First, let’s discuss terminology. “Autograft” refers to tissue (bone in this context) harvested from and placed in a separate site of the recipient. “Allograft” refers to bone provided from a donor of the same species as the recipient. “Xenograft” refers to bone provided by a donor from a species different than the recipient. “Alloplast” in the context of periodontal pocket treatment refers to a synthetic bone graft substitute, such as hydroxyapatite or tricalcium phosphate. “Osteoconductive” refers to a substance that acts as a scaffold for adjacent bone cells to grow across and through the graft site. Osteoinductive materials actively stimulate osteoprogenitor cells to differentiate into osteoblasts. Autografts are ideal in some cases, with no risk of rejection, minimal risk of infection, and osteoinductive capability. The challenge lies in obtaining an adequate autograft without significantly increasing morbidity or anesthesia time. Bone collection devices can be used to obtain cortical bone shavings from exposed bone adjacent to the defect. The first osteoconductive product introduced in the veterinary market was bioglass. Bioactive glass was discovered in 1969 and provided for the first time as a clinical option in human medicine in 1985.1 The first study described in veterinary clinical patients (36 dogs and 5 cats) was published in 1997.2 In the osseous periodontal defect treatment group, clinical probing depths decreased significantly, and there was an apparent gain in attachment level.2 A newer product is a composite of tricalcium phosphate and bioactive glass with interlocking granules containing pores that mimic cancellous bone structure and allow for vascular ingrowth.3 Another product, a solid cross-linked gelatin, has been described for use in the treatment of periodontal pockets and in furcation defects where the gingiva is not receded in areas of furcational bone loss.4 What about osteoinductive products? Human recombinant bone morphogenetic protein (rhBMP-2), once available commercially as a veterinary product in Europe, and occasionally available in U.S. veterinary schools, has amazing potential for new bone formation when delivered to the area of bony defects in a compression-resistant carrier containing collagen, hydroxyapatite, and tricalcium-phosphate.5 In fact, a 60 percent rhBMP soak volume resulted in excessive production of bone during mandibular reconstruction.5 Canine allografts have been commercially available for nearly 30 years.6 Bone is obtained from donated pet cadavers (one such program is called “Pets Helping Pets”). The bone is sterilized and processed to remove antigenicity. Products used to treat periodontal bone loss consist of osteoinductive demineralized bone matrix and osteoconductive cancellous bone chips. Demineralized freeze-dried bone allograft has been shown to be more effective in increasing percent of bone height fill in a grafted area, when compared to control and bioactive glass.7 After performing open or closed root planing, placing bone graft into an area of vertical bone loss can help save teeth with periodontal bone loss that have no mobility and no progression to endodontic disease (Figure 1). A resorbable barrier is placed over the bone graft to limit epithelial migration while new bone formation occurs. A) An allograft is placed into an area of vertical bone loss on the distal surface of tooth 409 and in the alveolus of extracted tooth 410. B) One year later, improvements in alveolar bone height are seen radiographically, and probing depth has returned to normal. Photos courtesy Dr. John R. Lewis A new piezoelectric hydrogel product containing gelatin methacryloyl and barium titanate utilizes piezoelectric effects to encourage bone production. Electrical microcurrents created may stimulate osteoblasts. The same electrical microcurrents also aid in disrupting biofilm. Using a ligature model of periodontal disease induction in mice, pocket depths were determined to be 0.2 mm in healthy teeth and 0.55 mm in disease-induced teeth. After 30 days of treatment, the piezogel treatment group showed pocket depths averaging 0.2, whereas the pocket depths in the scaling and root planing alone group were similar to those in the no-treatment group.8 Most new periodontal products are labeled as “devices” rather than medications. The U.S. Food and Drug Administration (FDA) does not require pre-market approval of devices intended for animal use, and these devices are exempt from post-market reporting. It is the responsibility of the manufacturer and/or distributor of these articles to ensure these animal devices are safe, effective, and properly labeled. The FDA encourages veterinarians and animal owners to report adverse drug experiences and product defects associated with animal devices to the FDA.9 John Lewis, VMD, DAVDC, FF-OMFS, practices veterinary dentistry and oral surgery at Veterinary Dentistry Specialists and teaches at Silo Academy Education Center, both located in Chadds Ford, Pa. References Hench LL. The story of Bioglass. J Mater Sci Mater Med. 2006;17(11):967-78. DeForge DH. Evaluation of Bioglass/PerioGlas (Consil) synthetic bone graft particulate in the dog and cat. J Vet Dent. 1997;14(4):141-5. https://biomendex.com/vet/technology/?v=0b3b97fa6688 https://regumvetprn.com/veterinary-resources/ Lewis JR, Boudrieau RJ, Reiter AM, Seeherman HJ, Gilley RS. Mandibular reconstruction after gunshot trauma in a dog by use of recombinant human bone morphogenetic protein-2. J Am Vet Med Assoc. 2008;233(10):1598-604. https://vtsonline.com/about/company-profile/ Hall EE, Meffert RM, Hermann JS, Mellonig JT, Cochran DL. Comparison of bioactive glass to demineralized freeze-dried bone allograft in the treatment of intrabony defects around implants in the canine mandible. J Periodontol. 1999;70(5):526-35. Roldan L, Montoya C, Solanki V, Cai KQ, Yang M, Correa S, Orrego S. A Novel Injectable Piezoelectric Hydrogel for Periodontal Disease Treatment. ACS Appl Mater Interfaces. 2023;15(37):43441-43454. https://www.fda.gov/animal-veterinary/animal-health-literacy/how-fda-regulates-animal-devices
