Table 2 Comparison of the relevant bone substitutes.
Type | Source | Examples | Advantages | Disadvantages |
|---|---|---|---|---|
Autograft | Same patient | Cortical Cancellous | • Osteoinduction • Osteogenic • Osteoconductive • High safety – no risk of transmission | Limited availability and quantity Delayed incorporation Second surgery may be required Surgery time is increased Morbidity is increased Additional cost Increased bleeding Unpredictable resorption |
Allograft | Same Species | FDBA DFDBA | • Osteoconduction • Osteoinduction • No donor site morbidity • Less pain • High availability | Rejection of graft Delayed incorporation Inadequate vascularisation Risk of disease transmission Ethical concerns |
Xenograft | Another species | Anorganic Bovine Bone | • Osteoconduction • Osteoinduction • More economic • High availability • Less pain | Risk of disease transmission Lacking in osteoconductive properties As granular structure, can be harder to hold in surgical sites Not fully resorbable (Valentini and Bosshardt, 2018) |
Alloplastic (synthetic) graft | Lab-made | β-Tricalcium phosphate | • Osteoconduction • Biocompatability • Less pain • Unlimited supply • Easy sterilisation • Easy storage • Injectbility | Brittle Low compression and tensile strength |
Hydroxyapatite | • Unlimited quantities • Biocompatibility | Delayed resorption rate Low mechanical strength Lacks the microporous structure of bovine hydroxyapatite | ||
Calcium phosphate cement | • Osteoconduction • Self-setting • Injectability • Gradual absorption and replacement by new bone • Mouldability • Biocompatability | Brittle Low speed of cell adhesion Low strength, not useful in load bearing areas | ||
Calcium sulphate | • Low cost • Readily available • High mouldability • Biocompatability • Short setting time | Limited osteoconductivity due to not being porous Rapid resorption | ||
Phytogenic | Red Algae | Algae-based | • Osteoconduction • Good resorbability • Low immunogenicity | Lack of studies |
Marine Coral | Coral-based | • Osteoconduction • Good compressive strength • Improved cell adhesion • Low immunogenicity | Brittleness Poor resorption Low tensile strength |
