Autologous Bone for Periodontal and Craniofacial Regeneration: Donor Sites, Characteristics and Indications

After decades of clinical use, autogenous bone continues to represent the gold standard material for promoting hard tissue regenerative processes in oral and craniofacial reconstructive interventions. This status is attributed to its robust scientific foundation and its unique biological properties, such as osteoinductive, osteoconductive, and osteogenic potential, which are crucial for the effective regeneration of bone tissue. The versatility of autogenous bone makes it applicable for a wide range of clinical scenarios, from periodontal reconstructive therapy to more complex craniofacial and maxillofacial reconstructions. Despite its extensive clinical applications and the current availability of innovative harvesting techniques and devices, the use of autogenous bone remains constrained by several factors. These include the morbidity associated with harvesting procedures, potential complications, and limitations in bone availability depending on the donor site. These limitations necessitate careful patient selection, alongside the use of refined harvesting techniques and advanced surgical devices designed to mitigate harvesting-related risks and minimize post-operative morbidity. Furthermore, while autogenous bone remains irreplaceable for many clinicians in specific clinical applications, alternative materials and technologies are continuously being explored to address these inherent limitations. This review aims to comprehensively evaluate the biological basis and clinical indications for the rational use of autogenous bone in periodontal reconstructive therapy, bone augmentation, and craniofacial regeneration. It dives into the biological mechanisms that make autogenous bone the material of choice, particularly in contexts requiring optimal integration and long-term stability. Additionally, the review examines a broad range of clinical scenarios where autogenous bone is indicated and where it can be replaced by biomaterials, with a particular focus on its application in bone grafting for peri-implant defects, ridge preservation, and the management of vertical and horizontal bone deficiencies in the maxilla and mandible. Finally, a detailed and updated overview of the current state-of-the-art in both intra-oral and extra-oral autogenous bone harvesting techniques is provided, highlighting various donor sites, along with their advantages and drawbacks. Illustrative clinical cases are provided to exemplify the effective use of autogenous bone in diverse settings, emphasizing its role in achieving predictable clinical outcomes and enhancing long-term surgical success.