Table 2.

Characteristics of synthetic bone grafting materials.

Material Type	Product Name	Forms Available	Indications	Advantages	Limitations	Type of Study and Outcome	Reference
Hydroxyapatite	OstimTM EndobonTM	Blocks, wedges and granules	Intraosseous defects Furcation defects Socket preservation Horizontal or vertical augmentation in non-stress bearing areas Periodontal osseous defects	Osteoconduction Macroporous structure comparable to human bone Biocompatibility Excellent hydrophilicity for vessel uptake	Donor site morbidity Low mechanical strengths Delayed resorption rate Limited availability	Clinical trial Significant bone regeneration in 2 and 3-wall intrabony periodontal defects 6 months following placement of OstimTM graft Decreased periodontal pocket depth, decreased clinical attachment loss, decreased intrabony defect depth, 6 months following placement of OstimTM graft	[93,94]
Tricalcium phosphate ceramics	CerasorbTM OSferionTM OrthograftTM	Blocks, cylinders, wedges, granules	Void filler for alveolar, periodontal, periapical, peri-implant and cystic defects	Osteoconduction Ease of handling Radiopacity allowing monitoring of healing Good resorbability Low immunogenicity	Poor mechanical properties in particular compressive strength	In vivo (goat) Bone regeneration comparable to that of autografts in alveolar clefts, 6 months following placement of β-TCP Clinical trial Successful osseointegration and prominent bone formation along graft surface evident 28 days after placement of OSferionTM	[95,96]
Biphasic calcium phosphate ceramics	MASTERGRAFTTM	Moldable putty, granules	Void filler for alveolar, periodontal and cystic defects Preservation of sockets Ridge augmentation Maxillary sinus lifting Periapical surgery	Osteoconduction Osteoinduction Resorbability Comparatively greater mechanical strengths than either TCP or HA alone	Compressive strength remains lower than that of cortical bone	Clinical trial New bone formation with histological observation of osteogenic activity surrounding MASTERGRAFT granules, 4-5 months following graft placement New bone formation and minimal ridge width reduction observed in post-extraction alveolar ridges of 15 patients	[97,98]
Bioglasses	PerioglasTM BiogranTM	Particulates	Periodontal defects Furcation defects Socket preservation Cystic defects Fenestration and dehiscence defects	Osteoconduction Biocompatibility Antimicrobial activity Porous structure Completely resorbable	Brittle Low mechanical strength Poor fracture resistance	Clinical trial 88.6% success rates of implants placed in sites grafted with bioactive glasses, 29 months following bioglass material Decreases in periodontal pocketing depth, clinical attachment loss, gingival recession, depth of bony defect observed, 9 months after placement of PerioglasTM either alone, or in combination with a non-resorbable membrane GoreTexTM or bioresorbable membrane Resolut AdaptTM	[99,100,101]
Calcium phosphate cements	NorianTM ChronOS injectTM HydrosetTM BoneSourceTM	Injectable paste, moldable putty	Bony defect filler Reconstruction of bony fractures Implantology	Osteoconduction Self-setting ability Mouldability Biocompatibility	Low speed of cell adhesion Brittle Concerns relating to extrusion of material to adjacent tissues	Clinical Trial Nearly complete bone regeneration in alveolar ridge defects, 6 months following placement of CPC material Case Report Complete replacement by newly formed bone of NorianTM graft placed in a large 3-wall mandibular defect, one year following graft placement	[102,103]
Calcium sulfates	OsteoSetTM	Various sizes pellets	Void filler for surgical defects and furcation defects Preservation of sockets and alveolar bone heights	Osteoconduction Low cost Readily available High mouldability Biocompatibility Short setting time	Rapid resorption which is faster than that of human bone Relatively high risk of infection and inflammation	Clinical trial When used in combination with FDBA, resulted in the reduction of periodontal probing depths, gains in clinical attachment, defect fill and resolution, 12 months following placement of calcium sulfate graft material Double-blind randomized trial 42% of bony defect filled with new bone, 6 weeks after placement of OsteoSetTM graft. No statistically significant additional bone formation observed during 3-6 months period.	[104,105]
Polymers	Bioplant HTR Synthetic BoneTM	Particulates, granules, ready to use in syringe	Ridge augmentation and preservation Furcation defects	Osteoconductive Biocompatible Customizable forms Low immunogenicity Porous structure Radiopaque	Concerns relating to acidic degradation products	Clinical trial Reduction in periodontal probing depths, clinical attachment gain and significant resolution of defects in alveolar crest bone, 6 months following placement of Bioplant HTR Synthetic BoneTM Decreased periodontal probing depths, mean horizontal and vertical furcation probing attachment levels, six years after placement of Bioplant HTR Synthetic BoneTM	[106,107]
Metals	OSS BuilderTM	Mesh/membrane available in lateral and papilla design forms	Lateral forms—horizontal or vertical bone augmentation Papilla forms—restoring papilla height for aesthetics	Osteoconduction, acts as a membrane barrier for GBR Good mechanical strength Good biocompatibility Corrosion resistance Porous structure enhancing cell adhesion	Need for a second surgical visit Possibility of soft tissue dehiscence and exposure of the membrane	Clinical trial Significant bone formation in alveolar ridge, 4 months following placement of autograft with titanium mesh Case Report Increase in alveolar crestal bone width and height observed, 5 months after placement of autograft mixed with equine-derived xenograft and a titanium mesh	[108,109]
Composites	NanoBoneTM (nanocrystalline HA/silicon dioxide)	Putty, granulate, block, ready to use “QD”	Bone void filler Socket preservation	Osteoconduction Osteoinduction Resorbability Moldability Good cell adhesion	Lack of studies investigating use of NanoBoneTM in humans	In vivo (mouse) New trabecular bone formation, followed by resorption of graft material, 8 months following placement of NanoBoneTMIn vivo (dog) Significantly greater amount of new bone formed in extraction sockets observed at 45 and 90 days after placement of NanoBoneTM with PRF than NanoBoneTM alone or in the control group	[110,111]
	Fortoss VitalTM (β-TCP/calcium sulphate)	Paste	Alveolar bone augmentation Implant rehabilitation Socket preservation	Osteoconduction Osteoinduction Fully resorbable Moldability Porous structure Good cell adhesion	Contact with blood will delay setting time of the paste	Clinical trial Formation of new viable bone, 12 weeks after placement of Fortoss VitalTM Reduction in periodontal pocketing depth, clinical attachment loss, but increases in gingival recession observed 2 years after placement of Fortoss VitalTM	[112,113]
	SmartBoneTM (DBM/polymer/collagen)	Blocks, microchips, plate, granules, wedge, cylinder, rod	Periodontal osseous defects Socket preservation Alveolar ridge augmentation Sinus augmentation	Similar morphology to human bone Rapid blood cell adhesion and proliferation due to high hydrophilicity Improved volumetric stability High load resistance for large bony defects	Comes in single use only packages	Clinical trial Formation of new bone, and increases in alveolar bone dimension, 4 months following placement of SmartBoneTM Successful osseointegration and new bone formation observed surrounded by vascular connective tissue, 4 months following placement of SmartBoneTM graft.	[114,115]

FDBA: freeze-dried bone allograft; GBR: guided bone regeneration; TCP: tricalcium phosphate; PRF: platelet-rich fibrin; DBM: demineralized bone matrix; HA: hydroxyapatite; CPC: calcium phosphate cements.