when we use a key sentence to start a text, an announcement or a speech, such as the one above, there’s a purpose to do so:

– It is to draw the attention of those who read, or of those who listen.

In this situation, the warning call is not for bone grafting itself, because it already exists, but for those who advertise and sell it, treating everything as being bone grafting, in which any bone operation or defect filling, even if inexistent, is pompously named as bone grafting.

Be it for commercial or corporate purposes or to adjust unreasonable egos, unfortunately we now often see a lot of bone grafting procedures being claimed, sold or promised to patients, but bone grafting carried out with strictness, purposefulness and surgical ability I’d have to stay, in all honesty and on behalf of my professional class, on behalf of codes of ethics and on behalf of the surgical Legis Artis, I will say and repeat, that I have seen very few colleagues that behave like that in my career.

I’m not claiming that my team or I are the only individuals who are perfectly aware of what they’re doing, as a matter of fact, if I did that, it wouldn’t be surgery, science-tier surgery, but surgery as an ability, as something empirical, and that is not clinical, it is a skill, with all the medical and scientific strictness that such does not have.

A medical or surgical operation has a learning curve, which relies on the experience and knowledge attained by the surgeon throughout his clinical practice, but one that any knowledgeable, trained and responsible surgeon is capable of executing once he reaches and masters its learning curve. Thus, if one of us, surgeons or doctors, tells you that he has a technique which only he is capable of carrying out and mastering, that is not science, it’s pure juggling.

And, with that, I now approach the Oral Surgery chapter, which talks about Bone Grafting.

We need to place the bone where it doesn’t exist and remove it from where it’s not needed or exists in excess. Thus, in surgery, we have to simultaneously insert bone grafts and rectify, shape or reduce the amount of bone.

Manipulating the bone, in other words, its cut, wear, perforation, screwing, its own physical manipulation outside of the body and replacement, from one spot to another, demands a high level of knowledge, training, expertise and technology, as well as the engagement of a team properly trained to carry out this task. Not to mention the anatomical, physiological, biological and genetic knowledge which is implied for all those who present themselves as a Doctor.

Thus, bone grafting is not a myth and it is something that works rather well.

Then we have a myriad of information and alternative information on the origin of bone grafting, with all sorts of root causes, from a miraculous “powder” to phenomenal membranes to which one just needs to add boiling water and we immediately have the whole soup ready to be served…

Sarcasm aside, and pardon this exaggeration of mine, but whether it is in the training initiative which I’m part of as a trainer, at the University of London where I’m continuing to expand my Surgical education, or during these last 10 years, a period in which I have been exclusively dedicating myself to Oral Surgery and its Clinical practice, there are countless cases of bone grafting that ended up in failure due to several reasons: a mistake in planning, in the material chosen or in the surgical technique adopted; or because of an infection, tobacco, the patient’s lack of hygiene, or simply because it doesn’t suit the patient’s medical history.

Without wanting to unfurl things from a medical or surgical point of view, as this is not the purpose of this document and also because, instead of clarifying, I may end up complicating even more a subject that, by itself, is already complex and a source of countless announcements, scientific articles, book chapters, medical journals, conferences, postgraduates, master degrees and PhD.

Taking that into account, I must not overcomplicate its description and advice, nor there should be a laid-back approach to its use, or turn it into something banal, since I have already witnessed some saying that bone grafting is just inserting some material in a defect, or applying a membrane on the top of the bone, be it artificial or autogenous (of the patient himself) and that’s it, not respecting the properties of materials, nor their behaviour in the body.

– What is the graft’s source?

– Is it an animal source?

– Is it from a cadaver?

-Is it from the patient himself?

– Which one is the best?

We are now approaching the stage in which, besides talking about the surgical technique that needs to be chosen, we need to mention the type of graft, the type of material or its origin.

The graft can have a synthetic, animal or human origin.

