TCP Bone Graft: Failure Rate?

Dear patient, it is not the arrow...it is the indian....if you are looking for a concept to incriminate your doctor, you will not find it. If you are not a patient and do want to talk bad about a product, it is because TCP is creating you commercial problems.....

Great reply,well done.

Great response

Many factors may have lead to failure in this case . Whatever the material good clean surgical technique with passive primary closure is really essential to cover and seal the grafted material from the oral environment. I have used both xenogtafts and synthetic materials and feel that both have a lot to offer depending on the situation. The new synthetic materials are not old technology .

I have used TCP mixed with irradiated bone in over 1500 sinus grafts as well as over 3000 patients with bone grafting around implants and found TCP to be a wonderful material. Dr. Alfred L. "Duke" Heller

Thank-you so much for your responses, I truly appreciate your insight. I don't want to point fingers at a certain product or material, but have just recieved such contradictory opinions on Synthetics, especially TCP, that I was hoping this forum would offer a wider breadth of opinion. After two failed bone grafts I dont know what steps to take from here so your opinions are extremely helpful. Please keep them coming, and thanks again.

THese materials can be technique sensitive as to the results achievable.There is a new version of a product in the UK which is a 2 syringe mixing and placement thro a widened nozzle. This makes it easier and it sets harder even with excess blood present,newer versions of the TCP products are vastly improved although they have been used for years..

Calcium phosphate ceramics, e.g. hydroxyl apatite (HA) and tricalcium phosphate (TCP), are frequently used for bone reconstruction, because of their close resemblance to the bone mineral phase .Both HA and TCP are biocompatible and osteoconductive, but at the same time have their disadvantages. Previous studies revealed that HA particles are a good bone filler for new bone formation, but they are poorly resorbable. On the other hand, TCP tends to resorb unpredictably in biologic fluids and in a variety of solvents .The fabrication of biphasic calcium phosphate ceramic (BCP) made it possible to control the resorbability of the material and at the same time to maintain its osteoconductive property. It was confirmed again that β-TCP particles with a size of 300–500 μm are indeed osteoconductive, as the new bone formation was guided by the outer surfaces of the particles and resulted in a larger amount of newly formed bone in comparison with the empty defects. After 2 weeks, some of the particles are also completely embedded in bone without an intervening fibrous tissue. Evidently, the β-TCP particles cannot cause any inflammatory reaction. New bone formation has been observed after the first week in a 3D model.

I get a kick out of all the shills who reply to these very legit questions. Now then - attention please - how many dentists out there have even the faintest clue about some of the scientific jargon used by some of these guys above and in other threads? Like above - however I'd say don't blame the arrow blame the indian -- who can't shoot straight - and doesn't know what he's shooting at anyway!!

NOW THEN Back to the main question What is the FAILURE RATE OF BONE GRAFTS? let's keep it simple...A front upper incisor tooth or canine absent for say 10 years? Answers - empiracally backed please! And sourced!

To "AL says" Looks like your are the fastest shooting cowboy there is and who knows all the answers and never have missed the target! So let us hear of your great thriumps and knowledge so we can learn something from someone like you!

It's troubing to me to see that this question has not received a competent and honest answer. I think we are here to offer answers, although it seems some feel that offering up an opinion or commentary on the question itself without an educated and relevant answer is an urge too tempting to resist.

Drs. Heller and Bendowski are correct. You also have to protect the graft and baby it till one has good gingival healing. There are about 12 keys that have to be addressed when grafting, from zero infection, adequate blood supply, good primary exposure. The host genetic potential and the condition of the host site prior to grafting are also very important but do not get enough lip service.

Ladies and Gentlemen, I would like to see a "good" answer(well researched) with proper recommentations for the TCB Bone Graft failure rate. Med Administrator(US Navy RET)

We have used only BTcP ( not TCB ) for the last 5 years a few times a week in severe defects and sinus augmentation and have had two " failures" both in marginal uncontrolled diabetics , but there are many varieties of this material and they can be very technique sensitive. Although they were used 20 years ago the newer products are vastly different and come from extensive use in Orthopedic and Spinal surgery. ( where you can Google , PubMed the research ).Some of these newer materials are combined with Ca So4 or polylactides to improve their characteristics . There is a lot of new research , some still to be published which show very positive findings. Here in Europe this appears to be a direction of a lot of thought.

The TCP's used 20 years ago were mostly in powder form and were made up of a combination of alpha, beta, and HA forms. This made resorption highly unreliable and altered osteoblastic response. The poor results with these triphasic materials resulted in these products quickly disappearing from the market. The current TCP graft materials are phase pure; entirely bTCP. The beta form resorbs in a controlled manner and has a remarkable effect on osteoblasts. As the granules dissociate, they release free cytosolic calcium, up-regulating osteoblasts, increasing the production of parathyroid hormone related peptide, alkaline phosphatase, osteopontin, osteocalcin, and inhibiting bone resorption by down-regulating osteoclasts. This occurs to a minor degree with allografts and is virtually nonexistent with Bio-Oss (no resorption). The phase pure TCP's are unquestionably the best choice when a particulate graft is needed. With regard to the failures quoted above, virtually all of them are problems of technique (premature dehiscence of flaps), or failure to debride the graft site of infected tissue. RJM

I recently had a lumbar spine fusion fail, due to resorption of the bone graft (which was a combination of ceramic sponge, BMP-2, bone marrow aspirate, and other DBM bone fillers). Turns out I had almost no testosterone, and i was hypothyroid and anemic. Once I get the testosterone and thyroid normalized, the anemia disappeared, and the DXA scans showed that I started to have a net positive bone growth in my femur and back (it was negative before...I was losing bone, T=-1.5 and getting worse). You should have all your hormone levels worked up before doing another bone graft. Also, Forteo (teraparitide), is showing to be an excellent bone growth drug to help bone grafts succeed.

when having a wisdom tooth extracted is a bone graft necessary? considering a normal healthy extraction.

A bone graft is not normally required in a routine wisdom tooth extraction, unless RARELY it is associated with a cyst which may weaken the jaw after the removal. ( Your surgeon will advise you after looking at the x-rays, etc ) However most wisdom teeth extractions or surgical removals are straight forward and the jaw bone heals spontaneously without any need of grafting. NH