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Cadaver Bone for Grafting?
Dr. S, from Los Angeles, asks us:
As I'm sure everyone is aware there has been alot of controversy surrounding grafts made from cadaver bone, following the recent stolen body parts scandal. As such, I wanted to get a consensus view from OsseoNews readers about the current state of affairs.
How much danger is there really in using cadaver bone for bone grafting? Many of my patients are concerned they may contract a communicable disease. But what are the chances of this? Are most of you just switching to synthetic materials because of this bad PR? But, are the synthetic grafting materials a good and predictable alternative? What are the pros and cons? What are the alternatives and where is your practice headed? Thanks.
October 17, 2006 in Bone Grafting | Permalink
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Comments
Very simply:
There has never been a reported case of any disease transfer for PROCESSED BONE ALLOGRAFT. Also be sure to use only tissue banks that are members of the AATB.
There have been reported case of HIV in FRESH FROZEN ALLOGRAFTS, but these are not
used in dentistry. Synthetic grafts (alloplasts) have a very poor track record with regard to regenerative potential.
Posted by: | Oct 17, 2006 2:18:53 PM
Cadaver treated bone is safe, there has never been to my knowlegde a single case of a tranmited disease related to a dental graft. Just be sure what you buy.
Bone has a much better record than synthetics. I dont really give my patients a choice... I use human bone for grafts.
Posted by: Alejandro Berg | Oct 17, 2006 3:25:56 PM
Want a win/win? We have used xenografts in our practice for over 10 years for all grafting procedures. We also use them at the dental school. Better patient acceptance and proven histology.
Posted by: | Oct 17, 2006 3:50:34 PM
Well then you'll have to explain not getting mad cow disease from bovine grafts
Posted by: | Oct 17, 2006 8:11:38 PM
for bovine graft you need more maturation time than human bone graft.
if you reenter site prematurely you will be surprised to find your graft still looking at you instead of new bone.
synthetic grafts used alone do not match the succes of humane bone graft.
Posted by: satish joshi | Oct 17, 2006 8:26:36 PM
Mad Cow disease? Has there ever been a documented case in the US? I believe that bovine is FDA approved for bone grafts. Is human cadaver?
Posted by: | Oct 18, 2006 7:17:01 AM
So if I understand Satish Joshi's comment, human bone remodels very quickly. Is that a good thing?
Posted by: M. Williams | Oct 18, 2006 7:21:28 AM
I use patient's own bone for grafting. More painful but better. If some one was placing a bone graft in my jaw , I would prefer the temporary extra pain from donor site ,rather than worry about possible infection from dead human or dead animal source.
Posted by: MHA | Oct 18, 2006 12:39:28 PM
of course, autogenous is best bone, but wait until you hit a site where you won't have enough graft unless you look for out side the mouth.
Posted by: satish joshi | Oct 18, 2006 1:22:27 PM
Seven Plead Guilty in Stolen Body Parts Case
By TOM HAYS, AP
NEW YORK (Oct. 18) - Seven funeral home directors linked to a scheme to plunder corpses and sell the body parts for transplants pleaded guilty to undisclosed charges and have agreed to cooperate with investigators, prosecutors announced Wednesday.
The unidentified directors secretly pleaded guilty in the probe of what investigators say was a plot to harvest bone and tissue and sell it to biomedical supply companies, Brooklyn District Attorney Charles Hynes said.
"It is clear that many more funeral home directors were involved in this enterprise," Hynes said at a news conference.
The seven entered their pleas in closed courtrooms and their names were withheld, but defense attorneys said that among those cooperating was the director of a funeral home that took parts from the body of "Masterpiece Theatre" host Alistair Cooke, who died in 2004.
The four original defendants in the case pleaded not guilty on Wednesday to enterprise corruption, body stealing and other charges in the new indictment. If convicted, they face up to 25 years in prison. All remain free on bail.
