IMPLANT DENTISTRY / VOLUME 19, NUMBER 5 2010 361
Guest Editorial
Autogenous Bone: Is It Still the
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Gold Standard?
or historical and biologic reasons, autogenous
F bone has long been considered the “gold stan-
dard” among graft materials. Autogenous bone
is the only graft material that is osteogenic and
fulfills all three components of the regeneration
triad. In the mid-1970s, Brånemark began using
autogenous bone grafts with dental implants in the
treatment of the atrophic edentulous jaws. How-
ever, the use of machined implants often placed
simultaneously with the graft and a steep learning
curve led to poor implant survival rates. Over the
years, the use of intraoral donor sites has become
preferred when possible to decrease the complex-
ity and risks of bone grafting. Block bone grafts
can be combined with particulate bone and guided
bone regeneration techniques to enhance periph-
eral volume gains.
Autogenous bone grafting has several advan-
tages over other augmentation techniques including
short healing times, favorable bone quality, lower
material costs, no risk of disease transmission or
antigenicity, and predictability in the repair of larger
defects or greater atrophy. Denser cortical bone
grafts exhibit minimal resorption on incorporation,
making them ideal for site development.
The obvious disadvantage of using autograft is
the morbidity from bone harvest. However, ap-
proaches to minimize morbidity have been ad-
dressed including the use of preemptive analgesia,
long-acting anesthesia, and harvesting techniques
such as piezoelectric surgery. There are also donor
sites associated with a lower incidence of complica-
tions (proximal tibia and mandibular ramus) that can
be procured in the office setting. In the treatment of
more demanding reconstructions, the benefits of au-
tograft often outweigh the risks of complications.
Iliac bone grafts are reserved for the reconstruction
of larger defects and severe atrophy.
ISSN 1056-6163/10/01905-361
Implant Dentistry
Volume 19 • Number 5
Copyright © 2010 by Lippincott Williams & Wilkins
DOI: 10.1097/ID.0b013e3181f8115b
My observations have been that many clini-
cians have become too quick to abandon tradi-
tional well-established approaches for easier,
faster, and less-complicated procedures that may
not provide comparable results. It is frustrating to
inherit a case where grafting was attempted using
bone substitutes when autogenous bone would have
been the preferred choice. Sometimes clinicians ar-
gue, “the patient did not want a hip or chin graft.” I
have met few patients who actually wanted to have
bone harvested from their body. It has been said, “if
you want an omelet, you have to break some eggs.”
Well, sometimes if you want to reconstruct a ridge,
you have to harvest bone.
Improvements in implant designs have reduced
the need for bone augmentation in many cases.
Studies have found autogenous bone may not be
needed routinely in the management of localized
bone defects and sinus bone grafting. However, the
use of autogenous bone continues to be an invalu-
able technique in the management of more difficult
augmentation cases. It is unlikely that existing bone
substitutes (allografts, xenografts, and alloplasts)
will ever challenge the gold standard. However,
growth factors may improve their biologic activity
and improve results. Stem cells, signaling molecules,
and new scaffolds are areas of intense research in
regenerative medicine. Future advancements in tissue
engineering will likely produce alternatives to autoge-
nous bone grafts that may well exceed existing clinical
outcomes and replace traditional indications for its use.
Until then, we should continue to use well-researched
techniques that provide predictable outcomes in vari-
ous clinical situations.
Craig M. Misch, DDS, MDS
Member, Editorial Board, IMPLANT DENTISTRY