title: Autogenous bone graft:  basic science and clinical implications.
abstract: No single biomaterial is optimum for every craniomaxillofacial application. Instead, surgeons should consider the advantages and disadvantages of each alternative in a given clinical situation, and select the material with lowest overall cost and morbidity, and the highest likelihood of success. Autogenous bone is still considered the gold standard for most applications; it becomes vascularized and osseointegrates with surrounding bone, thus minimizing the risk of infection, dislodgement, or break-down. Limitations include added operative time for graft harvest, donor site morbidity, graft resorption, molding challenges, and limited availability, especially in the pediatric population. Numerous alternatives to bone graft have become available to address these limitations; unfortunately, most of these products are expensive, do not osseointegrate, and have unpredictable biologic activity. Understanding the physiologic behavior of autogenous bone graft can help clarify the indications for its use and provide a conceptual framework for achieving the best possible outcome when this alternative is chosen.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Children's National Medical Center, Washington, District of Columbia 22102, USA. grogers@cnmc.org
authors.forename: Gary F
authors.initials: GF
authors.lastname: Rogers
authors.forename: Arin K
authors.initials: AK
authors.lastname: Greene
mesh_terms: D001672:Biocompatible Materials / Q000627:therapeutic use; D001861:Bone Regeneration / Q000502:physiology; D001862:Bone Resorption / Q000503:physiopathology; D018786:Bone Substitutes / Q000627:therapeutic use; D016025:Bone Transplantation / Q000379:methods* / Q000473:pathology / Q000502:physiology; D002470:Cell Survival / Q000502:physiology; D004388:Dura Mater / Q000502:physiology; D005147:Facial Bones / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D018919:Neovascularization, Physiologic / Q000502:physiology; D016348:Osseointegration / Q000502:physiology; D010006:Osteoblasts / Q000502:physiology; D010011:Osteocytes / Q000502:physiology; D010012:Osteogenesis / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012886:Skull / Q000601:surgery*; D014021:Tissue Preservation / Q000379:methods; D020858:Tissue and Organ Harvesting / Q000379:methods; D060053:Transplant Donor Site / Q000033:anatomy & histology; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; D018786:Bone Substitutes