J O U R N A L O F
Volume XXI. Number One. 1995
Bone Grafts, Derivatives, and Substitutes, by Marshal R. Urist,
Brian T. O'Connor, and R. Geoffrey Burwell, with 29 contributors, 421 pp
with comprehensive bibliographical references and index. Oxford: Butterworth-Heinemann
Although written for the orthopedic literature, Bone Grafts, Derivatives,
and Substitutes is a valuable guidebook for any dental surgeon involved
with graft placement. With many preeminent contributors, it brings us state-of-the-art
information as well as a look at the latest research.
Geoffrey Burwell begins by building a basic science foundation in an historical
manner, entertaining while enlightening the reader. One notices the change
in the field from of being surgically influenced to one of being research-driven.
Twenty-two pages of ensuing bibliography show the effort that was put into
In the next chapter, Burwell expands upon the bone-inductive mechanism,
running through 30 years of research. He cites numerious studies to back
his theory, culminating in a thorough investigation of the importance of
bone marrow stroma in osteogenesis.
A full chapter on true bone ceramics, marketed in this country as Osteograf,
is written by its Japanese developers. Having direct impact on dentists
are Chapters 7 and 8 on bone banking and Chapter 9 on the use of human decalcified
bone. Replaminaform coral-derived materials, introduced by the Replam Corporation
(now known as Interpore International),are discussed with eight orthopedic
case studies. Chapter 12 touches upon bioactive glass ceramics: however,
the discussion is limited to the block form (A-W,GC) and does not appreciably
involve Bioglass,the more appropriate dental material.
Therein lies one of the shortcomings of the book as it relates to dentistry.
Because of the different environs (intramembranous vs. endochondral)
and different engineering requirements (alveolus vs. long bones),
and one should read in context. Also conspicuously absent is the concept
of guided bone regeneration, probably due to the limited success in the
orthopedic arena (Christer Dahlin, personal communication). The chapter
on Collagraft, and its future as a morphogen carrier seems bright.
The most exciting and promising subject of the book is written by Marshall
R. Urist, one of the pioneers of bone biology. Chapter 12, "The Search
for and the Discovery of Bone Morphogenetic Protein (BMP)", describes
how Urist, in 1965, while teaching at UCLA, assigned students experiments
relating to calcification. Evidence for the existence of BMP was manifested
in the ability to transform demineralized bone in normally non-calcifying
tissues. This chapter is a well-organized treatise that also shows the elegance
of the scientific method. Urist's next chapter, in conjunction with Eric
E. Johnson, shows current clinical use of autolyzed antigen-extracted allogenic
(AAA) bone supercharged with BMP in heretofore hopeless amputation cases
(non-union fractures). Developments are on the horizon.
The final and most current chapter is written by J.M. Wosney, who helped
sequence the amino acid structure and genetic expression of the BMP's. The
molecular biology of the BMP's points to future research, namely, insights
into osteoporosis and other diseases.
Many times the dental and orthopedic literatures are divergent. Bone
Grafts, Derivatives, and Substitutes includes numerous citations from
the dental literature. It is also a valuable source book involving orthopedic
literature as well. One cannot help being excited over the possibilities
of this research. As stated in the text, BMP will no doubt become available
clinically by the end of the century, in some way, shape, or form.
-Frederick J. Nau, DDS
New York, NY