Abstract
Critical-sized bone defects are a reconstructive challenge, particularly in the craniomaxillofacial
(CMF) skeleton. The “gold standard” of autologous bone grafting has been the work
horse of reconstruction in both congenital and acquired defects of CMF skeleton. Autologous
bone has the proper balance of the protein (or organic) matrix and mineral components
with no immune response. Organic and mineral adjuncts exist that offer varying degrees
of osteogenic, osteoconductive, osteoinductive, and osteostimulative properties needed
for treatment of critical-sized defects. In this review, we discuss the various mostly
organic and mostly mineral bone graft substitutes available for autologous bone grafting.
Primarily organic bone graft substitutes/enhancers, including bone morphogenic protein,
platelet-rich plasma, and other growth factors, have been utilized to support de novo
bone growth in setting of critical-sized bone defects. Primarily mineral options,
including various calcium salt formulation (calcium sulfate/phosphate/apatite) and
bioactive glasses have been long utilized for their similar composition to bone. Yet,
a bone graft substitute that can supplant autologous bone grafting is still elusive.
However, case-specific utilization of bone graft substitutes offers a wider array
of reconstructive options.
Keywords
bone graft substitutes - bone graft enhancement - craniofacial reconstruction - bone
reconstruction - bioactive - implants
