Autogenous Bone Grafting in Oral and Maxillofacial Surgery: Principles, Biology, and Clinical Applications

Abstract

Background: No one bone graft material is best for every situation in oral and maxillofacial surgery. As such, selecting the appropriate bone graft should be determined on a case-by-case basis through evaluation of the cost, morbidity, and predicted success rate of each grafting material. Objective: This article reviews the biological basis of the process of autologous bone graft incorporation and survival, differentiates between autologous and other grafting materials, and explains the biological considerations behind choosing a particular grafting material and approach. Methods: Narrative review of the literature pertaining to the biology and physiology of autologous and non-autologous bone grafting materials. Results: While autologous bone is considered the gold standard of bone graft material because of its ability to incorporate and undergo osseointegration in host bone, it is limited by donor site morbidity, resorption, a limited supply, and time required for harvesting. Non-autologous grafting materials are unlimited in their supply and do not have donor-site morbidity but lack osteogenicity, have poorer incorporation and revascularization, and are more expensive. The factors affecting graft incorporation and survival include the vitality of osteocytes and osteoblasts, the microarchitecture of the graft material, and the osteogenicity of the recipient bone, with the cranial bone and inlay grafts on vascularized dura having the best volume retention.

Conclusion: An understanding of the biology behind autologous bone grafting allows clinicians to choose the best grafting material and techniques to optimize both biological properties of the graft and minimize donor-site morbidity, particularly in children.