Bone regenerative issues related to bone grafting biomaterials

Abstract Tens of millions of European citizens are partially edentulous and lack sufficient bone for placement of dental implants. This chapter reviews the different options used by oral surgeons for guided bone regeneration (GBR) prior to dental implant placement. Autologous bone grafting is the gold standard, but it requires a second surgery, induces pain, and the quantity is limited. Allogeneic bone from tissue banks carries the risk of immune rejection and is subjected to uncontrolled resorption. Animal-derived products such as deproteinized bovine bone are very popular in oral surgery, but there are safety concerns with the possible transmission of diseases. Synthetic bone substitutes such as calcium phosphate bioceramics are increasingly used for filling small bone defects because of their biocompatibility and osteoconductive properties. Mesenchymal stem cells (MSCs) associated with calcium phosphate bioceramics have shown to induce de novo bone in pre-clinical and clinical studies. These cells can be easily isolated and amplified in culture from a bone marrow aspiration. When mixed with biomaterials, these cells attach on their surface and the extemporaneous mixture can be applied to atrophied alveolar bone for its regeneration. GBR membranes are essential for favoring bone regeneration while preventing fibrous tissue invasion. However, synthetic resorbable membranes should be preferred over animal-derived products made from porcine skin for safety and ethical reasons. Furthermore these collagen membranes exhibit a rapid resorption when exposed to the proteases of the oral cavity. This chapter gives also the future directions in bone regeneration, such as the use of 3D printed personalized scaffolds and allogeneic MSCs.