From the functional point of view of Dental Medicine, we now have at our disposal an array and a variety of materials which allow different outcomes and that often complement each other.

We have materials that will streamline or induce bone formation, which is why they’re named Osteoinductors.

We have materials that conduct bone formation from one spot to another and hence the name Osteoconductors.

The synthetic materials for the filling constitute matrices, skeletons that allow the body to grow through them, which enable their invasion through the blood vessels and nerve endings that will take oxygen and nutrients to that spot, as well as biochemical and cellular markers in order to start the whole process of bone formation, the so-called Osteoinduction, in order to obtain Osteogenesis (bone formation).

This is part of my clinical and surgical intervention area on a daily basis, being part as well of my study curriculum in several Universities in several countries, Lisbon, Oporto, Barcelona, Paris, São Paulo, London, places that I have been to up until this day, and it will probably continue to be one of the most studied fields, able to engage an important share of the international scientific class.

In a blog text, I don’t want and I simply can’t go any deeper in terms of specific and specialized medical and scientific knowledge, but I will make available more material, in order to grant the dear readers with topics of interest, so that they can carry out further research on their own or in books or in the internet, a normal and conventional practice nowadays.

The graft can be of animal origin, such as bovine, swine, equine and so on.

In the past, and in some scientific centres as we speak, a cadaver bank constituted a resource, however, according to current literature, it is not the most used method to carry out a bone grafting surgery in Oral Surgery.

We have the patient’s own bone at our disposal, known as an autogenous graft.

Here we manage the bone asset of each patient and we remove the bone from where it exists to a spot where it doesn’t.

As local donors, we have several anatomical regions, from the iliac crest bone, to the rib, the tibia, the peroneus, the cranial vault, but according to my clinical, medical and surgical opinion, I repeat, in my opinion, properly based on years of experience, mine and of those from whom I’ve learned, and in studies, articles, in Medicine Based on Medical Evidence, I can reach the conclusion that this kind of donor areas are nowadays justified for major facial and jaw reconstruction cases, within the scope of Maxillofacial Surgery in post-trauma, and in post-oncological pathology with resective surgery.

The most used donor areas for Oral Surgery and Implantology, which allows us to have a broader predictability regarding the treatment, are found intraorally, grafting from the mandibular branch, the chin and the maxillary tuberosity.

Similar to any sort of medical procedure, having the surgical technique being carried out by a medical professional/skilled and trained surgeon for that purpose is something vital, one that is asserted with the proper curriculum for that matter. I know this seems blatantly obvious, but believe my words when I say it is not.

As a way to sum things up, here’s a small provocation:

– The dear readers can try to search on the internet and literature and, even simpler, there are professionals who spent years and years studying, who dedicate their whole lives to the medical and surgical practice, who usually have a location where they can welcome you, in their clinics, within a specific timeframe, in order to address any sort of questions, the so-called appointment.

Here’s my recommendation:

– Ask your questions, schedule an appointment with us or with your dentist.

However, there are situations in which, regardless of how big the graft is, the defect, the atrophy of the Upper Jaw, in this case, is so extensive that a conclusion has been reached in the last 15 years, particularly in the last 10 years, saying that the graft solution simply doesn’t suit anyone, hence we have another approach at our disposal:

– The Zygomatic Implants.

But this a completely different story…

This will be the upcoming subject of this blog.

See you soon and don’t forget to be happy. After all, smiling doesn’t hurt.

If that’s the case, if smiling causes you pain, nausea or dizziness, tell your dentist…

Until next time!

Dr. Luis Pinheiro

Dr. Luis Pinheiro

- Luis Pinheiro, Dentist with exclusive practice in Oral Surgery and Implantology

- Accountable for the Oral Surgery and Implantology Department at C.E.R.O.

- Master’s Degree in Oral and Maxillofacial Surgery at Eastman Dental Institute of the University College of London

- International Scientific Consultant of D.I.S. – dental implant system

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