Contemporary Trends in Bone Grafts and Substitutes for Dental and Implant Therapy: A Review on Current Evidence

Abstract

Bone is a dynamic tissue with remarkable regenerative capacity; however, extensive defects resulting from trauma, pathology, congenital anomalies, or surgical resection often require grafting to restore form and function. Bone grafting is among the most common procedures in orthopedics and dentistry, second only to blood transfusion as a tissue replacement worldwide. Autografts, long regarded as the “gold standard,” uniquely combine osteogenic, osteoinductive, and osteoconductive properties, but their limitations—donor site morbidity, limited availability, and surgical burden—have driven the development of alternative grafts and substitutes. Current materials include allografts, xenografts, phytogenic sources, and an expanding range of synthetic substitutes such as calcium phosphate ceramics, bioactive glass, calcium sulfate, polymers, metals, and composite biomaterials. Despite advancements, most existing substitutes primarily serve as osteoconductive scaffolds, lacking the full biological profile of the autograft. Emerging strategies incorporating nanostructured ceramics, growth factors, and composite systems seek to improve osteogenesis, vascularization, and integration while minimizing immunogenicity and morbidity. In dentistry, bone grafts are widely applied in implantology, periodontal regeneration, and maxillofacial reconstruction, with nearly half of implant procedures involving grafting. This review provides an overview of currently available grafts and substitutes, their advantages and limitations, and highlights the unmet need for next-generation biomaterials with superior biological and mechanical properties.