Special Feature: New advances in bone grafting alternatives

Innovative development of new biomaterials provided reconstructive surgeons with options other than bone grafting for augmentation or reconstruction of the cranial and facial skeleton. Alloplastic materials such as solid silicone (Silastic) continue to be popular for chin and malar augmentation. Solid silicone is very flexible and can be inserted through small incisions. Other materials such as high density porous polyethylene (Medpore; Porex Industries, Fairburn, GA, USA) and expanded polytetrafluoroethylene (Gore-Tex; W.L. Gore & Associates, Inc., Flagstaff, AZ, USA) are also reliable alloplasts. Ceramic hydroxyapatite and calcium phosphate cements are osseoconductive and provide a reliable material for cranial and facial reconstruction. Porous ceramic hydroxyapatite is nonresorbable and can provide excellent structural contouring. Calcium phosphate cements are relatively easy to use and can be molded or used as a caulk-like material in osseous reconstruction. There are four bone cements available for dental applications, and they may prove to be a reliable way to close osseous defects or to alter contour. However, well-designed clinical studies are necessary to assess resorption rates, replacement by host bone, and long-term efficacy. Distraction osteogenesis is another option for correcting craniofacial anomalies. Distraction has proven effective for mandibular defects and is now used successfully in the midface. In the future, osseoinductive growth factors such as human recombinant BMP-2 may provide the surgeon with an effective means for reconstructing larger cranial and facial defects. Efficacy of these materials will require use of biocompatible carriers that provide reliable and reproducible delivery of the growth factor. Surgeons now can obtain a bone substitute material off the shelf and can eliminate the morbidity associated with harvesting bone grafts. These advances improved patient care and decreased patient discomfort while still providing reliable reconstruction.