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Mark Bornfeld, DDS
Mark Bornfeld, DDS, Dentist
Category: Dental
Satisfied Customers: 6015
Experience:  Clinical instructor, NYU College of Dentistry; 37 years private practice experience in general dentistry, member Academy of General Dentistry, ADA
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If I had cadaver bone put in to my lower left jaw implant

Customer Question

If I had cadaver bone put in to my lower left jaw for an implant procedure, and also in my upper right jaw, for the same procedure type, and my left side gum went and opened itself (not the incision/stitch site, but just opened up healthy gum tissue) to expel it (reject it), but the right side retained the cadaver bone, shouldn't one be placed on anti-rejection medications?
Submitted: 1 year ago.
Category: Dental
Expert:  Mark Bornfeld, DDS replied 1 year ago.

Technically speaking, the failure of your left-sided bone graft is not a "rejection" per se, because it involves a different mechanism than is typical for a true tissue or organ transplant rejection. There are several potential reasons for loss of a dental bone graft, but it usually involves either an insufficient blood supply to the graft (either due to pre-existing deficiency of blood vessels adjacent to the graft, a metabolic disruption in the contiguous bone tissue, or a deficiency in the surgical procedure itself). True host-versus-graft disease entails a different mechanism, which is the mobilization of an immune response to an antigenic substance (usually a foreign protein).

Anti-rejection medications are categorized as "immunosuppressive drugs"-- they act by weakening the immune system, and the rationale is that if the immune system is weakened, it has a harder time recognizing and mobilizing a response to a foreign material. However, because the immune system does some rather essential functions, such as fighting bacterial, viral, and fungal infections, as well as malignancy, the immunosuppressant strategy must rationally balance the risk of graft rejection with the unavoidable increase in risk of infection and cancer. (Granted, the use of immunosuppressants is becoming increasingly popular in the treatment of autoimmune diseases like rheumatoid arthritis and psoriasis, but if you've seen some of the commercials for these products on TV and paid attention to the accompanying drug warnings, you would have heard mention of increased risk of tuberculosis, lymphoma, and other problems). In any case, the rejection of a transplanted heart, kidney, liver, or lung would be considered by most to be catastrophic, so the application of anti-rejection medications is rational and justified in these cases despite the risk. In comparison, the loss of a dental bone graft is not life-threatening, and even if the use of these medications in such an application was approved (and they are NOT currently indicated by the FDA for dental bone grafts), it would be difficult to justify the trade-off between risk and benefit.

Hope this helps...

Customer: replied 1 year ago.
Ironically, my health deteriorated dramatically and rapidly after the graft expelled from one side, though it did keep it on the other side. I have been doctoring with specialists at Mayo Clinic for the past 5+ years. When I lay it all out, my health issues took off from the moment of that rejection. I do not want another person to ever have to go thru what I have, or endure what I must live with from here on out. I have just been put on methotrexate sodium injections recently, so besides the years of failing health, in the long run, I am ending up utilizing a med that may be could have been utilized to stop all of my health complications from the start? A no win situation. My body has been in fighting mode, attacking itself, since the moment of graft placement, but because it is so rare to have such a major reaction, it was somewhat dismissed or overlooked as the probable underlying cause for many years. Would it have been an option to just remove the grafting that remained, and subsequently would that have allowed the body to quit battling the foreign substance, or do grafts meld and become part of the whole body at a rapid rate?
Expert:  Mark Bornfeld, DDS replied 1 year ago.

Although a graft reaction (please note that I'm not specifying that it is a graft rejection) might have precipitated your systemic illness, it could have easily been the other way around (i.e., your systemic illness diminished your ability to tolerate the graft). In any case, I am unaware of any documented evidence that bone grafts (especially human/allografts) have led to systemic disease, although the theoretical potential of infection transmission can't be entirely ruled out. (Bone grafts are normally sterile, although true sterility depends on proper attention to the manner in which sterility is achieved.)

You do not specify the condition for which you are receiving treatment, although the reference to your body "fighting itself" implies an autoimmune disorder. Methotrexate is an immunosuppressant drug, and it is a relative contraindication for bone grafting. In other words, had you been taking methotrexate at the time your grafting was being contemplated, your surgeon probably would not have placed the graft.

In any case, the cause of autoimmune disease is not known. Although there is often a genetic component, environmental triggers are suspected of playing a role in disease flare.

Although it is normal protocol to remove a failing graft, I am unaware of any documented guidance that suggests that recommends removal of a successful graft in order to mitigate the symptoms of autoimmune disease. The rare exception to this issue is something called "graft versus host disease", which occurs after transplantation of immune cells (e.g., bone marrow transplant), but that does not apply here.

In general, bone grafts do not persist in the body, but merely form a scaffold on which the native cells of the recipient grow and replace the transplanted material. The rate at which the graft material is replaced can vary, depending on the blood supply, the size of the graft, and the metabolic activity of the recipient site, but it can be quite a while (several years) before it's entirely assimilated.