Preprosthetic bone graft augmentation with allogeneic bone: a preliminary report.

Allogeneic bone biologically interacts with host tissues at a graft site. Addition of autogenous cancellous bone and marrow to allogeneic bone enhances the osteogenic activity of the graft. These observations have been confirmed by noninvasive, quantitative radionuclide methods. The process of freeze-drying greatly reduces and, from the standpoint of clinical significance, essentially eliminates the antigenicity of allogeneic bone. Judged by the results of 14 cases that are under continuous follow-up, allogeneic bone graft augmentation of the denture-bearing area is a possible alternative to autogenous grafting. The process of obtaining and preparing the blanked bone for surgery is reasonable although some questions remain, such as the desirable length of time for tissue reconstitution and the need for culturing or adding antibiotics to the reconstitution solution, or both. It appears that the addition of autogenous cancellous bone and marrow is desirable in most instances unless the dimension of the area to be augmented is quite small or an iliac osteotomy is precluded for medical reasons. The occurrence of complications such as infection and dehiscence during the postoperative course is similar to that in patients with autogenous grafts. Dehiscence can be expected although it appears that if the graft has been supplemented with autogenous cancellous marrow the incidence and extent are dminished. It should be emphasized that dehiscence does not signify failure of the graft-allogeneic bone is not sloughed in toto after being exposed to the oral cavity. Secondary soft tissue procedures can be used in patients with allogeneic grafts; additional cases with long-term follow-up are still needed to establish this method.