Autograft bone, derived locally or from a second surgery site on the patient, suchas iliac crest or medullary canal, provides a scaffold, signaling proteins, and viable cells. The osteoinductivity of autograft is limited to those areas of bone that are undergoing routine remodeling. Local autograft originates from the surgical site. Once it is removed, it may be processed through a bone mill, and then re-implanted in the surgical site. The donor site morbidity & insufficient quantity are the main issues with autograft BGSs.

Allograft tissues are generously donated human tissues that come in many forms, appropriate for a multitude of treatment modalities for patients. A tissue bank is an organization that provides the donor screening, recovery, processing, storage, and/or distribution of allograft tissue. When tissues are obtained from the donor, the term harvest has been respectfully replaced with recovery out of reverence for the magnitude of the gift of donation.

Xenograft bone is harvested from a different species, most commonly cows (bovine), pigs (porcine) or horses (Equine). It can differ from human bone is mineral content or structure, which may result in remodeling rates different from human bone. Due to concerns about a potential immune response, xenograft bone is treated at high temperatures to remove organic components.

Synthetic bone substitutes provide a scaffold designed to imitate human bone. They are made from a variety of different materials, including beta tri-calcium phosphate, bioactive glass, hydroxyapatite, polyether ether ketone (PEEK), and others. Synthetic bone substitutes come in a wide variety of forms, including bone void fillers of different configurations and sizes, as well as structural grafts designed to provide support upon implantation.

Bone grafting products with recombinant proteins provide a large dose of a signaling protein that is associated with bone formation.  BMP-2 comes with a bovine collagen sponge, which acts as a carrier for the growth factor. PDGF-BB is provided with beta tri-calcium phosphate that acts as a scaffold. Both of these products are considered combination products. There are several definitions of combination products, such as drug/device, biologic/device, drug/biologic, or drug/device/biologic.

Soft Tissue allografts/xenografts for wound management and reconstruction are used to facilitate wound closure. Graft properties can vary as a barrier and protective covering. Grafts of placental origin focus on covering wounds and acting as a barrier, and acellular dermal matrices provide a scaffold into which a patient’s cells can migrate, attach, and proliferate. Placental and dermal allografts are used for the treatment of acute burn injuries, chronic wounds, and surgical reconstruction.