that influence the stimulation or support of bone regeneration. In daily clinical practice, before selecting from the wide variety of biomaterials, a wise step is to analyze and compare the clinical and histological results obtained with these materials. This article examines the clinical applications and osteoconductive and/or osteoinductive properties of some currently available biomaterials.