Published online Mar 18, 2015. doi: 10.5312/wjo.v6.i2.269
Peer-review started: April 30, 2014
First decision: June 27, 2014
Revised: July 7, 2014
Accepted: October 14, 2014
Article in press: October 16, 2014
Published online: March 18, 2015
Autologous bone graft is considered as the gold standard for all indications for bone grafting procedures but the limited availability and complications in donor site resulted in seeking other options like allografts and bone graft substitutes. Demineralized bone matrix (DBM) is an allograft product with no quantity limitation. It is an osteoconductive material with osteoinductive capabilities, which vary among different products, depending on donor characteristics and differences in processing of the bone. The purpose of the present review is to provide a critical review of the existing literature concerning the use of DBM products in various procedures in the extremities. Clinical studies describing the use of DBM alone or in combination with other grafting material are available for only a few commercial products. The Level of Evidence of these studies and the resulting Grades of Recommendation are very low. In conclusion, further clinical studies of higher quality are required in order to improve the Recommendation Grades for or against the use of DBM products in bone grafting procedures.
Core tip: Demineralized bone matrix (DBM) is an allograft product that was found to be safe as an option of bone grafting. As far as its effectiveness is concerned, and according to the existing literature: (1) there is a good evidence for its use in bone cysts combined with autologous marrow aspirate; (2) in fracture nonunion and filling the defects after tumor surgery DBM used alone or combined with other grafting material are supported by a lower quality studies; and (3) there is insufficient evidence to make a treatment recommendation for DBM use in fracture treatment of other applications. Furthermore, according to the existing literature there are results of clinical use of only a few DBM products and thus the recommendation concerning the DBM use should probably also be referred to these specific products and not to any DBM product.