6.5. Future prospects

This paper has demonstrated that trephining the anterior iliac crest for the purpose of harvesting autogenous bone is reliable, safe and predictable. It is associated with minimal intra-operative and post-operative morbidity. An advantage of this technique is that it can predictably be used on an outpatient basis eliminating the need for admission to hospital and the expenses associated with it. Future studies comparing this technique to other existing minimally invasive techniques, proximal tibia and bone marrow aspiration should also be performed to determine the best approach for patients requiring autogenous bone grafts. Additionally the future development of even less invasive intra-oral donor sites such as the zygomatic bone should be considered. In the future more sophisticated instrumentation for bone graft harvesting such as suction traps, which can harvest viable bone cells, and bone cell storage methods should be developed and investigated.

CDG can be used as a bone graft substitute. They seem to be well tolerated in the cranio-maxillofacial skeleton when introduced into a well vascularized, aseptic, subperiosteal pocket. Complications seem to be few in number and the result is an improvement over the pre-treatment situation in most cases. There however, is no direct evidence that coral granules actually become totally resorbed and transformed into bone in these cranio-maxillofacial sites. Future serial histological studies and serial volumetric CT scans could be used to investigate this question.

CDG may be used to preserve the dimensions of the alveolar ridge following extraction of retained primary molars lacking succedaneous premolars, thereby sparing the patient the potential morbidity associated with a future autogenous bone graft harvest. Future studies in this area could examine the use of CDG in combination with osteoactive agents.

However the future of the minimization of morbidity in reconstruction lies in the total elimination of the autogenous bone donor site, whether intra-oral or extra-oral. The further understanding of the complex interplay between osteocompetent cells and osteoactive agents along with their delivery is a pre-requisite for any major future development in bone regeneration.