Sintered Xenograft over Allograft?

I could be wrong, but I believe that "sintered" simply refers to a manufacturing process using heat, whereby the organic material is removed from the bovine bone. As such, Bio-Oss is a type of sintered xenograft (probably the most famous), as is BioXen. Both of these products are produced by the removal of organic material from bovine bone (i.e. sintering), so either could be used. As for the technique itself of using bovine xenograft over an allograft, I'd have to let others chime in, as I'm not familiar with that approach.

Bio-oss is not sintered. Sintering means using heat (1000 degrees plus) to remove organic components. This alters the crystalline structure making the xenograft look less like human bone. Bio-oss has a proprietary method of removing these organic components leaving the structure of the bone to look like hunan bone. More natural. The contour augmentation technique by buser uses bio-oss over autogenous bone to protect from premature resorption.

Sintered or not sintered, xenograft will never "look" like bone since it will never really integrate with the patient's natural bone. Xenograft is a great space filler. It will be encapsulated with thick cementum and will remain there as an island of foreign substance pretty much forever. Allograft will at least resorb and hopefully will be replaced by new bone if the patient is young and in good health. Optimally autologous cortical bone or autologous dentin graft will provide the best of both worlds. Integrate with the natural bone, or even ankylose to the alveolar bone, then slowly resorb and assist remodeling of new bone.

I believe Bio/oss undergoes several steps to completely de-protinize the bone. Chemical, gamma irradiation, temperature controlled cleaning. Endo In is a sintered bone. The crystalline structure is compromised. Bio-oss is actually very similar in shape, size and porosity to human bone under a microscope. That’s what makes it different than other xenografts. If you look at some histologies it incorporates very well with the native bone and helps maintain the volume and structure you need. I combine it with autogenous bone if I can scape some. This helps turn over a little quicker but stops the premature resorption.

Bio oss is a good space maintainer. It is as far as I know alkaline/heat deproteinized bovine bone keeping a good macro and micro architecture that allows new bone ingrow and aposition over the bio- oss particle. As any xenogenic biomaterial it first unchains a mild foreign body reaction mediated by multinucleated giant cells thought earlier to be osteoclasts. Due to the cristallinity of it main component hidroxiapatite, it resorbs very slowly therefore the regeneration obtained with Bio-Oss or any similar product is a composite Bone-Biomaterial suitable for most dental implant procedures and as space maintener. There are many other biomaterials that can be used for regenerative pourposses such as sinthetic Hidroxiapatite Ha, Tricalcium phosphate Tcp, human derived bone mineral (LDHB), matrix (LHB) or autologous bone or dentin. Autologous dentin is a promising source of autologous bone substitute material with good clinical and histological performance. Sinthetic calcium sulfate /Tcp Ha composite biomaterials such as Ethoss also perform very nicely.

Yes there is a lot a sales material driven stuff in Dentistry .... "xenograft looks like human Bone " ........ when my Histologist ( Professor with 35 years experience in Orthopedics ) first saw a xenograft in a core from us , he was shocked and had to ask what it was . He simply had never seen it before . I through my research get to see a little histology and it is simply not what I have seen . As I always say EthOss ( yes I have an involvement , so lets state that up front ) and other synthetics and xenografts are completely different materials . They are , as David alludes to Bone regeneration materials with a high Osteo-inductive potential ( over 200 published papers , most high impact ones ( over 6 , some are 12 ) in Pubmed although will not list them it includes PNAS ) whereas the Xenografts are space fillers which while may offer support to tissues , logically will significantly reduce the amount of true host bone in the site HL Chan HL WAng Systematic Review JOMI ) . So we often evaluate the graft site with a set of calipers but do not assess the more important aspect the Quality of the regenerated hard tissue to assess how much is in fact host bone , so histo-morphometry is the only tool for true success . Patients coming to us want to be healed in other words returned bak to a state of health they were in prior to the pathology that caused the bone loss . We make these decisions for our patients for the long term hence I prefer our approach of fully bio-absorbed material with osteo-inductive potential to help the host regenerate true host bone . Regards Peter

I agree with Peter. In the case mentioned if it is just esthetics I would advise sintered hydroxyapatite. It is never resorbed so it will maintain shape and is biocompatible so it will not be exfoliated like allografts.

Great information. What is the brand name of a "sintered hydroxyapatite?" Thanks. LG

LG I would not advise most of the dentsply bone grafts for general use but their sintered Ha is what you are looking for in this case. Symbios OsteoGraf D-300

Logic and Biologic sense from Greg Steiner .......we have to decide what we want ...

Cow bone "Bio-Oss" is unresorbable and you can find bovine proteins in it. Histologic Findings in Sinus Augmentation with Autogenous Bone Chips Versus a Bovine Bone Substitute. Source: International Journal of Oral & Maxillofacial Implants . Jan/Feb2003, Vol. 18 Issue 1, p53-58. 6p. 4 Color Photographs, 2 Black and White Photographs, 1 Diagram, 1 Graph. Author(s): Schlegel, Karl Andreas; Fichtner, Gabriele; Schultze-Mosgau, Stefan; Wiltfang, Jörg Abstract: Purpose: The aim of this study was to compare a bovine bone substitute (Bio-Oss) to autogenous bone with respect to its value as a material for sinus augmentation. Materials and Methods: In 10 beagle dogs 12 months of age, the 3 maxillary premolars were extracted on both sides. Six weeks later, 2 cavities of predefined size were produced in the region of the nasal cavity. The antral window was 25 mm long and had a vertical extension of 7 mm. Two Frialit-2 implants (3×8 mm) were placed in each bone defect (n = 20). Every implant was primarily stable because of fixation in native bone. In each maxilla, 1 bone defect was filled with autogenous bone harvested from the mandible and 1 was filled with Bio-Oss (material selected at random). The animals were sacrificed at 90 and 180 days, and histologic specimens were examined and the results subjected to statistical analysis by the Wilcoxon test for paired observations. Results: No healing problems were observed. Histologically, after 90 days the volume of the augmentation showed a reduction of 14.6 ± 4.4% within the Bio-Oss group and 3.8 ± 2.5% in the group with autogenous bone. Bone-implant contact of 52.16 ± 13.15% in the Bio-Oss group and 60.21 ± 11.46% in the autogenous bone group was observed. At 180 days, the Bio-Oss group showed bony in growth of the substitute, whereas in the autogenous group a differentiation from original bone could no longer be made. The volume reduction was 16.5 ± 8.67% in the Bio-Oss group and 39.8 ± 16.14% in the autogenous group. Bone-implant contact of 63.43 ± 19.56% in the Bio-Oss group and 42.22 ± 12.80% in the autogenous bone group was measured. Discussion and Conclusion: The results indicated that because of the nonresorptive properties of the bone substitute Bio-Oss, regeneration of the defects is achievable. It was demonstrated that the bone substitute seemed to behave as a permanent implant. The volume of the area augmented by autogenous bone decreased over the observation period. Copyright of International Journal of Oral & Maxillofacial Implants is the property of Quintessence Publishing Company Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.