Prosecutors allege Michael Mastromarino, a former oral surgeon, and three other men secretly removed skin, bone and other parts from up to 1,000 bodies from funeral homes, without the permission of families.
What The Corpses Fetch
They were charged in February with counts including body stealing, unlawful dissection and forgery in a case a district attorney called "something out of a cheap horror movie."
All the defendants pleaded not guilty before being released on bail.
Mastromarino, owner of Biomedical Tissue Services of Fort Lee, N.J., allegedly made millions of dollars by selling the stolen tissue to biomedical companies that supply material for procedures including dental implants and hip replacements, prosecutors said.
At the time, prosecutors said they had unearthed evidence that death certificates and other paperwork were falsified. In Cooke's case, his age was recorded as 85 rather than 95 and the cause of death was listed as heart attack instead of lung cancer that had spread to his bones.
Other evidence includes X-rays and photos of exhumed cadavers show that where leg bones should have been, someone had inserted white plastic pipes - the kind used for home plumbing projects, available at any hardware store. The pipes were crudely reconnected to hip and ankle bones with screws before the legs were sewn back up.
Copyright 2006 The Associated Press.
Posted by: | Oct 18, 2006 5:45:37 PM
Mastromarino, owner of Biomedical Tissue Services of Fort Lee, N.J., allegedly made millions of dollars by selling the stolen tissue to biomedical companies that supply material for procedures including dental implants
Posted by: | Oct 18, 2006 6:09:39 PM
"rather than worry about possible infection from dead human or dead animal"
Uh..duh! I ate a dead animal tonight for dinner tonight.
Posted by: | Oct 18, 2006 6:18:06 PM
amalgum is a long used very effective dental material but we dont use it primarily due to patient concerns.Patients through using the internet are aware and more often than not unneccessarily scared about what they read.
Synthetics are the future and with more development and improved techniques in use will become the "gold Stanadrd".Having only used synthetics in all my sinus lift cases for the last 18 months I now see the clear benefits to both the dental surgeon and patient alike
Posted by: Peter Fairbairn | Oct 19, 2006 7:12:19 AM
18 months are you kidding me, you are going to say that synthethetic bone is the gold standard. are you using amalgam in your sinus grafts. since your are doing an amalgam at the same time as a subantral augmentation you might as well you have the amalgam out. Please let us know how those implants in the synthetic sinus are going in 5 years.
Posted by: | Oct 19, 2006 9:27:26 AM
Find yourself a reputable bone bank that advertises Alistar- Cook-free bone and you should be OK. I believe only Puros was affected. FDB is effective and convenient. Obviously autograft is the gold standard, but harvesting it has it's morbidity and FDB works just as well. And remember bovine source products are no longer bone...just HA. If mad cow can live after being sinistered then more power to it.
Posted by: | Oct 19, 2006 10:41:24 AM
was puros the bone that was in the case?
Posted by: | Oct 22, 2006 12:11:51 AM
With regard to the cadaver bone issue, The FDA has had several recalls in the last year and a half. It has impacted 6 major bone bank suppliers. There are continuing concerns about allograft processing and donor verification records. These recalls continue to highlight a very unregulated industry that is fraight with potential problems. Graft materials, at the basic level, simply act as a scaffold for the ingrowth of host bone. What we should really be interested in length of time of turnover and amount of graft material left at time of implant placement. Over a decade of international research suggests that alloplasts, specifically beta TCP, is the only graft material that completely resorbs and does so at the same rate of new bone formation. Issues of potential transmission of disease are completely absent and these materials are easy to handle. My patients constantly ask me about tissue bank bone and are relieved when we explain that we no longer use them. If we can get the identical results with TCP as with autogenous bone, then why do we even need to consider allografts? We are now engaged in research using growth factors with TCP and getting results that we now call the "platinum standard" for bone grafting. While we can joke about the court case issues surrounding these problems, I can assure you that our patients DO NOT find this amusing. Get over it and start using these materials based on intellectually honest research rather than emotion.
