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 Lts., 1994.

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 this materwork.

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 TM.
(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