Clinical utility of demineralized bone matrix for osseous defects, arthrodesis, and reconstruction: impact of processing techniques and study methodology.

The findings of studies on DBM in the surgical management of osseous defects, arthrodeses, and reconstructive procedures have been promising. In general, DBM grafts have supported healing in a timely fashion without complication and with a diminished need to harvest bone from a secondary operative site. Nonetheless, controlled prospective trials are needed to confirm the comparative effectiveness of DBM and to quantitate the benefits of avoiding secondary site autologous bone harvesting. Notwithstanding the known deleterious effects of certain processing steps, current commercial demineralization processes vary widely and use ancillary procedures aimed at attenuating potential residual antigens and pathogens. While some of these procedures may improve or facilitate graft performance (eg, lipid and lipoprotein removal with detergents), others may be deleterious (eg, sterilization with radiation or ethylene oxide) (Table 1). Therefore, it is important that DBM be processed using methods that consistently establish conditions known to preserve DBM's documented osteoinductive potential and that authors appropriately identify processing methods known to have effects on graft performance.