Contamination in Bone Substitute Materials: A Systematic Review

Objective: Bone augmentation has become a significant practice in various areas of bone regeneration dentistry. This systematic review analyzes the research focused on evaluating bone substitute materials for the presence of contaminants. Methods: In June 2024, an extensive electronic search was conducted using renowned databases such as PubMed, Web of Science, and Scopus. Specific keywords employed in the search included ((bone AND (substitute) AND (remnants OR (purity)) OR ((graft AND tooth) AND (remnants OR purity)) OR ((graft AND dentin) AND (remnants OR purity)). The search adhered to the PRISMA protocol and the PICO framework. The review concentrated on the origin of bone substitute materials, the processing methods used for these materials, techniques for assessing purity, and types of contamination identified. A total of 594 articles were identified of which 22 met the criteria and were incorporated into the review. Results: Investigations into allogeneic and xenogeneic bone substitute materials have revealed that, despite manufacturers' assurances of purity, some materials still contain contaminants. Sample analyses demonstrated the presence of donor cellular remains, cellular debris, intertrabecular fat, connective tissue, and collagen. Similarly, synthetically produced bone substitute materials (alloplastic materials) contained various impurities, such as polyvinyl alcohol (PVA), CaO phases, calcium-deficient HAp phases, oily substances containing carbon and silicone, cellulose derivatives, alpha-tricalcium phosphate (alpha-TCP), and heavy metals. Conclusions: Bone-derived and bone-like graft materials can contain various organic and inorganic impurities.