Posted by: Robert J. Miller | Oct 22, 2006 8:35:26 AM
Ditto to Robert Miller!!! I couldn't have said it better myself.
Posted by: | Oct 22, 2006 5:06:36 PM
FDA has setup a task force to review the issue of tissue donation and the problems that have developed in the sale of donated tissues. There has been at least one case of Hepatitis C transmited to a patient via donated tissue. However that was not from bone grafting materials. As far a mad cows disease, no documented cases have occurred from graft materials. But 40 years ago we didn't know what a prion was. That is the fear regarding xenografts, not what we know but what we don't know.
Here is a link to the FDA on this topic. http://www.fda.gov/cber/safety/drs083006.htm
Posted by: | Oct 24, 2006 2:33:05 PM
Well said Dr. Miller ,it is time to move on.Those who have ,know and it sure puts the patients at ease
Posted by: peter Fairbairn | Oct 24, 2006 3:34:09 PM
PDGF + TCP is not the "platinum standard" when most doctors buying this product are not using the TCP and are waiting for PDGF to be available with another graft material like DFDBA. Research regarding TCP along with clinical experience using this graft material is the reason it is not being used in conjunction with the co-packaged PDGF. That hardly jumps it over the "gold standard" of Autogenous. Besides if you love growth factors why not use Emdogain which stimulates a variety of growth factors and not limit yourself to only one?
Posted by: | Oct 25, 2006 10:02:30 AM
"millions of dollars by selling the stolen tissue to biomedical companies that supply material for procedures including dental implants"
Does this include DFDBA and FBDA?
Posted by: | Oct 25, 2006 5:47:54 PM
Thousands of patients who underwent tissue, bone and organ transplants are at risk of developing serious diseases due to the use of untested body parts. Recent criminal charges detailed the illegal sale of untested body parts and tissue to hospitals, distributors and medical device manufacturers. The FDA is concerned that the recipients of untested body parts and tissues are potentially at risk of developing HIV, Hepatitis B, Hepatitis C, Syphilis and other infectious diseases.
The untested body parts and tissue scandal centers around Biomedical Tissue Services, which allegedly acquired body parts without donor permission and sold them for use in transplants performed at hospitals and other medical facilities within the United States. The owner and three other employees of Biomedical Tissue Services have been indicted in Brooklyn, New York for taking body parts without legal consent and without proper screening. It is believed that funeral home operators accepted money from the company in exchange for ignoring obviously forged death certificates and consent forms. The body parts and tissue in question have been distributed throughout the country and used in thousands of operations.
Biomedical Tissue Services sold these illegal body parts to several large companies including Lifecell Corp., Regeneration Technologies, Inc., Tutogen Medical, Inc., Lost Mountain Tissue Bank and Blood & Tissue Center of Central Texas. The FDA and most of the companies involved have not disclosed the number of patients that received the untested parts and tissue.
Untested Body Parts Scandal - Timeline
Posted by: | Oct 25, 2006 6:15:56 PM
This article is patently false. All of the BTS-sourced tissue have gone through the required FDA, AATB and/or specific tissue bank testing. The tests include; HIV 1 and 2 Antobodies,HIV and Hep C, HTLV1/2Ab, HbsAg - Hep B test, HbcAb, HCVAb, RPR/STS - Syphilis test. In the case of the BTS scandal, the screening and recovery of tissues was compromised due to the falsification of records and consents. All of the serological and processing tests were performed by the respective tissue processors.
None of the affected BTS tissues have proven to result in a virally transmitted disease. In fact, no demineralized bone tissue has ever been proven to result in virally transmitted diseases.
Posted by: Frank Meagher | Oct 26, 2006 7:22:20 AM
You wrote: "rather than worry about possible infection from dead human or dead animal. Uh..duh! I ate a dead animal tonight for dinner tonight."
Wouldn't your stomach acid kill anything from the dead animal? Now compare that to something implanted directly into your sinus cavity.
Posted by: | Oct 27, 2006 12:42:07 PM
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