Bone replacement grafts. The bone substitutes.

Bone substitutes will play a pivotal role in the future of periodontal regeneration. They are synthetically derived or processed from exoskeletons of other species (xenograft) and are an alternative to autogenous or allogeneic bone replacement grafts. Bone substitutes do not provide the cellular elements necessary for osteogenesis, and they cannot be considered osteoinductive, but instead are osteoconductive, providing a scaffold for new bone deposition. Currently, significant decreases in clinical probing depth and attachment levels have been reported with bone substitutes when compared to flap debridement surgery alone for periodontal osseous defects. Reported differences among bone substitutes, autogenous grafts, and allograft materials, occur with respect to histologic outcomes. Overall, probing depth reduction and attachment level gains are similar for all bone replacement grafts.