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Bone Allografts

What is an allograft?

A graft in which the replacement bone came from another person. There are several types of allografts:

  • Fresh or fresh-frozen
  • Freeze-dried
  • Demineralized freeze-dried

What is the risk of disease transmission with bone allografts?

Freeze-dried bone allograft (FDBA) and demineralized freeze-dried bone allograft (DFDBA) materials are widely used in periodontal therapy, and there are no reports of disease transmission during the 30-year history of using FDBA. Although four cases HIV infection were linked to procedures using fresh-frozen bone allografts, these cases involved surgeries of the spine, hip, and knee; fresh-frozen and fresh allografts are not typically used in periodontal therapy. Also, when using FDBA and DFDBA, the delay in processing ensures adequate time for testing for potential pathogens.

Most bone banks adhere to American Association of Tissue Banks (AATB) guidelines to procure, process, and sterilize bone grafts. The AATB advocates excluding collection of bone under the following circumstances:

  • Donors from high-risk groups, as determined by medical testing and behavioral risk assessments
  • Donors test positive for HIV antibody by ELISA
  • Autopsy of donor reveals occult disease
  • Donor bone tests positive for bacterial contamination
  • Donor and bone test positive for hepatitis B surface antigen or hepatitis C virus
  • Donor tests positive for syphilis

Because of donor exclusion criteria, the chance of getting a bone graft from an HIV-infected donor is negligible. These criteria, combined with recommended processing procedures (harvesting in a sterile manner, repeated washings, immersion in ethanol, freezing in liquid nitrogen, freeze-drying, demineralization, and vacuum sealing), render DFDBA and FDBA grafts safe for human implantation.

Selected References and Additional Resources

American Academy of Periodontology Position Paper: Tissue banking of bone allografts used in periodontal regeneration, J Periodontol 2001;72:834–838.

Buck BE, Malinin T, Brown MD. Bone transplantation and human immunodeficiency virus. Clin Orthop 1994;303:8–17.

CDC. Epidemiologic notes and reports transmission of HIV through bone transplantation: Case report and public health recommendations. MMWR 1988;37:597–599. Accessed 9/21/09.

CDC. Guidelines for preventing transmission of human immunodeficiency virus through transplantation of human tissue and organs. MMWR 1994;43(RR-8):1–17. Accessed 9/21/09.

Greenwald MA, Kuehnert MJ, Fishman JA. Infectious disease transmission during organ and tissue transplantation. Emerg Infect Dis [serial on the Internet]. 2012 Aug [accessed June 4, 2013]. http://wwwnc.cdc.gov/eid/article/18/8/12-0277_article.htm

Holtzclaw D, Toscano, N, Eisenlohr L, Callan D . The Safety of Bone Allografts Used in Dentistry: A Review. JADA September 2008 vol. 139 no. 9 1192–1199.

Mellonig JT. Donor selection, testing, and inactivation of the HIV virus in freeze-dried bone allografts. Pract Periodontics Aesthet Dent 1995;7:13–22.

Mellonig JT, Prewett AB, Moyer MP. HIV inactivation in a bone allograft. J Periodontol 1992;12:979–983.

Russo R, Scarborough N. Inactivation of viruses in demineralized bone matrix. FDA workshop on tissue transplantation and reproductive tissue, June 20–21, 1995, Bethesda, MD.

Simmonds RJ, Holmberg SD, Hurwitz RL, et al. Transmission of human immunodeficiency virus type 1 from a seronegative organ and tissue donor. N Engl J Med 1992;326:726–732.

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