Bone Grafting - Types, Procedure, Risks, and Benefits

Introduction

When it comes to replacing a defective bone or repairing fractured bones, bone grafting is the treatment of choice to restore the patient's physical functioning and replace the lost structure. Fortunately, with the medical advances, the bone grafting procedure supports implanted structures such as dental implants, fractured bones, and joints, allowing the bone around an implant to heal faster and cracked joints to fuse faster. This has simplified the surgical procedure and shortened the recovery period.

Bone is the second most commonly used material implanted into the human body after blood transfer. This estimates 600,000 bone grafts are done annually worldwide. People nowadays seek bone grafting to improve their physical appearance, reshape or reconstruct their jawbones, and wish to have a perfect proportion of their face. However, bone grafting is no longer a life-saving medical treatment but a cosmetic option for those who desire to improve their aesthetics.

What Is Grafting?

It is a surgical procedure to replace the diseased or damaged part of the body tissues or bones with a graft - a portion of healthy skin, tissue, or bone.

What Is Bone Grafting?

It is a surgical procedure in which a healthy part of the bone from a patient’s body is transplanted into the affected or diseased bone area within the patient’s body. For example, after a tooth extraction, bone grafting is done within the socket for support, reshaping the chin to improve facial structure and looks, knee replacement, etc.

Why Is Bone Grafting Done?

1. To rebuild the functional capabilities of the patient.

2. To improve the physical appearance.

3. To accelerate or fasten the bone healing or fusion process, such as fractured bone or spine injury.

4. To repair bone defects.

5. To improve bone healing around surgical implants placed within the patient’s body, such as bone around the dental implants (dental bone grafting) or total knee replacement.

Where Does the Bone Graft Come From?

A bone graft can be taken from the patient's body or a donor. It can also be an artificial or a synthetic material with similar properties to the natural bone graft.

What Are the Types of Bone Grafting?

There are different categories based on the bone grafting material as mentioned below:

1. Autogenous Bone Grafts - They are the most commonly used bone graft because they have all the properties of an ideal bone graft. They are available in small quantities and possess high risks and complications associated with the donor site (someone who donates their part of the bone to be used as a bone graft). These grafts are taken from the healthy bone of the patient itself and are inserted into the patient’s affected area.

2. Allografts - They are also commonly used grafts due to their numerous advantages over autogenous grafts. They are available in large quantities and have low risks and complications. These grafts are taken from a healthy bone of another person (a donor).

3. Bone Grafts Substitutes or Alloplastic Grafts - Synthetic materials such as calcium sulfate, calcium phosphate, and bioceramics are commonly used. Alloplastic grafts are made from hydroxyapatite, which is made from glass. It is a synthetic graft. These are available in different forms, such as pellets, blocks, and injectable liquids. In particular, bioceramics have the potential to overcome the associated risks and complications of autogenous and allografts.

4. Xenografts - These grafts are taken from animals. For example, a cattle or bovine.

What Is the Bone Grafting Procedure?

Bone grafting is performed by an orthopedic surgeon - a doctor specializing in bones, joints, muscles, etc., along with the help of other professionals, such as an anesthetic.

1. General or local anesthesia will be administered to the patient. This is done to avoid any pain or discomfort the patient feels during the procedure.

2. During the procedure, the team will monitor the vital signs regularly, such as body temperature, pulse rate, heart rate, etc.

3. The affected area or surgical site is cleaned with an antiseptic solution such as betadine solution with the help of a cotton gauze piece.

4. A deep cut is made through the skin and tissues at the surgery site.

5. If the bone graft is taken from the patient’s body, another cut is made at another site to take the healthy bone graft. A small part of the healthy bone is removed for graft use. For example, hip bone or thigh bone.

6. The bone graft (taken from the patient’s body, such as the hip or thigh area, or taken from a donor or synthetic material) is then placed into the damaged or defective bone area. For example, when bone grafting a fractured bone, the graft is placed between the cracked bones. This helps the cracked bones fuse and heal at a faster rate.

7. The cuts, both at the surgical site and the healthy bone site from where the graft was taken are then closed with the help of sutures.

How Much Does Bone Grafting Cost?

Bone grafting is an expensive procedure. Several factors affect the cost of the procedure. For example, hospital stay, source of the bone graft, etc., increase the cost of the procedure.

Is Bone Grafting Painful?

Because the procedure is done with anesthesia, the patient experiences little or no pain. After the surgery, if the medication instructions are followed carefully as and when prescribed by the doctor, the post-operative pain also gets relieved.

What Are the Risks of Bone Grafting?

1. Opening of the wound before complete healing. This leads to exposing the bone graft and contaminating it.

2. Delayed or poor bone healing. This may occur due to the poor immune response of the patient.

3. Infection at bone grafting site leading to grafting failure.

4. Increased infection and fracture rates in later stages of life.

5. Transmission of hepatitis B, syphilis, or human immunodeficiency virus infection (HIV) from the donor’s bone. This happens when the donor is not screened properly for possible viral transmissions before taking the bone graft.

What Are the Benefits of Bone Grafting?

1) Autogenous Bone Grafts:

• Considered as a gold standard or benchmark.

• No risk of disease transmission from another person, such as a donor.

• Less risk of grafting failure or rejection by the patient’s body.

• Increased chances of new growth of the bone graft tissues.

2) Allografts:

• They do not have a second surgical site in the patient’s body.

• The duration of the hospital stay is short.

• They are more acceptable to the patient’s body.

3) Synthetic Bone Grafts:

• No risk of disease transmission or contamination as they are sterile (free from germs).

• Available in large quantities, thus can be used for bone grafting of large sections of bone.

• Available in different shapes and sizes.

• No surgery is needed to collect the graft from the patient’s or donor’s body as they are artificially prepared.

When Is Bone Grafting Indicated?

1. A bone fracture that may not heal without a bone graft.

2. Previously untreated fracture with poor healing.

3. Diseases of bone or bone conditions such as cancer.

4. During implant surgery to replace a missing tooth.

5. During spinal surgery.

6. Knee replacement surgery or other implanted devices.

Conclusion :

Many factors influence bone healing, including the patient's immunological response, age, etc. Bone grafting increases healing, restores functional abilities and improves aesthetics. Before undergoing bone grafting or becoming a donor to help someone, it is important to get a thorough grasp of it.